Essentials of Nursing Research, Appraising Evidence for Nursing Practice

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Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01 Page and Header: 2, The Importance of Research to Evidence-Based Nursing 1. Which group is best served by the development of a rigorous base of evidence for nursing practice?

A) Nursing administrators B) Practicing nurses C) Nurses’ clients D) Nurse researchers Ans: C Feedback: Nurse leaders have recognized the need to base specific nursing decisions on trustworthy evidence indicating that the decisions are clinically appropriate, costeffective, and result in positive outcomes for their clients. Nursing groups benefit from nursing studies, but it is nurses’ clients themselves who benefit most because research-based evidence can improve their health and health-related quality of life.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 2, What Is Nursing Research?

2. Which is an example of a clinical nursing research question?

A) What percentage of nurses have a master’s or doctorate degree?

B) What factors contribute to clients’ risk of falling during a hospitalization?

C) In what ways do nursing students benefit from a course on evidence-based practice?

D) What course of action do nursing students pursue when faced with a moral dilemma?

Ans: B Feedback:

The answers to clinical nursing research questions have the potential to improve the health and well-being of nurses’ clients. Clinical nursing research questions focus directly on clients’ needs, experiences, and health behaviors, and answers to such questions can inform nurses’ decisions or lead to strategies to improve nursing practice. Researchers also study nursing education, but questions about nursing education, as exemplified in the other questions, would not be considered clinical nursing research questions.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 01 Page and Header: 2, The Importance of Research to Evidence-Based Nursing 3. Which goal is the highest priority for research in the nursing profession?

A) To generate evidence to inform nurses’ decisions and actions B) To conduct research focused on the context of nursing practice C) To document the role that nurses serve in society D) To establish priorities for areas of study by nurse researchers Ans: A Feedback: Nurses are increasingly undertaking clinical research, and practicing nurses are expected to base their practice on evidence from research. Evidence-based practice involves the use of the best evidence in making patient care decisions and typically comes from research conducted by nurses and other health care professionals. The other answers are possible goals for the nursing profession, but none is as high a priority as developing rigorous evidence for practice.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 2, The Importance of Research to Evidence-Based Nursing 4. In several countries, research in health care settings has come to play an important role in the nursing profession with respect to: A) providing opportunities to serve on important government policy-making boards.

B) credentialing and improving nurses’ status.

C) strengthening nurses’ bargaining power.

D) supporting better avenues for advanced degrees.

Ans: B Feedback: In the United States and in other countries, research plays an important role in nurses’ credentialing and status. In particular, research and efforts to promote evidence-based practice are key elements of the Magnet recognition program.

Changes to nursing practice now occur regularly because of EBP efforts, and these efforts enhance the status of the profession. The other answers are possible outcomes of increased research activity among nurses, but none is as important as the role of research in enhancing the visibility and credibility of the profession.Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Easy Integrated Process: Nursing Process Objective: 01 Page and Header: 3, Roles of Nurses in Research 5. What is the role of consumers of nursing research?

A) Generating evidence by undertaking studies B) Gathering information from clients that can be used in research C) Coming up with ideas for studies D) Reading research reports to find evidence that is relevant to nursing practice Ans: D Feedback: Knowledge of nursing research enhances the professional practice of both consumers of research (who read and appraise studies) and producers of research (who design and undertake studies). Between these two points on the consumer– producer continuum lies a rich variety of research activities in which nurses may engage. These activities include contributing an idea for a study, advising clients about their participation in a study, and searching for research evidence.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01, 09

Page and Header: 3, Roles of Nurses in Research 6. Which activity occurs in a journal club?

A) Development of an idea for a journal article B) Presentation by the author of a research article about the article’s central ideas C) Testing of participants on their comprehension of selected journal articles D) Discussion of a research article regarding its merits and relevance to practice Ans: D Feedback: Journal clubs exist in many practice settings, as an opportunity to share and discuss new evidence of relevance to clinicians. Journal clubs sometimes involve face-toface group meetings but also can involve online discussions to accommodate diverse schedules. Participants in a journal club do not develop ideas for a journal article, hear a presentation by an author, or get tested on journal article content.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 3, Nursing Research: Past and Present 7. Which statement is true?

A) In the early 1900s, most nursing research focused on education, not nursing practice.

B) Clinical nursing research has made steady progress since the work of Florence Nightingale.

C) Several nursing research journals began publication in the late 1800s.

D) The National Institute of Nursing Research was established in the United States in 1943.

Ans: A Feedback: After Florence Nightingale’s research in the 1850s, nursing research did not progress for many years. Early in the 1900s, nurses began to engage in research, but the focus was mainly on education, not nursing practice. No nursing journals focused on research until the 1950s. The National Institute of Nursing Research was established in1993, not 1943.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 4, Nursing Research: Past and Present 8. In the United States, a major source of funding for nursing research is: A) NINR. B) Magnet Recognition Program.

C) journal clubs.

D) Sigma Theta Tau. Ans: A Feedback: The National Institute of Nursing Research (NINR) is the leading source of funding for nursing research in the United States. Sigma Theta Tau also offers financial support to nurse researchers but on a smaller scale. The Magnet Recognition Program and journal clubs do not typically offer funding for nursing research (although institutions in the Magnet Program or who operate journal clubs may offer small grants to researchers).

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 4, Current and Future Directions for Nursing Research 9. Which is a likely trend for the future of nursing research?

A) Improving the methods for conducting research B) Improving nurses’ attitudes toward evidence-based practice C) Enhancing the applicability of research evidence to individual patients D) Enhancing nursing students’ interest in conducting their own research Ans: C Feedback: An emerging trend in health care research is a focus on patient-centeredness and the degree to which evidence applies to individual patients, small groups of

patients, and local contexts. Improving nurses’ attitudes toward research and students’ interest in doing research—and having better methods for doing research—are important objectives, but attending to the applicability of research findings is likely to become an increasingly important goal for nurses pursuing an evidence-based practice.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 03 Page and Header: 5, Knowledge Sources for Nursing Practice 10. Which is a compelling source for answering clinical questions in evidence-based nursing?

A) Input from an authorit B) Intuition C) Disciplined research D) Nurses’ clinical experience Ans: C Feedback: Nurses are increasingly expected to understand and undertake research and to base their practice on evidence from research—that is, to adopt an evidence-based practice (EBP). Experience, intuition, and authority are not wholly ignored in the EBP process, but research findings comprise a crucial source of evidence.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 5, Knowledge Sources for Nursing Practice 11. If nurses make clinical decisions by following “unit culture” practices, they are using which source of knowledge?

A) Tradition and authority B) Intuition C) Disciplined research D) Trial and error

Ans: A Feedback: Many decisions are made based on tradition or the guidance of an authority. These types of knowledge are so much a part of a common heritage that few people challenge their efficacy or seek verification. Such “sacred cows” are widely used to guide practice, but they are a weaker form of knowledge than disciplined research.

Clinical experience is a functional source of knowledge. It also has limitations as a source of evidence for practice because each nurse’s experience may be narrow.

Trial and error are alternatives tried successively until a solution to a problem is found. It can be practical, but the method tends to be haphazard and solutions may be idiosyncratic.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04, 09 Page and Header: 6, Paradigms and Methods for Nursing Research 12. What is a paradigm?

A) An assumption about the nature of the world B) An antecedent cause of reality C) A set of procedures for studying the world D) A worldview, a general perspective Ans: D Feedback: A paradigm is a broad worldview—a general perspective on the complexities of the real world. A paradigm is not an assumption, although alternative paradigms have assumptions. A paradigm is not an antecedent cause of reality, nor is it a set of procedures for understanding the world.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate

Integrated Process: Nursing Process Objective: 04, 09 Page and Header: 6, Worldview of the Positivist Paradigm 13. Which is a fundamental assumption of the positivist paradigm?

A) Reality is “out there” and can be objectively studied, known, and understood.

B) Phenomena do not necessarily have an antecedent cause.

C) Reality is not orderly but rather is haphazard.

D) Reality is not a fixed entity but rather is a construction of the human mind.

Ans: A Feedback: In the positivist paradigm, it is assumed that there is an objective reality, that natural phenomena are regular and orderly (not haphazard), and that phenomena have one or more antecedent cause that can be understood through research.

Positivists assume that reality exists and is independent of human observation.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04, 09 Page and Header: 7, Worldview of the Constructivist Paradigm 14. Which is a central assumption in the constructivist paradigm?

A) A fixed reality exists in nature for humans to understand.

B) The nature of reality has changed over time.

C) Reality is multiply constructed and multiply interpreted by humans.

D) Phenomena are not haphazard and result from prior causes.

Ans: C Feedback: In the constructivist paradigm, it is assumed that reality is not a fixed entity but is rather a construction of human minds—and thus, “truth” is a composite of multiple constructions of reality. Constructivists do not assume that a fixed reality exists in nature for humans to understand, nor that all phenomena have antecedent causes.

Constructivists do not believe that the nature of reality has changed over time but rather that it has always been constructed by human minds.

Format: Multiple Choice

Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 04, 09 Page and Header: 7, The Scientific Method and Quantitative Research 15. The scientific method is associated with which paradigm?

A) The positivist paradigm B) The constructivist paradigm C) The naturalistic paradigm D) The empirical paradigm Ans: A Feedback: The traditional scientific method involves the use of systematic and orderly procedures that are high on objectivity, consistent with the assumptions of the positivist paradigm. An important assumption of this paradigm is that values and biases of researchers can be held in check through disciplined strategies with tight controls. Those who espouse the constructivist (naturalistic) paradigm do not adhere to the tenets of the scientific method. There is no such thing as an “empirical” paradigm.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 7, The Scientific Method and Quantitative Research 16. Which attribute is a characteristic of the traditional scientific method?

A) A flexible, emergent design B) A holistic view of a phenomenon, studied in rich context C) An inductive reasoning process D) The systematic measurement of natural phenomena Ans: D Feedback: The scientific method refers to a set of orderly, disciplined procedures used to acquire information, and this includes the systematic measurement (quantification)

of natural phenomena. Investigators gather quantified data (make measurements) in a preplanned manner, using methods that are consistent across people participating in the study. Constructivist researchers tend to emphasize holistic and individual aspects of human life and use inductive reasoning and flexible designs.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04, 09 Page and Header: 7, The Scientific Method and Quantitative Research 17. What is empirical evidence?

A) Evidence derived from inductive reasoning B) Evidence derived from personal insights and beliefs C) Evidence rooted in the real world, gathered through the human senses D) Evidence based on custom or an expert/authority Ans: C Feedback: Researchers gather empirical evidence that is rooted in reality and gathered through their senses. The requirement to use empirical evidence means that findings are grounded in reality rather than in researchers’ personal beliefs.

Inductive reasoning is the process of developing generalizations from specific observations and is associated with the constructivist paradigm. Evidence from custom or authority is not typically empirical—based on information gathered through the human senses in a systematic manner.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 04 Page and Header: 7, The Scientific Method and Quantitative Research 18. What is a hallmark of the traditional scientific method?

A) Holistic strategies B) Systematic procedures C) Infallible methods D) Flexible procedures Ans: B Feedback: The scientific method refers to a set of disciplined, systematic procedures used to acquire knowledge. The investigator progresses logically and systematically through a series of steps, according to a prespecified plan of action. Constructivist researchers tend to emphasize the holistic and individual aspects of human experience using flexible designs and procedures. No method of inquiry is infallible.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 7, The Scientific Method and Quantitative Research 19. What is a limitation of the scientific method for answering questions about human experiences, characteristics, and health outcomes?

A) The difficulty of accurately measuring complex human traits B) The shortage of well-trained researchers C) The scarcity of ideas on what to study D) The shortage of theories about human behavior Ans: A Feedback: One important limitation of the scientific method for studying humans is that human beings are highly complex. Human characteristics are extremely difficult to measure (quantify) in an accurate, valid, and objective manner. At this moment in history, there is an abundance of ideas on what to study, many theories of human behavior, and thousands of well-trained researchers poised to make advances in understanding human health.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process

Objective: 04 Page and Header: 7, The Scientific Method and Quantitative Research 20. A researcher is investigating the effect of the bed angle of hospitalized patients (15 degrees, 30 degrees, 45 degrees) on the patients’ blood pressure. This is an example of what type of study?

A) A qualitative study B) A quantitative study C) A constructivist inquiry D) Cannot be determined—it depends on the researcher’s methods Ans: B Feedback: Quantitative research involves systematic measurement, and in this example, both bed angle and blood pressure would be carefully measured, recorded, and analyzed. The researchers chose the question to address, but the type of study (quantitative) is dictated by the question of whether bed angle affects heart rate.

Constructivist studies are heavily focused on understanding the human experience as it is lived, usually through the careful collection and analysis of qualitative materials that are narrative and subjective, which is not the case in this example.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 8, Constructivist Methods and Qualitative Research 21. A persistent criticism of the scientific method by those who espouse the constructivist paradigm is that it is: A) deductive.

B) laborious.

C) empirical.

D) reductionist.

Ans: D Feedback:

Researchers who reject the traditional scientific method believe that it is overly reductionist, in that the scientific method reduces human experience to the few concepts under investigation. Moreover, those concepts are defined in advance by the researcher rather than emerging from the experiences of the people under study. The scientific method is seldom criticized because it is deductive, laborious, or empirical.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 8, Constructivist Methods and Qualitative Research 22. Which statement is true about qualitative research?

A) It focuses on the idiosyncrasies of those being studied.

B) It attempts to have tight control over the research context.

C) It involves the gathering of narrative, subjective materials.

D) It focuses on the collection of numeric information.

Ans: C Feedback: Qualitative researchers attempt to understand human experience as it is lived through the collection and analysis of subjective, narrative materials, gathered using flexible procedures. Qualitative research does not impose controls on the research context, nor does it focus on the idiosyncrasies of those being studied.

Qualitative researchers do not emphasize numeric (quantitative) information, but rather collect in-depth narrative information.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 9, Constructivist Methods and Qualitative Research 23. Which is a potential limitation of qualitative research?

A) Qualitative research typically involves a small number of people, so the generalizability of findings can be a concern.

B) Qualitative researchers ask questions that tend to have limited significance in nursing.

C) Qualitative research is overly reductionist and tends to remove concepts from real-world contexts.

D) The quality of qualitative research is undermined because of difficulties in measuring phenomena.

Ans: A Feedback: Qualitative research usually involves a small number of people participating in a study, and it is sometimes difficult to know whether the findings would be true of a broader group of people. Qualitative researchers ask many questions of deep significance to nursing and other health care professionals. Quantitative research (not qualitative research) is sometimes accused of being reductionist because of its focus on a limited number of concepts. Qualitative researchers do not “measure” phenomena quantitatively.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 8, Constructivist Methods and Qualitative Research 24. Which research topic would most likely be the focus of a qualitative study?

A) Outcomes of patients admitted during the day versus the night to a hospital system’s trauma department B) Trends in hospitalizations of patients with antibiotic-resistant tuberculosis C) Risk factors associated with serious complications with abdominal surgery D) Mental health experiences of people who were unable to be with a loved one who died of COVID-19 Ans: D Feedback: Qualitative studies are heavily focused on understanding human experience as it is lived, through the careful collection and analysis of qualitative materials that are narrative and subjective. Outcomes, risk factors, trends, and treatment effectiveness are addressed with quantitative research.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care

Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 9, Multiple Paradigms and Nursing Research 25. Although the positivist and constructivist paradigms differ in many ways, the two paradigms have which feature in common?

A) Both rely on the cooperation of human beings to participate in a study.

B) Both have as a major goal the identification of the causes of phenomena.

C) Both involve the application of the scientific method.

D) In both, generalizability is a key objective.

Ans: A Feedback: Regardless of paradigm, nursing research most often involves the collection of information from human study participants. Without the cooperation of others, research would not be able to measure human attributes (quantitative research within the positivist paradigm) or gather in-depth narrative information (qualitative research within the constructivist paradigm). Unlike the constructivist paradigm, the positivist paradigm is associated with efforts to identify causes of phenomena, involves the scientific method, and strives for generalizability.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 05 Page and Header: 10, Research for Varying Levels of Explanation 26. Regarding research questions on the descriptive/explanatory continuum, which is a descriptive question that a qualitative researcher might ask?

A) How often do parents of a dying child express grief to others?

B) What is the nature of grief among parents of a dying child?

C) How intense is the grief of parents of a dying child?

D) Over how long a period do parents grieve for a dying child?

Ans: B Feedback:

Description of phenomena is an important purpose of research. Quantitative description focuses on the prevalence, size, and measurable aspects of phenomena.

Qualitative researchers describe the nature, dimensions, and salience of phenomena, as in the example of asking about the nature of grief among parents of a dying child.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 05 Page and Header: 10, Research for Varying Levels of Explanation 27. Regarding research questions on the descriptive/explanatory continuum, which research question is an example of a descriptive question for a quantitative study?

A) What is it like to experience sudden confusion?

B) Does postpartum depression predict toddlers’ temperaments?

C) What is the experience of loneliness like among caregivers of patients with Alzheimer’s disease?

D) What is the prevalence of elevated salivary cortisol in adolescents?

Ans: D Feedback: Quantitative description focuses on the prevalence, size, and measurable aspects of phenomena, such as the prevalence of elevated salivary cortisol. Qualitative researchers ask descriptive questions about the nature of phenomena, such as sudden confusion and loneliness. Descriptive questions do not focus on predictions, such as the extent to which postpartum depression predicts toddlers’ temperaments.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 05, 09 Page and Header: 10, Research for Varying Levels of Explanation 28. Which research question would be considered cause-probing?

A) What is the prevalence of vaping (using e-cigarettes) among college students?

B) Are students who use e-cigarettes at higher risk of respiratory infections than students who do not?

C) What are the characteristics of students who vape (use e-cigarettes)?

D) What is the process by which students initiate using e-cigarettes?

Ans: B Feedback: The question about the use of e-cigarettes in relation to respiratory infections basically concerns whether vaping might cause respiratory infection in some students. Two other questions are descriptive: the prevalence of vaping (quantitative description) and the process by which vaping is initiated (qualitative description). The question about student characteristics and vaping is not necessarily cause-probing—for example, one factor might be gender: Are males more likely than females to vape? This does not imply that gender might cause different rates of vaping.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 05 Page and Header: 11, Research Purposes Linked to Evidence-Based Practice 29. A nurse researcher is studying the effect of a health promotion intervention for inner-city adolescents on their daily amount of physical activity. In terms of purposes linked to EBP, this study has which purpose?

A) Therapy/treatment B) Etiology (causation)/harm C) Prognosis D) Meaning and processes Ans: A Feedback: The study is an example of intervention research, which is aimed at understanding whether a therapy or treatment (a health promotion intervention) is effective in improving a health-promoting behavior, i.e., engaging in physical activity. This study is not aimed at developing means of assessing clients, predicting the occurrence of a future health problem, or understanding the processes by which adolescents engage in certain behaviors.

Format: Multiple Choice Chapter: 1

Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 05 Page and Header: 11, Research Purposes Linked to Evidence-Based Practice 30.A team of nurse researchers is studying the emotional and cognitive development of toddlers whose mothers experienced postpartum depression during the children’s infancy. In terms of purposes linked to EBP, this study has which purpose?

A) Therapy/treatment B) Diagnosis/assessment C) Prognosis D) Meaning and processes Ans: C Feedback: The study is an example of a study aimed at Prognosis. The study goal is to understand whether there are potential developmental consequences to children of being raised by mothers who experienced postpartum depression. Such a study might provide guidance about the need for interventions for at-risk children. This study is not aimed at testing an intervention, assessing postpartum depression, or understanding the meaning of the mothers’ experience of postpartum depression.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 05 Page and Header: 10, Research Purposes Linked to Evidence-Based Practice 31.A nurse researcher is studying what it is like for children to be fearful when they undergo routine immunizations and how they cope with their fears. In terms of purposes linked to EBP, this study has which purpose?

A) Therapy/treatment B) Etiology (causation)/harm C) Prognosis D) Meaning and processes Ans: D

Feedback: This research would require an in-depth study of children going through a stressful process. Such a study would provide evidence about what the experience of getting shots means to children. This study does not involve the testing of an actual intervention, understanding factors that lead to children’s fears, or predicting the occurrence of future problems that result from immunizations.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01, 06, 09 Page and Header: 14, Definition of Evidence-Based Practice 32. Most definitions of evidence-based practice (EBP) call for the integration of best research evidence with: A) patient preferences and values.

B) well-worded clinical questions.

C) systematic reviews.

D) rankings on the evidence hierarchy.

Ans: A Feedback: Evidence-based practice, according to definitions offered by leaders in health care, calls for integrating best evidence from research with both patient preferences and clinical expertise. The evidence itself is often derived from (not integrated with) systematic reviews, which can be retrieved by asking well-worded clinical questions. The quality of evidence is sometimes ranked on evidence hierarchies according to the study’s methods.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 07, 09 Page and Header: 15, Evidence Hierarchies and Level of Evidence Scales 33. What is the purpose of an evidence hierarchy?

A) To promote the creation of systematic reviews

B) To guide researchers in selecting a research design C) To rank order evidence according to the strength of evidence provided D) To provide an incentive structure for those undertaking research Ans: C Feedback: Evidence hierarchies provide a framework for understanding the strength of evidence of a study and its risk of bias. Every study can be ranked, usually based on its design, within an evidence hierarchy. Several evidence hierarchies have been published, but most are hierarchies for ranking evidence for Therapy questions.

Evidence hierarchies do not play a role in creating a systematic review, and they are not intended to serve as a guide for selecting a research design or to provide an incentive structure.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 07 Page and Header: 15, Evidence Hierarchies and Level of Evidence Scales 34. Most evidence hierarchies and level of evidence scales put which evidence source at the pinnacle?

A) Randomized clinical trials (RCTs) B) Systematic reviews C) In-depth qualitative studies D) It depends on the research question.

Ans: B Feedback: Regardless of the type of question being asked, systematic reviews are at the pinnacle of evidence hierarchies because such reviews are rigorous syntheses of all the available evidence on a topic, using information from multiple studies.

Randomized controlled trials are high on the hierarchy for Therapy/intervention questions, and in-depth qualitative studies are high for Meaning/process questions, but systematic reviews can be undertaken for all types of research questions.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply

Difficulty: Moderate Integrated Process: Nursing Process Objective: 08 Page and Header: 15, Asking Well-Worded Clinical Questions for Evidence-Based Practice 35. For individual-level efforts to put research evidence into practice, nurses follow five major steps. Which step is first in the process?

A) Asking a clinical question that can be answered with research evidence B) Acquiring relevant research evidence C) Appraising and synthesizing the evidence D) Applying evidence (integrated with other factors such as client preferences) to clinical practice Ans: A Feedback: Individual nurses can put research into practice using five basic steps—the 5 As. The steps are (1) Ask well-worded clinical questions that can be answered with research evidence; (2) Acquire the best evidence; (3) Appraise the evidence; (4) Apply the evidence to clinical practice; and (5) Assess the outcome of the practice change.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 08 Page and Header: 16, Asking Well-Worded Clinical Questions for Evidence-Based Practice 36. In the following clinical question, what is the outcome (O component)? “What is the effect of relaxation therapy versus biofeedback on the functional ability of patients with rheumatoid arthritis?”

A) Functional ability B) Rheumatoid arthritis C) Biofeedback D) Relaxation therapy Ans: A Feedback: In the PICO question format, P stands for the population or patients (patients with rheumatoid arthritis); I stands for the intervention, influence, or exposure

(relaxation therapy); C stands for the comparator (biofeedback); and O stands for the outcome (functional ability).

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 08 Page and Header: 16, Asking Well-Worded Clinical Questions for Evidence-Based Practice 37. In the following clinical question, what is the intervention/influence/exposure (the I component)? “Does taking antidepressants affect the risk of suicide in cognitively impaired adolescents?”

A) Adolescence B) Suicide C) Antidepressant use E) Cognitive impairment Ans: C Feedback: In the PICO question format, P stands for the population or patients (cognitively impaired adolescents); I stands for the intervention, influence, or exposure (use of antidepressants); and O stands for the outcomes (risk of suicide). There is no formally stated comparator (C) in this question—the implied comparator is the nonuse of antidepressants.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 08 Page and Header: 16, Asking Well-Worded Clinical Questions for Evidence-Based Practice 38. In the following clinical question, which PICO component is the eye masks? “Do earplugs, relative to eye masks, have a beneficial effect on perceived sleep quality among patients in intensive care?”

A) The population (P) B) The intervention or influence (I) C) The comparator (C) D) The outcome (O) Ans: C Feedback: The “I” component (intervention) in this question is the earplugs, and the comparator (C component) is the eye masks. The “O” component (outcome) is perceived sleep quality. The population (P) is patients in intensive care. ] Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 08 Page and Header: 16, Asking Well-Worded Clinical Questions for Evidence-Based Practice 39. In the following clinical question, what is the population (P component)? “Do stress and depression affect dyspnea in patients with chronic obstructive pulmonary disease (COPD)?”

A) Patients who are stressed B) Patients who are depressed C) Patients who experience dyspnea D) Patients with COPD Ans: D Feedback: In the PICO question format, P stands for the population or patients under study (here, patients with chronic obstructive pulmonary disease); I stands for the intervention, influence, or exposure (stress and depression); and O stands for the outcome (dyspnea). There is no formally stated comparator in this question—it would be patients with COPD who are not stressed or depressed.

Format: Multiple Choice Chapter: 1 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process

Objective: 08 Page and Header: 16, Asking Well-Worded Clinical Questions for Evidence-Based Practice 40. In the following clinical question, which PICO component is missing? “Relative to sterile water, what is the effect of sucrose on pain during intravenous cannulation?”

A) The population (P) B) The intervention or influence (I) C) The comparison (C) D) The outcome (O) Ans: A Feedback: In this clinical question, no population (P) is specified. One example of a population might be infants 1 to 3 months of age. Sucrose is the intervention (I component), sterile water is the comparison component (C), and pain during intravenous cannulation is the outcome (O).

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 25, The Faces and Places of Research 1. Which term do qualitative researchers avoid when referring to people who participate in a study?

A) Informants B) Study participants C) Subjects D) Key informants Ans: C Feedback: The people who provide information to the researchers in a study are sometimes referred to as “subjects” in quantitative research but rarely in qualitative research.

The terms “informant” and “key informant” are used primarily in qualitative studies.

Both quantitative and qualitative researchers use the term “study participant.”

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 01 Page and Header: 25, Concepts, Constructs, and Theories 2. Which term is used by both quantitative and qualitative researchers to refer to the abstractions under study?

A) Concept B) Theory C) Construct D) Variable Ans: A Feedback:

Both quantitative and qualitative researchers use the term concept to refer to the abstractions in which they are interested. The terms construct and variable are more often used by quantitative researchers than qualitative researchers. A theory is an explanation of some aspect of reality that knits concepts together into a coherent system.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 25, Concepts, Constructs, and Theories 3. mA qualitative researcher is studying the experience of living with idiopathic pulmonary fibrosis (IPF). In this study, the experience of living with IPF would most likely be called the: A) construct of interest.

B) variable of interest.

C) phenomenon of interest.

D) theory of interest.

Ans: C Feedback: Qualitative researchers refer to the abstractions in which they are interested as phenomena. Quantitative researchers are more likely than qualitative researchers to describe the key focus of their research as a construct or variable. Theories are explanations of some aspect of the world, typically involving multiple concepts or constructs.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 25, Concepts, Constructs, and Theories 4. Which of the following abstractions is most likely to be called a construct?

A) Gender B) Body temperature

C) Blood type D) Self-care Ans: D Feedback: Researchers sometimes use the term construct; like a concept, a construct refers to an abstraction, but often one that is deliberately invented (or constructed). For example, self-care in Orem’s model of health maintenance is a construct. Gender, body temperature, and blood type are not complex, deliberately invented constructs. In a study, these abstractions would most likely be referred to as concepts or variables.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 26, Concepts, Constructs, and Theories 5. In qualitative research, theory most often plays which role?

A) As a basis for developing hypotheses B) As a tool to direct the research project C) As a product of the research D) As a strategy to gain entrée into a research setting Ans: C Feedback: A theory is an explanation of some aspect of the real world. In qualitative studies, theory often is the product of the research—that is, a theory is developed based on what the qualitative researcher discovers. In qualitative studies, theory is not used to develop hypotheses, nor is it a tool to direct the study or to help gain entrée into a research setting.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 26, Variables

6. “Male” is which of the following?

A) An independent variable B) A dependent variable C) Not a variable D) The type of variable would depend on the research question.

Ans: C Feedback: A variable is a characteristic or quality that takes on different values (i.e., varies from one person or object to another). “Male” does not take on different values and so is not any type of variable; it is one of the values for the variable gender. In a study, the variable gender is most likely to be an independent variable—that is, the presumed influence on the dependent (outcome) variable.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 26, Characteristics of Variables 7. Which statement about variables is true?

A) In a study, the independent variable would not be allowed to vary.

B) Variables in a study can be intrinsic human traits or can be created by researchers.

C) Abstractions with a few categories are not considered variables.

D) In a study of older people in a nursing home, age would be a constant.

Ans: B Feedback: Variables (abstractions) are often intrinsic human traits (age, fatigue levels, blood type), but can also be created (e.g., when a researcher compares the effects of an innovative intervention versus standard care). By definition, the independent variable in a study would always vary. Variables can be on a continuum with many possible values (such as the variable body temperature) or can be categories with only a few values (such as blood type). In a study of older people in nursing homes, age would almost surely vary (e.g., from residents in their 60s to those in their 90s).

Format: Multiple Choice

Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 27, Dependent and Independent Variables 8. In terms of the PICO framework for asking well-worded questions in an evidence search, a dependent variable in a study corresponds to which component?

A) P B) I C) C D) O Ans: D Feedback: The dependent variable is the outcome variable—the “O” component in the PICO framework. P stands for population, I stands for intervention or influence, and C stands for a comparator for I. Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 01 Page and Header: 27, Dependent and Independent Variables 9. In terms of the PICO framework for asking well-worded questions in an evidence search, an independent variable in a study corresponds to which combination of components?

A) P and O B) P and I C) I and C D) C and O Ans: C Feedback: The independent variable is an intervention or influence (I), plus a comparative intervention or influence (C). Other combinations do not correspond to the independent variable—or to anything meaningful in terms of research variables.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 27, Dependent and Independent Variables 10. Which is the dependent variable in the research question “Is the quality of life of nursing home residents affected by their functional ability or hearing acuity?”?

A) Functional ability B) Quality of life C) Hearing acuity D) Residence in a nursing home Ans: B Feedback: The dependent (outcome) variable is the behavior or characteristic the researcher is interested in explaining, predicting, or affecting, which in this case is the residents’ quality of life. In the context of this research question, functional ability and hearing acuity are the independent variables, which are the presumed causes of, antecedents to, or influences on the dependent variable—the residents’ quality of life. Nursing home residents are the population of interest; in the context of this study, residence in a nursing home is not a variable.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 27, Dependent and Independent Variables 11. Which is the independent variable in the research question “What is the effect of noise levels on postoperative pain and blood pressure fluctuations in ICU patients?”?

A) Noise levels B) ICU patients C) Blood pressure D) Postoperative pain Ans: A

Feedback: The independent variable is the presumed cause of or influence on the dependent variables, and in this case, the independent variable is noise levels in the ICU. The dependent (or outcome) variable is the behavior, characteristic, or outcome the researcher is interested in explaining, predicting, or affecting—in this case, postoperative pain and blood pressure fluctuations. ICU patients in this question are the population, not a variable.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 01 Page and Header: 27, Dependent and Independent Variables 12. Which is the independent variable in the question “Are male patients with a COVID-19 infection more likely to become hospitalized and require ventilation than female patients with COVID-19?”?

A) A COVID-19 infection B) Hospitalization and ventilation for COVID-19 C) Male patients D) Patients’ gender Ans: D Feedback: In this question, patients’ gender is the independent variable, which is the presumed cause of, antecedent to, or influence on the dependent variable (here, the need for hospitalization and ventilation). The study sample to answer this question would include male and female patients with a COVID-19 infection.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 01 Page and Header: 27, Dependent and Independent Variables

13. Which is the dependent variable in the question “Are depressive symptoms among patients with cancer affected by their degree of physical mobility and their pain levels?”?

A) Depressive symptoms B) Degree of physical mobility C) Pain level D) A cancer diagnosis Ans: A Feedback: The dependent (outcome) variable is the behavior or characteristic the researcher is interested in explaining, predicting, or affecting, which in this case is depressive symptoms. There are two independent variables (factors that could affect or influence the dependent variable)—degree of physical mobility and pain levels.

Patients with cancer in this question are the population (study participants), which is not a variable in the context of this research.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 28, Conceptual and Operational Definitions 14. What is the function of an operational definition?

A) To specify how a concept will be measured B) To explain the theoretical meaning of the concept C) To describe the expected relationship between the variables under investigation D) To clarify the empirical underpinnings of a variable Ans: A Feedback: An operational definition of a concept specifies how a variable will be measured and “put into operation” in the context of the study. A conceptual definition presents the abstract or theoretical meaning of the concepts being studied. Neither operational nor conceptual definitions concern expected relationships. Operational definitions of concepts in a study yield empirical information, but they do not clarify the “empirical underpinnings” of a variable.

Format: Multiple Choice

Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 28, Data 15. Which could be a datum from a quantitative study of the labor and delivery experiences of women over age 40 years?

A) Length of time in labor B) 107 ounces C) Infant’s Apgar score D) Vaginal versus cesarean delivery Ans: B Feedback: Research data (singular, datum) are the pieces of information obtained in a study.

Quantitative researchers collect data in numeric form; 107 ounces (representing infant birth weight) is an example of a datum in numeric form. Length of time in labor, infant’s Apgar score, and vaginal versus cesarean delivery are variables, not an actual datum.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 28, Data 16. Which could be a datum from a qualitative research study on the labor and delivery experiences of women over age 40 years?

A) 14.6 hours in labor B) 60-minute in-depth interviews one day after delivery C) “It was much more painful than I ever imagined.”

D) 50 women aged 40 years or older with a hospital delivery Ans: C Feedback:

In qualitative studies, researchers collect qualitative data, that is, narrative descriptions of participants’ experiences, such as “It was much more painful than I ever imagined.” The value of 14.6 hours in labor is a quantitative datum. “60minute in-depth interviews 1 day after delivery” is a description of how the qualitative data were collected, and “50 women aged 40 years or older with a hospital delivery” is a description of who might be in the study sample—neither of these two is data.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 01 Page and Header: 29, Relationships 17. Which statement expresses a relationship between variables?

A) Young people do not get enough sleep.

B) Older people tend to take daytime naps.

C) Sleeping problems are common in older people.

D) Older people sleep less than younger people.

Ans: D Feedback: A relationship is a connection between two or more variables. In the statement “Older people sleep less than younger people” there are two variables—amount of sleep and age; the statement expresses a prediction that these two variables are related. In the other alternatives, age is not a variable. The focus is either on young people (not getting enough sleep) or older people (having sleeping problems or taking daytime naps).

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 29, Relationships 18. Which of the following is a question about a causal relationship?

A) Does rigorous daily exercise reduce the risk of obesity?

B) Do men exercise more than women?

C) Do people who exercise have better nutritional habits?

D) What amount of exercise is optimal for adolescents?

Ans: A Feedback: Rigorous daily exercise is a factor that can directly affect body weight and thus risk of obesity; amount of exercise can cause variation in weight. The relationship between gender and exercise, and between exercise and eating habits—if such relationships exist—are associative. Gender does not cause the amount of exercise, and eating habits do not cause exercise levels (or vice versa). The question about optimal amounts of exercise for adolescents does not ask about any type of relationship.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 02 Page and Header: 30, Quantitative Research: Experimental and Nonexperimental Studies 19. What are the two broad classes of quantitative research?

A) Grounded theory and phenomenological research B) Empirical and nonempirical research C) Experimental and nonexperimental research D) Cause-probing and predictive research Ans: C Feedback: A basic distinction in quantitative studies is between experimental research, in which researchers actively intervene (e.g., to test a new intervention), and nonexperimental (observational) research, in which researchers make observations of existing phenomena without intervening. All quantitative research is empirical.

Many quantitative studies are cause-probing, and some are predictive, but these two types are not the basic distinction in quantitative research. Grounded theory and phenomenological studies are types of qualitative, not quantitative, research.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy

Integrated Process: Nursing Process Objective: 03 Page and Header: 31, Qualitative Research: Disciplinary Traditions 20. Which of the following is not a research tradition used by qualitative nurse researchers?

A) Experimental B) Phenomenology C) Ethnography D) Grounded theory Ans: A Feedback: “Experimental” refers to a type of quantitative research in which there is an active intervention and is not a qualitative research tradition. Qualitative research often is rooted in research traditions that originate in other disciplines. Three such traditions are grounded theory, phenomenology, and ethnography.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 03 Page and Header: 32, Qualitative Research: Disciplinary Traditions 21. Which qualitative research tradition focuses on understanding phenomena within a cultural context?

A) Qualitative description B) Phenomenology C) Ethnography D) Grounded theory Ans: C Feedback: Ethnography provides a framework for studying the patterns, lifeways, and experiences of a defined cultural group. Descriptive qualitative research is not a qualitative tradition per se—it is a type of qualitative research undertaken without being embedded in a tradition. Neither grounded theory nor phenomenology—both of which are qualitative research traditions—has culture as a focal point of a study.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 32, Qualitative Research: Disciplinary Traditions 22. In which qualitative research tradition would the following question be rooted?

“What is it like to experience a heart transplantation?”

A) Qualitative description B) Phenomenology C) Ethnography D) Grounded theory Ans: B Feedback: Phenomenology focuses on the lived experiences of humans and is an approach to learning what the life experiences of people are like and what they mean.

Descriptive qualitative research is not a qualitative tradition per se—it is a type of qualitative research undertaken without being embedded in a tradition, and such studies do not focus on lived experiences. Neither grounded theory nor ethnography—both of which are qualitative research traditions—has lived experiences as a central focal point of a study.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 33, Step 2: Reviewing the Related Literature 23. Which activity occurs during the conceptual phase of a quantitative research project?

A) Obtaining funding for the project B) Developing operational definitions C) Selecting an appropriate research tradition D) Undertaking a literature review Ans: D

Feedback: During the conceptual phase, researchers undertake a thorough literature review as a foundation on which to build new evidence. Funding is not usually sought until a formal plan is developed, and operational definitions are not established until all the key variables have been identified. Quantitative researchers do not select a “research tradition,” although they make decisions during the design and planning phase about whether the study will be experimental or nonexperimental.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 04 Page and Header: 32, Phase 1: The Conceptual Phase 24. Quantitative researchers develop predictions about relationships among the variables in their studies. In research terms, what are these predictions called?

A) Hypotheses B) Frameworks C) Research questions D) Conceptual definitions Ans: A Feedback: A hypothesis states a researcher’s expectation or prediction about relationships between study variables. The conceptual phase of research involves several steps, including developing research questions, devising a framework, and developing conceptual definitions—i.e., the other response options; however, these other terms are not predictions about whether the variables in a study are related.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 32, Phase 1: The Conceptual Phase 25. In which type of study would deductive reasoning most likely be used?

A) An ethnographic study

B) A phenomenological study C) A grounded theory study D) An experimental study Ans: D Feedback: Deductive reasoning is used in quantitative studies—such as in experimental studies—to derive hypotheses from a theory or prior findings. Induction (and not deduction) is the reasoning process most often used in qualitative research, such as ethnographic, phenomenological, or grounded theory studies.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 34, Phase 2: The Design and Planning Phase 26. Which decision is made in connection with the research design for a quantitative study?

A) How many hypotheses will be tested B) How frequently data will be collected C) What framework to use D) Whether clinical fieldwork is needed Ans: B Feedback: During the design phase of the study, researchers identify a research design that specifies an overall plan for the study, including how often data will be collected.

The number of hypotheses to be tested, the framework used to guide the study, and the undertaking of clinical fieldwork are activities undertaken during the conceptual phase, before a research design is specified.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 04 Page and Header: 34, Phase 2: The Design and Planning Phase

27. Which term refers to the aggregate of individuals or objects to which a quantitative researcher wishes to generalize study results?

A) Population B) Gatekeepers C) Sample D) Study subjects Ans: A Feedback: A population is all the individuals or objects with common, defining characteristics— the “P” in the PICO framework. Researchers do not seek to generalize study results to gatekeepers (who provide access to a study sample), to the study sample (a subset of the population providing information), or to study subjects.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 04 Page and Header: 35, Phase 3: The Empirical Phase 28. Which of the following activities would occur during the empirical phase of a quantitative study?

A) The distribution of questionnaires to 200 study participants B) The selection of a research design C) The development of protocols for an intervention D) The development of a plan for selecting and recruiting study participants Ans: A Feedback: The empirical phase of a quantitative study involves the collection of research data—such as distributing questionnaires to a sample of study participants.

Selecting a research design, developing intervention protocols, and developing a sampling plan are activities that occur during the design and planning phase of a quantitative study.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care

Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 35, Phase 4: The Analytic Phase 29. Which of the following activities is used in the analysis of quantitative data?

A) Developing a data collection plan B) Creating a plan to safeguard human rights C) Undertaking statistical analyses D) Formulating hypotheses Ans: C Feedback: Quantitative data are analyzed through statistical analyses, which are used to answer research questions or test hypotheses. The hypotheses are developed during the conceptual phase of a study. Creating a plan to protect human or animal subjects or a plan for collecting data occur during phase 2, the design and planning phase.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 37, Doing a Literature Review 30. Which statement about undertaking literature reviews in the context of a study is true?

A) All researchers acknowledge the importance of doing a thorough upfront literature review.

B) Only qualitative researchers undertake a thorough upfront literature review.

C) Only quantitative researchers undertake a thorough upfront literature review.

D) Some qualitative researchers postpone doing a thorough literature review until after they have collected their data.

Ans: D Feedback:

Some qualitative researchers are concerned that a thorough upfront literature review might bias their understanding of the phenomenon of interest—they want to understand how study participants experience the phenomenon first. Most quantitative researchers, and some qualitative researchers, undertake a thorough literature review while they are conceptualizing their study.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 37, Conceptualizing and Planning a Qualitative Study 31. Gaining entrée in a qualitative project may require negotiations with whom?

A) Researchers B) Gatekeepers C) Informants D) Consultants Ans: B Feedback: Gaining entrée often involves negotiations with gatekeepers who have the authority to permit entry into their world. A researcher may collaborate with other researchers and may engage a consultant for some part of the project, but these would seldom be involved in efforts to gain entrée. Informants (another term for study participants in qualitative research) are seldom the gatekeepers who can permit or deny access to a research setting.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 37, Conceptualizing and Planning a Qualitative Study 32. Which statement about qualitative research design is true?

A) Study protocols for the study design are finalized during the planning stage.

B) The design for many qualitative studies emerges and evolves during data collection.

C) The design must be approved by gatekeepers before permission for entry into a site is granted.

D) The design incorporates the kind of themes and categories that the researcher anticipates finding.

Ans: B Feedback: Qualitative researchers use an emergent design that materializes during data collection. Data collection, analysis, and interpretation are ongoing activities and are used to guide the design in an evolving manner. The study protocols are not finalized before going into the field, the design is not typically “approved” by gatekeepers, and the design does not incorporate themes—the themes emerge as the findings of a qualitative project.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 38, Conducting a Qualitative Study 33. Which statement is an example of raw data from a qualitative study?

A) Most women experienced emotional exhaustion while caring for their dying child.

B) The process of adjusting to widowhood evolved over many months.

C) “I couldn’t even get out of bed in the morning; I just wanted to hide from the world.”

D) The most commonly expressed emotions by spouses were shame and selfloathing.

Ans: C Feedback: Raw data in qualitative studies are verbatim narrative passages, directly from the study participants. They are not summaries of the study results, such as are suggested in the other response options.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04

Page and Header: 38, Conducting a Qualitative Study 34. Which statement about qualitative studies is true?

A) Qualitative researchers measure their variables with instruments of known accuracy and validity.

B) Qualitative data are not interpreted until all of the data have been analyzed.

C) Qualitative researchers carefully plan how many study participants will be included in the study.

D) The inductive analysis of qualitative data typically yields themes and categories.

Ans: D Feedback: The process of qualitative data analysis involves clustering together related narrative information into a coherent pattern. Through an inductive approach, researchers identify themes and categories, which are used to develop a rich description or theory of the phenomenon. Qualitative researchers do not “measure” variables, nor do they know in advance how many people will be needed in their studies. In qualitative research, analysis and interpretation occur concurrently and are used to guide “next steps” in the project.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 38, Conducting a Qualitative Study 35. In qualitative research, what does saturation indicate?

A) There are too many study participants.

B) Themes and categories in the data are becoming redundant.

C) Too many variables are included in a study.

D) The quality of the data is excellent.

Ans: B Feedback: In making sample size decisions, many qualitative researchers use the principle of saturation. Saturation occurs when themes and categories in the data become repetitive and redundant, such that no new information is likely to be gleaned by continuing to collect data. Saturation does not indicate that there are too many subjects or too many variables. Achieving saturation does not guarantee that the quality of the data is excellent.

Format: Multiple Choice Chapter: 2 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 38, Conducting a Qualitative Study 36. What is the final step in both quantitative and qualitative research?

A) Assessing the trustworthiness of the data B) Undertaking a literature review C) Disseminating research results D) Addressing ethical issues Ans: C Feedback: In both quantitative and qualitative research, an important final step is to share research results with others, either at conferences or in publications. All researchers need to address ethical issues but not as the last step. Literature reviews are undertaken either early in the project or during the interpretation phase—not as the last step. Trustworthiness is assessed by qualitative researchers throughout the actual conduct of the study, not as a final step.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 01 Page and Header: 43, Types of Research Reports 1. In which of the following are nurses most likely to find research evidence?

A) Wikipedia B) Journal articles C) Textbooks D) Dissertations Ans: B Feedback: Nurses are most likely to locate research evidence in professional journals, which publish articles that describe the background, methods, and results of studies. A textbook is not a primary source for research results but rather an overview of established knowledge in a field; textbooks can quickly become outdated.

Dissertations are lengthy documents that describe research completed by a graduate student. Wikipedia provides some research evidence for some entries, but it cannot be counted on to provide up-to-date, rigorous evidence on topics of interest to nurses.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 43, Types of Research Reports 2. A research article usually undergoes a “blind” review for a journal. What does this mean?

A) The journal editors do not know who submitted the article.

B) The authors of the article do not know who the editor of the journal is.

C) The article is published without indicating the authors’ names.

D) The reviewers making recommendations about acceptance or rejection are not told who the authors are.

Ans: D

Feedback: Usually, manuscripts are reviewed by two or more reviewers who make recommendations about whether to accept or reject the manuscript or to suggest revisions. Reviews are usually “blind”—reviewers are not told researchers’ names, and authors are not told reviewers’ names. Journal editors always know who submitted the article, and authors can easily learn online who the editor of the journal is. When an article is published, authorship is always indicated.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 01, 06 Page and Header: 44, Types of Research Reports 3. Which of the following statements is true?

A) Peer reviewers are friends (peers) of a journal’s editor.

B) Journal articles are typically 40 to 50 double-spaced pages in length.

C) Poster sessions involve simultaneous visual displays of multiple research summaries at a conference.

D) Because journal articles are carefully reviewed, readers can assume the evidence in the article is strong and reliable.

Ans: C Feedback: Poster sessions at conferences involve having many researchers simultaneously present visual displays, and attendees can walk around perusing the displays. Peer reviewers may have a friendship with a journal’s editor, but most do not; the reviewers are other researchers and are considered “peers” of the researchers/authors, not the editor. Journal articles tend to be short—typically no more than 20 or so pages in length, double spaced. Even with peer review, studies often have some methodological deficiencies, and so the evidence cannot be accepted uncritically.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01, 06

Page and Header: 44, The Content of Research Journal Articles 4. The acronym for the conventional organization of a research journal article is IMRAD. What does the “D” stand for?

A) Discussion B) Design C) Dissemination D) Data analysis Ans: A Feedback: Journal articles typically conclude with a discussion (D) of the study findings. The study design and research strategies are described in the method (M) section. Data analysis approaches are also described in the method section, but data analysis results are presented in the results section (R). Dissemination issues are rarely described in journal articles—the article itself is a form of dissemination of research evidence.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 44, The Introduction 5. In a quantitative research article, a review of prior research on the problem under study is most likely to be found in which section?

A) Introduction B) Method section C) Results section D) Discussion Ans: A Feedback: The introduction to a research article acquaints readers with the research problem on which the study focused, including what is known from prior research. The method section describes the methods used to answer the research questions. The results section presents the findings that were obtained by analyzing the study data. In the discussion, the researcher presents conclusions about the meaning and implications of the findings.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 45, The Method Section 6. In which section of a research article would the following sentence most likely appear: “The sampling plan called for the recruitment of 200 mother–infant dyads from an inner-city neighborhood”?

A) Introduction B) Method section C) Results section D) Discussion Ans: B Feedback: The method section describes the methods the researchers used to answer the research questions, including a description of the sampling plan. The introduction to a research article acquaints readers with the research problem and its context. The results section presents the findings that were obtained by analyzing the study data. In the discussion, the researcher presents conclusions about the meaning and implications of the findings.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 44, The Introduction 7. In which section of a research article would the following sentence most likely appear: “The purpose of this study was to explore the factors contributing to methamphetamine abuse in older adults”?

A) Introduction B) Method section C) Results section D) Discussion Ans: A

Feedback: This sentence, which indicates the study purpose, would appear in the introduction of a research article. The introduction sets the stage for a description of a study by providing information about the existing literature; the conceptual framework; the problem; the purpose, research questions, or hypotheses; and the study rationale.

Statements about the study purpose do not appear in the method, results, or discussion section of a research report.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 01 Page and Header: 45, The Method Section 8. Which of the following aspects of a quantitative study would most likely be described in the method section of a research journal article?

A) Whether statistical significance was achieved B) What the study hypothesis was C) Whether the findings are consistent with prior research D )How the dependent variable was operationalized Ans: D Feedback: The method section describes the methods used to answer the research questions, including how variables were operationalized (measured). Study hypotheses are stated in the introduction to a research article. The results section presents findings, including whether results were statistically significant in quantitative studies. The discussion often discusses whether study findings are consistent with prior research.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 01 Page and Header: 45, The Method Section 9. Which aspects of a qualitative study would most likely be reported in the method section of a research journal article?

A) What the central phenomenon under study is B) What the characteristics of the study site and the context are C) What the study limitations were D) What important themes were discovered Ans: B Feedback: The method section describes the methods used to answer the research questions; in qualitative studies, the study methods must be understood within the context of the research setting—the study site. The introduction would describe the central phenomenon under investigation. Important themes are reported in the results section of a qualitative article. Study limitations are usually described in the discussion section, and the limitations should be taken into consideration in interpreting the findings.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 45, The Results Section 10. In which section of a research article would the following sentence most likely appear? “Patients who coughed were significantly more likely to have spontaneous dislodgement of small-bore nasogastric tubes than patients who did not.”

A) Introduction B) Method section C) Results section D) Discussion Ans: C Feedback: The results section presents the findings that were obtained by analyzing the study data—here, the results of a statistical test. The method section describes the methods used to answer the research questions. The introduction to a research article acquaints readers with the research problem and its context. In the discussion, the researcher presents conclusions about the meaning and implications of the findings.

Format: Multiple Choice

Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 46, The Results Section 11. In a qualitative research article, themes would be presented in which section?

A) Introduction B) Method section C) Results section D) Discussion section Ans: C Feedback: In qualitative reports, researchers often organize the results section according to the major themes, processes, or categories that were identified in the data. None of the other sections of a qualitative report would present themes. The introduction acquaints readers with the research problem and its context. The method section describes the methods used to answer the research questions. In the discussion, the researcher presents conclusions about the meaning and implications of the findings—themes might be discussed or interpreted, but they would not be “presented” because that would have occurred earlier in the paper.

Format: Multiple Choice Chapter: 3 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 01 Page and Header: 45, The Results Section 12. What is the meaning of the statement, “This finding was statistically significant”?

A) A significant theme was identified.

B) The finding is clinically important.

C) A significant number of people participated in the study.

D) The finding is probably true and replicable in a new sample.

Ans: D Feedback:

The statement “This finding was statistically significant” means that a specific finding has a high probability of being true and replicable. Statistically significant does not mean that the finding is clinically important. Statistical significance is not an issue in qualitative studies, where themes are discovered through an analysis of the narrative data. Statistical significance does not directly concern the number of study participants.

Format: Multiple Choice Chapter: 3 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 01 Page and Header: 45–46, The Results Section 13. What does significance at the .05 level mean?

A) That there is a 95% probability that the finding is reliable, not spurious B) That the finding applies to 5% of the study participants C) That 95% of the study participants had a good outcome D) That the value of the calculated statistical test is .05 Ans: A Feedback: The level of significance (p value) is an index of how probable it is that findings are reliable. If a finding is significant at the .05 probability level, it means that 95 times out of 100, the finding would not be spurious. A significance level does not correspond to the percentage of study participants affected, nor does it correspond to the value of a calculated test statistic.

Format: Multiple Choice Chapter: 3 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01 Page and Header: 46, The Results Section 14. Which value would indicate the highest probability of a reliable statistical result?

A) p < .01 B) p < .05 C) p < .10

D) p = .02 Ans: A Feedback: The smaller the p value, the higher is the probability that a result is reliable. Among the four alternatives, a probability of less than .01 indicates the strongest likelihood that the result is not spurious—less than 1 in 100. Using current conventions for probability thresholds, one of the alternatives (p < .10) would indicate that the finding is not statistically significant.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 46, The Discussion Section 15. In which section of a research journal article would the following sentence most likely appear? “The negative results may have been influenced by our inability to recruit the desired number of study participants.”

A) Introduction B) Method section C) Results section D) Discussion Ans: D Feedback: In the discussion, researchers consider the meaning and implications of the findings, e.g., what the results mean, what the study limitations were, how the findings fit with other evidence, and how the findings can be used in practice. The sentence in question concerns a possible study limitation and would appear in the discussion section. The method section describes the methods used to answer the research questions. The introduction to a research article acquaints readers with the research problem and its context. The results section presents the findings that were obtained by analyzing the study data.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process

Objective: 02 Page and Header: 47, The Style of Research Journal Articles 16. Which statement about research articles is true?

A) Most journal articles reporting quantitative studies are written in the active voice.

B) Personalized aspects of a research project are usually described in journal articles to make them more lively and inviting.

C) The use of research jargon in research articles can make the articles difficult to read and comprehend.

D) The stories described in quantitative research reports are easier to understand than the stories in qualitative reports.

Ans: C Feedback: Research has many terms and symbols that can seem esoteric, and this jargon can make research articles hard to read. Most quantitative research reports are written in the passive, not the active, voice. Because space in journals is limited, personalized aspects of a research inquiry are seldom reported. All research reports tell a “story,” but the stories in quantitative reports are more difficult to comprehend than the stories in qualitative reports.

Format: Multiple Choice Chapter: 3 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 04 Page and Header: 48, Research Critiques and Critical Appraisals 17. Which is the term used to refer to an objective assessment of a study’s strengths and limitations?

A) Evidence-based practice B) Statistical testing C) Research critique D) Literature review Ans: C Feedback:

A research critique is an objective assessment of a research study’s strengths and limitations. Comprehensive critiques are often undertaken by peer reviewers who assess the merits of both the research and the report and make decisions about the publication of an article. When research evidence is being assessed for use in nursing practice, the term critical appraisal is likely to be used instead of critique.

An assessment of a study’s strengths and weaknesses is not called evidence-based practice, statistical testing, or a literature review.

Format: Multiple Choice Chapter: 3 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 05 Page and Header: 51, Inference 18. A conclusion derived from the evidence presented in a study, taking into account the study methods, is called: A) statistical significance.

B) scientific merit.

C) triangulation.

D) an inference.

Ans: D Feedback: An inference is a conclusion drawn from the evidence presented in the research study, using logical reasoning and taking into account the methods used to generate the evidence. For example, the results of an intervention study might lead to the inference that the intervention caused improvements to patients’ health.

Statistical significance means that a result has a high probability of being “real.”

Scientific merit is the overall soundness of a study. Triangulation is a strategy involving the use of multiple sources to conclude what constitutes the truth.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 05, 06 Page and Header: 52, Reliability, Validity, and Trustworthiness 19. Which statement is true?

A) The rigor of a qualitative study is sometimes referred to as its scientific merit.

B) Bias is a concern in quantitative studies but not in qualitative studies.

C) A central feature of qualitative studies is research control.

D) Rigorous research methods facilitate researchers’ ability to make appropriate inferences.

Ans: D Feedback: Inference is an integral part of doing research, and the use of strong methods yields evidence that supports the desired inferences. Qualitative researchers avoid using research control in their studies, and do not use the term “scientific merit”— these are associated with quantitative researchers. Bias is of concern in both quantitative and qualitative research.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 05, 06 Page and Header: 52, Reliability, Validity, and Trustworthiness 20. Which criterion of scientific rigor used by quantitative researchers concerns the soundness of the evidence obtained in a study?

A) Reliability B) Validity C) Trustworthiness D) Generalizability Ans: B Feedback: Validity is a complex concept that broadly concerns the soundness of the study’s evidence—that is, whether the findings are cogent, unbiased, and well-grounded.

Reliability (a key challenge in quantitative research) refers to the accuracy and consistency of information obtained in a study. Generalizability in a quantitative study concerns the extent to which the findings can be applied to other groups and settings. Trustworthiness is a quality criterion of relevance to qualitative researchers.

Format: Multiple Choice Chapter: 3

Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 05, 06 Page and Header: 52, Reliability, Validity, and Trustworthiness 21. Which is a criterion of scientific rigor used by quantitative researchers that concerns the accuracy and consistency of information obtained in a study?

A) Reliability B) Trustworthiness C) Transferability D) Credibility Ans: A Feedback: A major challenge concerning the scientific merit of quantitative studies is ensuring reliability, which refers to the accuracy and consistency of information obtained in a study. The other options refer to quality criteria that are relevant in qualitative research.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 05, 06 Page and Header: 52, Reliability, Validity, and Trustworthiness 22. A researcher used a scale that measured a child’s body weight as 52.3 pounds (23.7 kg) 1 minute and as 48.7 pounds (22.1 kg) the next minute. What should the researcher be concerned about?

A) The scale’s validity B) The scale’s reliability C) The scale’s trustworthiness D) The scale’s credibility Ans: B Feedback: The issue in this situation is the accuracy and consistency of the weight measurements, which concern the scale’s reliability. Accuracy and consistency are not the focus of the criteria of validity, trustworthiness, or credibility—the last two of which are criteria for evaluating quality in qualitative studies.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 05, 06 Page and Header: 52, Reliability, Validity, and Trustworthiness 23. Which quality criterion is especially important for trustworthiness in a qualitative study?

A) Triangulation B) Reflexivity C) Reliability D) Credibility Ans: D Feedback: Credibility is a particularly important aspect of a study’s trustworthiness. Credibility is achieved when the methods engender confidence in the truth of the data.

Triangulation, the use of multiple sources to draw conclusions about what constitutes the truth, is a strategy used to enhance credibility. Reflexivity is another strategy for strengthening credibility, referring to the process of reflecting critically on the self and of scrutinizing personal values that could affect data collection and interpretation. Reliability is a criterion for assessing data quality in a quantitative study.

Format: Multiple Choice Chapter: 3 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 05, 06 Page and Header: 52, Reliability, Validity, and Trustworthiness 24. A researcher collects data about a phenomenon by observing people in a naturalistic setting and also by interviewing people in that setting. What strategy for enhancing trustworthiness did the researcher use?

A) Triangulation B) Reliability C) Validity D) Credibility Ans: A

Feedback: Triangulation is the use of multiple sources or referents to draw conclusions about what constitutes the truth—here, the use of both interviews and observations.

Reliability and validity are not research strategies; they are criteria used by quantitative researchers to evaluate evidence quality. Credibility, also not a strategy, is a criterion used to evaluate evidence in qualitative studies.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 05 Page and Header: 53, Bias 25. Which can be a source of bias in both quantitative and qualitative studies?

A) The absence of triangulation B) Participants’ desire to present themselves in the best light C) The use of research control D) The use of reflexivity Ans: B Feedback: Participants may provide biased or distorted information to protect their privacy, or to “look good” (or “normal”) to research staff, both in quantitative and qualitative studies. The absence of triangulation does not in itself result in bias. Using reflexivity does not contribute to bias. The use of research control can in some cases obscure meaning in a qualitative study but is a tool used by quantitative researchers to reduce bias.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 05, 06 Page and Header: 53, Bias 26. A digital thermometer consistently measures people’s body temperature as 1.0 degree lower than their true body temperature. What type of bias is this?

A) Sampling bias

B) Random bias C) Systematic bias D) Reflexive bias Ans: C Feedback: Random bias occurs when error is random and the distortions are as likely to bias values in one direction as the other for different people. Systematic bias, on the other hand, is consistent and distorts values in a single direction for all people, as is the case in this example. The term “reflexive bias” is not used in research.

Sampling bias concerns a flawed research sample that does not reflect the characteristics of the population and is not a term related to bias in measurements.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 05, 06 Page and Header: 53, Research Control 27. A nurse researcher compared men’s and women’s stress levels following cardiac surgery and made sure that both groups were comparable in their age. Patient age in this study would be considered: A) the independent variable.

B) the dependent variable.

C) a mediating variable.

D) a confounding variable.

Ans: D Feedback: Researchers seek to control confounding (or extraneous) variables—variables that are extraneous to the purpose of a specific study but that might contaminate the results because they may influence the dependent variable. In this case, patients’ age could be the actual influence on stress levels (the dependent or outcome variable), rather than gender (the independent variable of interest), if women in the sample were either older or younger than the men. As described, there are no mediating variables in this fictitious study.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care

Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 05 Page and Header: 54, Research Control 28. What is a general strategy that researchers use to control a confounding variable?

A) Holding it constant in the study B) Being reflexive about it C) Strengthening its validity D) Being “blinded” about its presence Ans: A Feedback: A general strategy that researchers use to control confounding (extraneous) variables is to hold them constant in the context of the study. The confounding variable must be handled in a manner that makes it unrelated to the independent variable or the outcome variable. Being “reflexive” about a confounder would not control it, nor would efforts to strengthen its validity. Being blinded about the presence of a confounder could worsen its influence in a study and would not control it.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 05, 06 Page and Header: 54, Research Control 29. A researcher hypothesizes that an intervention will improve the self-efficacy of patients with advanced cancer, which in turn will attenuate their levels of depression. What type of variable is “self-efficacy” in this scenario?

A) The independent variable B) The dependent variable C) A mediating variable D) A confounding variable Ans: C Feedback:

In this example, the researcher expects the intervention (the independent variable) to improve patients’ levels of depression (the dependent variable) through the intervention's effect of self-efficacy (the mediating variable). In other words, the hypothesized linkages are intervention à self-efficacy à depression. In this example, potential confounding variables are not stipulated.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 05 Page and Header: 54, Bias Reduction: Randomness and Blinding 30. If all people in a population have an equal chance of being selected as study participants, the sampling method would involve which type of selection?

A) Blind B) Controlled C) Random D) Biased Ans: C Feedback: When people are selected at random, each person in the initial pool has an equal probability of being selected, which in term means that there are no systematic biases. Randomness is a powerful tool for eliminating or reducing bias in a study.

There is no research term called “controlled” or “blind” selection.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 05 Page and Header: 54, Bias Reduction: Randomness and Blinding 31. If some study participants received a musical intervention through headphones to reduce anxiety and others are asked to wear headphones that do not transmit music, what would those in the second group be receiving?

A) A confounding variable B) A placebo

C) A mediating variable D) A triangulated variable Ans: B Feedback: A placebo is a sham intervention—an intervention without any “active ingredients” to affect outcomes. In this example, simply wearing headphones would not be expected to reduce anxiety. The placebo group would not be receiving any kind of “variable.”

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 05, 06 Page and Header: 54, Bias Reduction: Randomness and Blinding 32. What is the term for the strategy of withholding information from participants, interventionists, or other research staff to enhance objectivity?

A) Randomizing B) Generalizing C) Blinding D) Triangulation Ans: C Feedback: Blinding (or masking) is the term used for the strategy of withholding information, which is used in some studies to prevent biases stemming from people’s awareness or expectations. Objectivity can often be enhanced if participants or staff are not aware of who is getting special treatment, for example. Randomizing and triangulation are not strategies that involve withholding information. Generalizing is not a strategy, it is a criterion used to evaluate quantitative studies.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 05, 06 Page and Header: 55, Reflexivity

33. What mechanism is used by qualitative researchers to think critically about themselves and to scrutinize personal values that could affect their decisions and interpretations?

A) Reflexivity B) Triangulation C) Research control D) Randomness Ans: A Feedback: Reflexivity, the process of reflecting critically on the self and of scrutinizing personal values that could affect the conduct of the study and the interpretation of the data, is an important tool to guard against personal biases in qualitative research.

Research control and randomness are strategies used to enhance quality in quantitative studies, not in qualitative studies. Triangulation is a strategy, used by both quantitative and qualitative researchers, involving the use of multiple sources; it does not involve scrutiny of personal values.

Format: Multiple Choice Chapter: 3 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 05, 06 Page and Header: 55, Generalizability and Transferability 34. Quantitative researchers seek to ensure that their findings can be applied to other groups and settings. What is this goal called?

A) Reflexivity B) Generalizability C) Research control D) Transferability Ans: B Feedback: Generalizability in a quantitative study concerns the extent to which findings can be applied to other groups and settings. The qualitative analog is transferability.

Reflexivity, the process of reflecting critically on the self, is a quality-enhancing strategy used primarily in qualitative research. Research control is a tool used to enhance the rigor of quantitative studies.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 01, 03, 06 Page and Header: 61, Historical Background 1.The Tuskegee Syphilis Study, an example of research with serious ethical transgressions, violated which ethical principle?

A) Failure to conduct debriefing sessions B) Failure to obtain a Certificate of Confidentiality C) Failure to treat participants as a vulnerable group D) Failure to protect participants from harm Ans: D Feedback: The Tuskegee Syphilis Study investigated the effects of syphilis among 400 poor African American men; medical treatment was deliberately withheld to study the course of the untreated disease. The study violated the ethical principle of freedom from harm. The other answers are not ethical principles—they are strategies for addressing ethical principles. In any event, there would be no need for a Certificate of Confidentiality, and (despite their illness) participants would not be considered a vulnerable group.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 01 Page and Header: 61, Codes of Ethics 2. In response to human rights violations, various codes of ethics have been developed. Which code of ethical standards was developed after the Nazi atrocities were made public?

A) The Nuremberg Code B) The Declaration of Helsinki C) The Belmont Report D) The ICN Code of Ethics Ans: A

Feedback: The Nuremberg Code, developed after Nazi atrocities were made public during the Nuremberg trials, represented an international effort to establish ethical standards.

The other codes of ethical standards were developed more recently for different purposes and audiences.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 01, 07 Page and Header: 61, Government Regulations for Protecting Study Participants 3. Which of the following was the basis for regulations affecting research sponsored by the U.S. government?

A) Nuremberg Code B) Declaration of Helsinki C) Belmont Report D) The ICN Code of Ethics Ans: C Feedback: In the United States, an important code of ethics was adopted by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The commission issued the Belmont Report, which provided a model for many guidelines adopted in the United States. The Nuremberg Code was developed in response to the Nazi atrocities. Several other international standards have subsequently been developed, including the Declaration of Helsinki. The International Council of Nurses (ICN) developed the ICN Code of Ethics for Nurses.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 61, Ethical Dilemmas in Conducting Research 4. In the context of health research, a situation that results in an ethical dilemma is one in which:

A) Informed consent cannot be obtained from all study participants.

B) Participants’ rights and the demands for rigorous research are in conflict.

C) Researchers knowingly violate ethical principles to achieve personal goals.

D) An ethical transgression is unavoidable.

Ans: B Feedback: Ethical dilemmas arise because the codes of ethical conduct sometimes constrain the researchers’ ability to undertake a study rigorously, pitting the benefits of new research evidence against the well-being of study participants. Ethical dilemmas are usually resolved by using less rigorous methods, not by knowingly committing ethical transgressions. Problems with obtaining informed consent do not create ethical dilemmas. Violating ethical principles to achieve personal goals is not an ethical dilemma—it is an ethical transgression.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 62, Ethical Principles for Protecting Study Participants 5.The Belmont Report articulated three broad principles of ethical conduct in research with human study participants. Which of the following is not one of these principles?

A) Beneficence B) Respect for human dignity C) Informed consent D) Justice Ans: C Feedback: The Belmont Report has three broad principles on which standards of ethical conduct in research are based: beneficence, respect for human dignity, and justice.

Informed consent is not a principle—it represents a strategy to protect the rights articulated under the broad principle of “Respect for human dignity.”

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand

Difficulty: Moderate Integrated Process: Nursing Process Objective: 03, 07 Page and Header: 62, Beneficence 6. In the context of ethical principles, what is beneficence?

A) Researchers’ obligation to fully disclose aspects of the research to participants B) Participants’ right to self-determination C) Researchers’ obligation to protect participants’ privacy D) Researchers’ obligation to maximize benefits and minimize harms Ans: D Feedback: Beneficence involves the requirement that researchers minimize harm and maximize benefits—often, maximizing the potential for benefits to others rather than to participants themselves. Participants’ rights to full disclosure and selfdetermination are aspects of the broad principle of “Respect for human dignity.”

Privacy protections fall under the broad principle of justice.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03, 06 Page and Header: 63, The Right to Protection from Exploitation 7. A researcher recruits patients for a study and advises them that their time commitment will be 45 minutes in a single session. Participants are not told at the outset that the researcher plans to collect more data from study participants 6 months later. This might be considered an example of: A) invasion of privacy.

B) exploitation.

C) covert data collection.

D) emotional harm.

Ans: B Feedback: The researcher could be accused of exploiting the researcher–participant relationship by returning for further data without telling participants in advance (in addition, this is an example of lack of full disclosure). This situation is not an

invasion of privacy or covert data collection, and presumably, there was no maleficence (causing emotional harm).

Format: Multiple Choice Chapter: 4 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 63, The Right to Protection from Exploitation 8. Which statement about the protection of study participants is true?

A) The principle of beneficence involves protecting participants from minimal risks.

B) The right to self-determination means that participants could decide that a friend could take their place in the study.

C) It would be ethically commendable to offer a stipend of US$250 to homeless veterans to participate in a study.

D) Qualitative researchers are often in a better position than quantitative researchers to “do good” (and not just avoid harm) with study participants.

Ans: D Feedback: In qualitative studies, researchers may develop a strong (and possibly semitherapeutic) relationship with participants through their in-depth discussions.

Beneficence involves avoiding harms for participants during the study but not protecting them from minimal risks. The right to self-determination does not mean that a participant could select a replacement to be in the sample. The offer of a large monetary stipend to a severely disadvantaged group could be considered mildly coercive and not ethically commendable.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03, 07 Page and Header: 64, The Right to Self-Determination 9. Which item would best be considered a stipend in a nursing study?

A) A gift card to a local restaurant B) A copy of the Belmont Report

C) A fact sheet about the study, with the researcher’s contact information D) A list of services that participants could access if they are troubled by their participation Ans: A Feedback: A stipend is an item of monetary value (such as a gift card to a restaurant), usually offered as an incentive to encourage participation in a study. A copy of the Belmont Report would be of limited interest to participants (and is available online). Fact sheets and lists of services provide information to participants, but they do not have a monetary value.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03, 06 Page and Header: 64, The Right to Full Disclosure 10. In recruiting participants for a study about perceived racial discrimination in health care, the researcher tells people that the study is about their health beliefs.

Which ethical right does this violate?

A) The right to freedom from harm B) The right to protection from exploitation C) The right to full disclosure D) The right to privacy Ans: C Feedback: The researcher used deception in describing the study, which violates the participants' right to full disclosure. Full disclosure involves a complete and accurate description of the study's purpose and the likely risks and benefits. This deception did not affect participants’ rights to freedom from harm, protection from exploitation, or privacy.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process

Objective: 03, 06 Page and Header: 64, The Right to Full Disclosure 11. Which ethical principle would be violated if a researcher unobtrusively studies interactions among clients in a psychiatric hospital without their consent?

A) Confidentiality B) Freedom from harm C) Right to full disclosure D) Right to privacy Ans: C Feedback: In this situation, which involved covert data collection (concealment), participants were not able to decline being observed—the researcher’s study methods violated both the right to full disclosure and the right to self-determination. Other rights and principles were not specifically violated by this covert data collection.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 65, The Right to Privacy 12. Which of the following has a bearing on the ethical principle of justice?

A) NINR B) HIPAA C) IRB D) ICN Ans: B Feedback: In the United States, the Health Insurance Portability and Accountability Act (HIPAA) articulates standards to protect patients’ medical records and health information, which concerns patients’ right to privacy—an element of the justice principle. None of the other acronyms are specifically relevant to the ethical principle of justice. NINR is the acronym for the National Institute of Nursing Research, IRB is the acronym for an Institutional Review Board (which would oversee adherence to ethical principles), and ICN is the acronym for the International Council of Nurses, which has developed a code of ethics for nurses.

Format: Multiple Choice Chapter: 4 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 65, The Right to Fair Treatment 13. To protect participants’ right to fair treatment, what are researchers who seek a federal research grant in the United States required to do?

A) Include women and minorities in their studies B) Disclose the benefits of the research to participants C) Offer participants a stipend for participation in the study D) Obtain informed consent from participants Ans: A Feedback: Researchers seeking funding from the U.S. National Institutes of Health are required to include women and minorities in studies to ensure their right to fair treatment. Disclosing the benefits of research is an aspect of participants’ right to full disclosure. Offering participants a stipend for their participation in the study is often used as an incentive to cooperate, but it is not a requirement for a federal grant. Obtaining fully informed consent from participants protects their right to selfdetermination and their right to full disclosure, not their right to fair treatment.

Format: Multiple Choice Chapter: 4 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 04, 07 Page and Header: 65, Risk/Benefit Assessments 14. In the context of health care research, minimal risks are risks that: A) affect a minority of study participants.

B) are no greater than those encountered in daily life.

C) make informed consent unnecessary.

D) do not require the payment of a stipend.

Ans: B Feedback:

Minimal risks are risks that are no greater than those ordinarily encountered in daily life or during routine tests or procedures. Minimal risks do not concern the proportion of participants at risk. Informed consent is advisable even when risks are minimal. The payment of a stipend is related to the researcher’s desire to have an incentive, not to a person’s degree of risk of participating in a study.

Format: Multiple Choice Chapter: 4 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 65, Risk/Benefit Assessments 15. Which of the following is something nurse researchers can do to protect study participants?

A) Perform a risk/benefit assessment to evaluate the costs and the benefits of participation.

B) Keep painful procedure information from study participants until the study is completed.

C) Prevent psychological discomfort during the study.

D) Collect data from participants without their knowledge to prevent any possibility of stress or embarrassment.

Ans: A Feedback: One strategy that researchers can use to protect participants is to carefully assess the risks and the benefits of study participation. Keeping painful procedure information from study participants would violate their right to full disclosure and should not be done. Collecting data covertly is ethically questionable, as it also violates participants’ rights to full disclosure and self-determination. Researchers are not always able to prevent psychological discomfort during a study, but efforts to address such discomfort can be devised in identifying this as a potential risk.

Format: Multiple Choice Chapter: 4 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 65, Risk/Benefit Assessments

16. In undertaking a risk/benefit assessment to enhance the ethical conduct of a study, which of the following might the researchers identify as a potential benefit?

A) Researchers’ opportunity to publish in a prestigious journal B) Participants’ opportunity to take some time off from work C) Students’ opportunity to gain research experience D) Knowledge gains that could benefit patients in the future Ans: D Feedback: The benefit to society, in terms of knowledge gains that can lead to future improvements, is often the key reason for doing health research. Researchers might succeed in getting good publications, participants might get some time off, and students might gain research experience, but these are not part of the equation in deciding whether a study is ethically justified.

Format: Multiple Choice Chapter: 4 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04, 07 Page and Header: 66, Informed Consent 17. Which safeguard mechanism allows prospective participants to make reasoned decisions about their participation in a study?

A) Confidentiality B) Anonymity C) Informed consent D) Privacy protections Ans: C Feedback: Informed consent procedures provide prospective participants with the information needed to make a reasoned and voluntary decision about whether to participate in a study. Privacy protections (which include anonymity and confidentiality procedures) do not provide relevant information to inform decisions about study participation.

Format: Multiple Choice Chapter: 4 Client Needs: Safe and Effective Care Environment: Management of Care

Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 66, Informed Consent 18. In what situation is informed consent not needed?

A) The researcher pays the participants a stipend.

B) The risk/benefit ratio is low.

C) A Certificate of Confidentiality has been obtained.

D) Informed consent is needed in almost all situations.

Ans: D Feedback: Informed consent procedures provide prospective participants with the information they need to decide whether or not to participate in a study. Informed consent is needed even when researchers pay participants a stipend or when the risk/benefit ratio is low. Researchers in the United States may obtain a Certificate of Confidentiality to protect them against the forced disclosure of confidential information in a civil, criminal, administrative, or legislative proceeding. However, such a Certificate does not negate the need to obtain informed consent from study participants.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04, 07 Page and Header: 66, Informed Consent 19. In a qualitative study that involves multiple contacts between the researcher and study participants, the researcher may negotiate with participants in which type of procedure?

A) Implied consent B) Stipend provision C) Process consent D) A risk/benefit assessmen Ans: C Feedback:

In qualitative studies, consent may need to be continually renegotiated with participants as the study evolves, through procedures called process consent.

Stipends and risk/benefit assessments are not negotiated. Implied consent (used in connections with written questionnaires) is more likely to be a feature of a quantitative study than a qualitative study.

Format: Multiple Choice Chapter: 4 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 04, 07 Page and Header: 66, Informed Consent 20. A researcher distributes a questionnaire to classrooms of nursing students about their health-promoting activities. The researcher considered the completion of the questionnaire as an indicator of the students’ permission to use their data.

This is an example of: A) process consent.

B) implied consent.

C) confidentiality.

D) deception.

Ans: B Feedback: Researchers often assume that a completed and returned questionnaire is evidence of implied consent—that is, that people willingly returned the questionnaire, and thus, they implied their permission to use their responses to the questionnaire as research data. Process consent involves ongoing renegotiating of consent, primarily in qualitative studies. The situation described does not concern confidentiality; the returned questionnaire may or may not have information that could divulge the person’s identity. There is nothing in the description of this situation to suggest the use of deception.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04, 07 Page and Header: 67, Anonymity

21. What is the safeguard mechanism by which researchers cannot link study data to specific participants?

A) Confidentiality B) Anonymity C) Informed consent D) Covert data collection Ans: B Feedback: Privacy can be maintained through anonymity (wherein not even researchers know participants’ identities) or through formal confidentiality procedures. Formal confidentiality procedures involve a pledge to safeguard the information that participants provide, but the researcher can link participants to their data. Informed consent procedures provide prospective participants with the information needed to make a reasoned decision about participation, but they are not confidentiality procedures. Covert data collection involves collecting data without participants’ awareness and is also not a confidentiality procedure.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04, 07 Page and Header: 67, Confidentiality Procedures 22. Which of the following constitutes an ethical transgression?

A) Breaching confidentiality B) Not performing a risk/benefit assessment C) Not collecting data anonymously D) Failing to obtain a Certificate of Confidentiality Ans: A Feedback: Study participants have the right to expect that their privacy is protected by assurances of confidentiality; it is a serious ethical transgression to have a breach in the confidentiality of participants’ data. Performing a risk/benefit assessment is desirable, but not performing such an assessment does not constitute an ethical transgression. In many studies, anonymity is not possible, but this does not necessarily create ethical problems. Relatively few studies gather sensitive data that require a Certificate of Confidentiality.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 67, Confidentiality in the Absence of Anonymity 23. What action could a researcher take to increase the confidentiality of study participants?

A) Avoid collecting any of their identifying information.

B) Avoid introducing participants to other participants in the study.

C) Maintain all identifying information on computer files rather than in manual files.

D) Destroy all identifying information within 3 years of the end of the study.

Ans: A Feedback: The confidentiality of study participants is increased when no identifying information is obtained, although this is not always possible because it limits researchers’ ability to communicate with participants (e.g., to share study results with them). Study participants are rarely introduced to other participants, but a simple introduction need not undermine the confidentiality of the data provided.

Confidentiality is not necessarily increased by maintaining information on computer files or by destroying information at a certain time after the study has ended.

Format: Multiple Choice Chapter: 4 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 04, 06 Page and Header: 67, Confidentiality in the Absence of Anonymity 24. In which study would a researcher most benefit by having a Certificate of Confidentiality?

A) A study of factors affecting postpartum depression B) A study of caregiver burden among caregivers of people with Alzheimer’s disease C) A study of the effects of yoga on stress among women D) A study of heroin abuse among rehabilitation patients using opioid pain medicine Ans: D

Feedback: To avoid the forced disclosure of sensitive research information (e.g., through a court order), researchers in the United States can apply for a Certificate of Confidentiality from the National Institutes of Health. Although sensitive information might be divulged in virtually any study (e.g., an incidence of child abuse among women with postpartum depression, elder abuse among caregivers of people with Alzheimer’s disease), a study of heroin abuse would almost surely reveal compromising information for many study participants because heroin addiction is the focus of the study.

Format: Multiple Choice Chapter: 4 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 04, 07 Page and Header: 68, Debriefings and Referrals 25. Researchers can show their respect for participants in several ways, including the use of debriefing sessions. What are debriefing sessions?

A) Discussions with prospective participants to recruit them into the study B) Discussions with participants after data collection to allow them to ask questions or provide feedback C) Discussions with a human subjects committee before a study to obtain their permission to proceed as planned D) Discussions with a small group of participants before the study to test the informed consent process Ans: B Feedback: Debriefing sessions are conducted after data collection is completed to permit participants to ask questions, air complaints, or suggest improved processes.

Debriefings are not recruitment sessions, tests of the informed consent process, or discussions with human subjects committees.

Format: Multiple Choice Chapter: 4 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 05, 07 Page and Header: 68, Treatment of Vulnerable Groups

26. Which group would be considered vulnerable for research purposes, according to conventional guidelines?

A) Women hospitalized for a mastectomy B) Members of a senior citizens group C) People who do not speak English D) Pediatric patients Ans: D Feedback: Vulnerable groups include people who are incapable of giving fully informed consent, such as young children (pediatric patients). Women hospitalized for a mastectomy, members of a senior citizens group, or people who do not speak English would not be considered vulnerable groups.

Format: Multiple Choice Chapter: 4 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 05, 07 Page and Header: 68, Treatment of Vulnerable Groups 27. Which group would be considered vulnerable for research purposes, according to conventional guidelines?

A) Patients in a dialysis clinic B) Patients in an outpatient rehabilitation facility C) Patients in a prison hospital D) College students Ans: C Feedback: Vulnerable groups include people who are institutionalized (e.g., prisoners), who might feel that they would be penalized by not cooperating in a study. Patients in a dialysis clinic or an outpatient rehabilitation facility would not be considered vulnerable groups, nor would college students.

Format: Multiple Choice Chapter: 4 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply

Difficulty: Moderate Integrated Process: Nursing Process Objective: 05, 07 Page and Header: 68, Treatment of Vulnerable Groups 28. Which group would be considered vulnerable for research purposes, according to conventional guidelines?

A) Patients in hospice care B) Women who have had a miscarriage C) Patients who are refugees D) Patients waiting for an organ donation Ans: A Feedback: Vulnerable groups include people who are terminally ill, who cannot realistically be expected to benefit personally from the research. Patients who are refugees or who are waiting for an organ donation would not be considered vulnerable groups according to standard guidelines, nor would women who experienced a miscarriage.

Format: Multiple Choice Chapter: 4 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 05 Page and Header: 68, Treatment of Vulnerable Groups 29. Who could sign the informed consent form for a 12-year-old child to participate in a study?

A) A grandmother B) A father C) A sibling over 18 years of age D) The child Ans: B Feedback: Children are an identified vulnerable group and do not have the competence to give informed consent. Consent must be obtained from a parent (or legal guardian), not from another adult family member. Although a 12-year-old could not formally consent to participate in a study, it is appropriate to obtain the child’s assent, in addition to parental consent.

Format: Multiple Choice Chapter: 4 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 04, 07 Page and Header: 69, External Reviews and the Protection of Human Rights 30.The function of an Institutional Review Board is to: A) authorize Certificates of Confidentiality.

B) review the ethical aspects of a study before it gets underway.

C) identify ethical dilemmas.

D) oversee the humane treatment of animals in research.

Ans: B Feedback: In the United States, an Institutional Review Board (IRB) is the institutional committee (e.g., a committee in a hospital or university) that reviews the adequacy of the protection of human study participants in a proposed study. IRBs do not authorize Certificates of Confidentiality (these are issued by the National Institutes of Health), or do they oversee procedures used with research animals. IRBs may, in reviewing research plans, identify ethical dilemmas, but that is not their role—their role is to ensure that, despite any dilemma, participants are adequately protected.

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02 Page and Header: 76, Basic Terminology 1. “Does stress during a woman’s first trimester of pregnancy affect the birth weight of her infant?” is a: A) research question.

B) portion of a problem statement.

C) statement of purpose.

D) hypothesis.

Ans: A Feedback: Research questions are the specific queries researchers want to answer in addressing the research problem. Problem statements articulate the nature, context, and significance of a problem to be studied. A statement of purpose summarizes the overall study goal. A hypothesis states predicted relationships between two or more variables. Hypotheses, problem statements, and statements of purpose are not worded in the interrogative form.

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 02, 05 Page and Header: 75, Basic Terminology 2. What is a research problem?

A) A situation involving a troubling condition amenable to disciplined inquiry B) An argument that spells out the basis for a new study C) A specific query that researchers want to answer in addressing a problem D) A specific accomplishment that the researcher hopes to achieve by conducting a study Ans: A Feedback:

A research problem is an enigmatic or troubling condition that is amenable to systematic, disciplined inquiry. A research problem is not an argument, although the need to address the problem through research is described in a reasoned argument. Specific queries about the problem to be addressed in the study are articulated as research questions. The specific accomplishments researchers hope to achieve in a study are the research purposes or goals.

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 76, Research Problems and Paradigms 3. The research question “What is the meaning of spirituality to patients in end-oflife care?” is: A) most likely to be addressed using a quantitative approach.

B) most likely to be addressed using a qualitative approach.

C) amenable to either a qualitative or a quantitative approach.

D) not appropriately worded.

Ans: B Feedback: A qualitative approach would be most appropriate for addressing this question about the meaning of a phenomenon. Qualitative studies are often undertaken because researchers want to develop a rich and context-bound understanding of a poorly understood phenomenon—as in the case of this appropriately worded research question. Quantitative studies usually involve concepts that are fairly well developed and for which reliable methods of measurement have been (or can be) developed. Quantitative methods are not suitable for understanding the meaning of phenomena.

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 76, Research Problems and Paradigms

4.The research query, “Among patients with cancer, are high levels of death anxiety more prevalent for men or for women?” is: A) most likely to be addressed using a quantitative approach.

B) most likely to be addressed using a qualitative approach.

C) amenable to either a qualitative or a quantitative approach.

D) not appropriately worded.

Ans: A Feedback: Quantitative studies usually involve concepts that are fairly well developed and for which reliable methods of measurement have been (or can be) developed. In this appropriately worded question, both the independent variable (a person’s gender) and the dependent variable (death anxiety) can be measured. A qualitative approach would not be suitable for this question but could be used for related questions (e.g., What is the essence of death anxiety among patients with cancer?).

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 76, Research Problems and Paradigms 5. Which statement about research problems and paradigms (as paradigms relate to research methods) is true?

A) All research questions can be addressed using either quantitative or qualitative research methods.

B) Research problems emerge from a commitment to either the positivist paradigm (quantitative methods) or constructivist paradigm (qualitative methods).

C) Many research questions cannot be answered within either of the two main paradigms.

D) Quantitative studies typically address problems for which reliable methods of measurement exist.

Ans: D Feedback:

Quantitative studies focus on concepts that are fairly well developed, and these concepts are amenable to reliable measurement, usually with existing methods.

Most research questions lend themselves to either a qualitative or a quantitative approach, not to both. Allegiance to a paradigm does not serve as the basis for a research problem but may guide the type of questions that are of interest. Although many questions cannot be answered within the two main paradigms (e.g., questions of a moral nature), most research questions can be answered within the two main paradigms.

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 76, Sources of Research Problems 6.Which is a major source of ideas for research problems?

A) Journal clubs B) Nursing code of ethics C) Nurses’ personal clinical experience D) Evidence hierarchies Ans: C Feedback: Major sources of ideas for nursing research problems are nurses’ clinical experience, relevant literature, and theories in nursing and related fields. The nursing code of ethics and evidence hierarchies are not sources of ideas for research problems. Discussions in a journal club may suggest an idea for a study, but such discussions are not a major source of research ideas.

Format: Multiple Choice Chapter: 5 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 78, Problem Statements 7. A problem statement has many components. Which of the following is unlikely to be a component of a written problem statement for a quantitative study?

A) The scope of the problem

B) Researchers’ views about how to fix the problem C) Gaps in what is known D) The consequences of not fixing the problem Ans: B Feedback: A problem statement for a quantitative study usually has six components: identification of the problem, background of the problem, scope of the problem, consequences of the problem, knowledge gaps, and proposed solutions to the problem. Researchers’ opinions about how to fix the problem usually are not included in a problem statement—although they might be mentioned in the discussion section of a report.

Format: Multiple Choice Chapter: 5 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 79, Problem Statements 8. Which type of research communication does the following represent? “For the thousands of patients on chemotherapy, nausea and vomiting are common side effects. To date, interventions have been only moderately successful in reducing these effects. New interventions that can reduce or prevent these side effects need to be identified to improve the quality of life of these patients.”

A) A hypothesis B) A research question C) A statement of purpose D) A portion of a problem statement Ans: D Feedback: Problem statements articulate the nature, severity, and scope of a problem, and indicate what information is lacking to solve the problem. The statement in question is not a statement of purpose, a hypothesis, or a research question. A statement of purpose summarizes the overall goal of a study and identifies the key variables and the population. A hypothesis is a statement of a predicted relationship between two or more variables. A research question is the specific query researchers want to answer in addressing the research problem.

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 80, Statements of Purpose 9. “This study sought to understand the experience of living with a colostomy among patients who had surgery for colon cancer” is a: A) research question.

B) portion of a problem statement.

C) statement of purpose.

D) hypothesis.

Ans: C Feedback: A statement of purpose for a qualitative study, which summarizes the overall study goal, identifies the key concept or phenomena (here, living with a colostomy) and the study group or population (patients who had surgery for colon cancer). The statement in question is not a hypothesis, a research question, or a portion of a problem statement. Research questions are the specific queries researchers want to answer in addressing the research problem—and the statement under consideration is not worded as a query. A problem statement articulates the nature, context, and significance of a problem to be studied. A hypothesis states predicted relationships between two or more variables, and qualitative studies do not test hypotheses.

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 80, Statements of Purpose 10. In a statement of purpose, the researcher often communicates information beyond the substantive content of a study through: A) the scope of the problem.

B) operational definitions of the research variables.

C) predicted relationships among variables.

D) the choice of verbs about what will be undertaken.

Ans: D

Feedback: In the statement of purpose, researchers communicate information about their study goals through their choice of verbs (e.g., explore, describe). The statement of purpose does not provide operational definitions of research variables or information about the scope of the problem. Hypotheses, not statements of purpose, articulate predicted relationships among variables.

Format: Multiple Choice Chapter: 5 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 80, Statements of Purpose 11. In a statement of purpose, a researcher indicates that the goal of the study is to understand the lived experiences of family members caring for a terminally ill child with cancer. What type of study is this?

A) Ethnographic B) Grounded theory C) Phenomenological D) Experimental Ans: C Feedback: Phenomenology is concerned with the lived experiences of humans. Terms often associated with this tradition include experience, lived experience, meaning, and essence. The grounded theory tradition seeks to describe and understand the key social psychological processes that occur in a social setting, not lived experiences.

Ethnographic studies focus on the patterns and lifeways of a culture. The purpose statement in question is not for an experimental (quantitative) study.

Format: Multiple Choice Chapter: 5 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 80, Statements of Purpose

12. A research team stated that the purpose of their study was to explore the culture of an inner-city health clinic during the COVID-19 pandemic. What type of study is this?

A) Ethnographic B) Grounded theory C) Phenomenological D) Experimental Ans: A Feedback: Ethnographic studies focus on the patterns and lifeways of a culture—in this case, the culture that evolved in an inner-city health clinic during the COVID-19 pandemic. Phenomenology is concerned with the lived experiences of humans, not their cultures. The grounded theory tradition seeks to describe and understand the social–psychological processes that occur in a social setting, not a culture. The purpose statement in question is for a qualitative study, not an experimental (quantitative) study.

Format: Multiple Choice Chapter: 5 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 80, Statements of Purpose 13. Which verb for a statement of purpose is least likely to suggest a bias on the part of the researcher?

A) Demonstrate B) Compare C) Prove D) Show Ans: B Feedback: The verbs in the purpose statement should connote objectivity. “Compare” is the least likely of the verb options to indicate a bias on the part of the researcher because it does not suggest that the researcher has a priori assumptions about the study findings. A statement of purpose indicating that the study goal was to prove, demonstrate, or show something suggests the possibility of bias.

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 80, Statements of Purpose 14. Which of the following sentences is most likely to be a statement of purpose for a grounded theory study?

A) The aim is to describe the cultural behaviors of immigrant women going through menopause.

B) The aim is to explore the lived experience of immigrant women going through menopause.

C) The aim is to understand the process by which immigrant women adapt to transitions during menopause.

D) The aim is to describe the percentage of immigrant women who go through menopause and seek health care advice.

Ans:C Feedback: Grounded theory studies focus on processes and social interactions, such as major life transitions and adaptation to them. Cultural behaviors are studied in ethnographies, and phenomenologists focus on lived experiences. A quantitative study, rather than a qualitative one, would seek to learn the percentage of menopausal immigrant women who seek health care advice.

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 80, Statements of Purpose 15. Which verb used in a statement of purpose is most likely to signify that the study is quantitative?

A) Explore B) Discover C) Understand D) Evaluate

Ans: D Feedback: Verbs such as “evaluate” or “test” are used mostly in statements of purpose for quantitative studies—especially for studies addressing Therapy questions. Verbs such as “discover,” “understand,” and “explore” are more often used in qualitative studies.

Format: Multiple Choice Chapter: 5 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 80, Statements of Purpose 16. Which is most likely to be a statement of purpose for a quantitative study?

A) The purpose was to explore the lived experience of emotional anguish among people in hospice care.

B) The purpose was to assess the effectiveness of music for decreasing agitation in nursing home residents.

C) The purpose was to describe the experiences of people with untreated obstructive sleep apnea.

D) The purpose was to describe the processes of families in managing the care of children with chronic illnesses at home.

Ans: B Feedback: A study designed to assess (test) the effectiveness of an intervention (music) on measurable outcomes (frequency or intensity of agitation) would use quantitative methods. The other answers are more likely to be from qualitative studies, including phenomenological studies of the lived experience of hospice patients’ emotional anguish and of people with obstructive sleep apnea. Grounded theory might be the tradition used to study family processes in caring for a chronically ill child.

Format: Multiple Choice Chapter: 5 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 02

Page and Header: 81, Research Questions in Quantitative Studies 17. Identify the independent variable in the following research question: “What is the effect of acetaminophen compared to ibuprofen on liver function in female adolescents with hepatitis?”

A) Acetaminophen B) Liver function C) Ibuprofen D) Type of pain reliever Ans: D Feedback: The independent variable is the type of pain reliever, acetaminophen versus ibuprofen. Liver function, the dependent variable, might be differentially affected by alternative pain relievers.

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 02 Page and Header: 81, Research Questions in Quantitative Studies 18. In the following research question, what would correspond to the C component in the PICO scheme? “What is the relationship between pregnant women’s smoking behavior and infant birth weight?”

A) Pregnancy status B) Smoking C) Not smoking D) Infant birth weight Ans: C Feedback: The research question concerns the effect of maternal smoking on infants’ birth weight. The “I” component is smoking, and the comparator (C) is not smoking.

Pregnant women are the population (P) and the outcome (O) is infant birth weight.

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care

Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 02 Page and Header: 81, Research Questions in Quantitative Studies 19. Which would be a research question template for a quantitative Etiology/harm study, where IV = the independent variable and DV = the dependent variable?

A) In a population, does exposure to IV increase the risk of DV? B) In a population, what is the effect of an intervention (IV) on the DV? C) In a population, what is the relationship between the IV and the DV? D) In a population, what is the frequency of occurrence of the DV? Ans: A Feedback: Etiology/harm questions concern factors that cause or contribute to the risk of a health problem or a disease. The general question about the relationship between the IV and DV is the most generic question template—not specific to Etiology/harm questions. The question template that has an intervention as the IV is for a Therapy question. A question about frequency of occurrence of a research variable is simply descriptive, not about relationships between variables.

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 82, Research Hypotheses 20. Which statement about research hypotheses is true?

A) Induction is the logical reasoning process for deriving hypotheses from a theory.

B) Simple hypotheses make predictions about a single variable.

C) Research articles typically stipulate the null hypotheses.

D) Qualitative researchers do not develop hypotheses prior to data collection.

Ans: D Feedback:

Quantitative researchers make specific predictions about relationships between variables and then test those predictions, but qualitative researchers want to learn from participants without having a priori conjectures. Deduction (not induction) is the process of deriving hypotheses from general propositions, such as theories.

Hypotheses involve two variables at a minimum—the independent and the dependent variable. Researchers rarely state their hypotheses in the null form in a research report; the null hypothesis is used primarily as the basis for statistical tests.

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 83, Wording of Hypotheses 21. “Women who jog regularly are more likely to have amenorrhea than those who do not jog regularly” is an example of which type of hypothesis?

A) Directional B) Nondirectional C) Null D) Complex Ans: A Feedback: Directional hypotheses predict the direction of a relationship, and in this example, there is an explicit prediction that women who jog regularly are at higher risk of amenorrhea than those who do not. Nondirectional hypotheses predict the existence of relationships, not their direction. This hypothesis is neither null (no relationship predicted) nor complex (three or more variables).

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 03 Page and Header: 83, Wording of Hypotheses

22. Here is a research hypothesis: “Women with high levels of prenatal physical activity have infants of lower birth weight than sedentary women.” What is an alternative wording for this hypothesis?

A) Women’s levels of prenatal physical activity are unrelated to their infants’ weight at birth.

B) The greater the amount of maternal prenatal physical activity, the lower the infant’s birth weight.

C) There is a correlation between a woman’s prenatal physical activity and the birth weight of her infant.

D) Women who are sedentary during their pregnancies are as likely as physically active women to have infants that are of below-average weight.

Ans:B Feedback: The hypothesis in question is a directional hypothesis, predicting that women who are physically active during their pregnancies have infants with lower birth weight than women who are sedentary. The wording “The greater the amount of maternal prenatal physical activity, the lower the infant’s birth weight” also states a directional hypothesis. The other hypotheses are either null (“are unrelated” and “are as likely”) or nondirectional (“There is a correlation . . . ”).

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 03, 05 Page and Header: 84, Wording of Hypotheses 23. Which statement is a null hypothesis?

A) Patients with Parkinson’s disease are as likely to fall indoors as outdoors.

B) The greater the amount of time spent outdoors by patients with Parkinson, the greater the likelihood of a fall.

C) Among patients with Parkinson’s disease, the risk of falling is greater outdoors than indoors.

D) Among patients with Parkinson’s disease, an outdoor fall is more likely to result in injury than an indoor fall.

Ans: A Feedback:

The null hypothesis states that there is no relationship between the independent variable (a person’s location—indoors versus outdoors) and the dependent variable (a fall); it is this hypothesis that would be subjected to statistical testing. All of the other answers are directional research hypotheses with a specific prediction.

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 03 Page and Header: 84, Wording of Hypotheses 24. A null hypothesis is used: A) to avoid the appearance of bias.

B) when a researcher is uncertain what the findings will be.

C) in testing hypotheses statistically.

D) when the researcher predicts that the relationship between variables is complex.

Ans: C Feedback: The null hypothesis is stated in the form that is subjected to statistical testing—the researchers use statistics to assess whether the prediction of no relationship can be rejected. A null hypothesis is seldom stated in a research report, and so null hypotheses are not used to avoid the appearance of bias. Researchers are never certain about predicted relationships, but hypotheses represent their “best guess,” taking into consideration theory or other research. The complexity of a hypothesis concerns how many variables are involved in the prediction, not whether a hypothesis is stated in null form.

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 83–84, Wording of Hypotheses 25. Here is a research hypothesis: “The greater the number of hours of watching television weekly, the greater a person’s body mass index (BMI).” Which wording for this hypothesis would make it nondirectional?

A) There is no relationship between weekly hours of television watching and a person’s BMI. B) Weekly hours of television watching are related to a person’s BMI. C) People who watch more television weekly are more likely to have a high BMI than those who do not.

D) Body mass index is higher among those who watch a lot of television.

Ans: B Feedback: Nondirectional hypotheses predict that two variables are related but do not predict whether higher or lower values on the independent variable (here, of TV watching) are associated with higher or lower values of the dependent variable (here, BMI).

The option that states “There is no relationship” is a null hypothesis. The other two options are directional—they predict that more TV watching is associated with higher BMI. Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 83, Wording of Hypotheses 26. What type of hypothesis is represented by the following prediction? “The fewer social supports an older person has, the more likely the individual will be institutionalized when experiencing a health problem.”

A) Null B) Complex C) Nondirectional D) Directional Ans: D Feedback: Directional hypotheses predict the direction of a relationship, and in this case, there is an explicit prediction about how social supports and institutionalization are related. Nondirectional hypotheses predict the existence of relationships, not their direction. Null hypotheses, which express the absence of a relationship, are the hypotheses subjected to statistical testing. Complex hypotheses involve three or more variables, and in this example, there are only two (amount of social support, risk of being institutionalized).

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 03, 05 Page and Header: 84, Wording of Hypotheses 27. Which of the following is a complex hypothesis?

A) Visual acuity is correlated with the risk of falling in older patients living in longterm care.

B) Among community-dwelling adults, the greater the degree of cognitive impairment, the younger person’s age at death.

C) School-aged boys differ from school-aged girls in attitudes toward physical activity.

D) A person’s health-related quality of life is related to that person’s income and marital status.

Ans: D Feedback: A complex hypothesis involves three or more variables. In this example, there are two independent variables (income and marital status) and one dependent variable (health-related quality of life). The other options are all simple hypotheses, with a single independent variable and a single dependent variable.

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 84, Wording of Hypotheses 28. The hypothesis “A person’s emotional status is not affected by a relocation to a nursing home” is: A) null.

B) complex.

C) directional.

D) nondirectional.

Ans: A

Feedback: Null hypotheses, which express the absence of a relationship, are the hypotheses subjected to statistical testing. A complex research hypothesis states predicted relationships between three or more variables, and in this example, there are only two (emotional status and relocation versus no relocation). Directional hypotheses predict the direction of a relationship; nondirectional hypotheses predict the existence of relationships, not their direction—and in the hypothesis in question, there is no prediction of a relationship.

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 04 Page and Header: 83, Characteristics of Testable Hypotheses 29. The hypothesis “Women who live in rural areas are unlikely to practice breast self-examination” is: A) null.

B) not testable.

C) directional.

D) nondirectional.

Ans: B Feedback: This hypothesis is not testable because it does not predict a relationship between two or more variables. Here, the only variable is practicing versus not practicing breast self-examination. “Women who live in rural areas” is the population, not a variable. Directional hypotheses predict the direction of a relationship between variables; nondirectional hypotheses predict the existence of relationships, not their direction. Null hypotheses express the absence of a relationship between variables.

Format: Multiple Choice Chapter: 5 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 04 Page and Header: 84, Hypothesis Testing and Proof 30. Which statement is worded inappropriately?

A) The findings suggest that male patients with hypertension are more likely than their female counterparts to adhere to medications.

B) The statistical results support our hypothesis that women who are physically abused are at higher risk of cardiovascular disease than women who are not abused.

C) The findings prove that people living with HIV are at greater risk for chronic comorbidities than those not living with HIV. D) Based on the results, we can accept the hypothesis that diminished appetite in the elderly is correlated with depression.

Ans: C Feedback: Hypotheses are never proved by hypothesis testing—rather they can be supported by evidence suggesting that they have a high probability of being correct. The other answers are appropriately worded, expressing a degree of tentativeness.

Format: Multiple Choice Chapter: 5 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 04 Page and Header: 83, Characteristics of Testable Hypotheses 31. In wording a testable hypothesis, which phrase would not be used?

A) Less than . . .

B) Meaning of . . .

C) More than . . .

D) Different from . . .

Ans: B Feedback: Hypotheses that do not make a relational statement cannot be tested using statistical analyses. If a hypothesis lacks a phrase such as more than, less than, different from, related to, or something similar, it is not readily testable. “Meaning of” is not a relational phrase predicting how variables are related.

Format: Multiple Choice Chapter: 5 Client Needs: Psychosocial Integrity Cognitive Level: Analyze

Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 82, Function of Hypotheses in Quantitative Research 32. Which statement regarding hypotheses is true?

A) Journal articles describing a quantitative study always state the researcher’s hypotheses.

B) Hypotheses are tested in qualitative study through an inductive process.

C) Hypotheses prove the existence of relationships between two or more variables.

D) Stating upfront hypotheses can reduce the possibility that spurious results will be misinterpreted.

Ans: D Feedback: Without stating their hypotheses upfront, researchers can readily interpret almost any result; hypotheses promote critical thinking and can lead to more thoughtful interpretations of study results. Researchers do not, however, always state their hypotheses, even when they have them. Hypotheses (and the tests of hypotheses) do not prove that variables are related. Qualitative researchers use inductive processes, but they do not test hypotheses.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 01 Page and Header: 90, Purposes of Research Literature Reviews 1. What is the primary purpose of a literature review in a research report?

A) Summarizing the current state of evidence about the research problem that was addressed in the study B) Demonstrating the research capabilities of the authors C) Helping readers to grasp the keywords for future searches D) Making recommendations about future study designs Ans: A Feedback: A literature review is a written summary of the state of evidence on a research problem. The literature review helps to develop the argument for the new study by summarizing what is known and what is not. The purpose of a literature review in the introduction of a research report is not to demonstrate the researcher’s skills, to help readers identify keywords for their own literature search, or to recommend study designs for future projects.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 01 Page and Header: 91, Purposes of Research Literature Reviews 2. Qualitative researchers have varying opinions about reviewing the literature before undertaking a new study. Researchers often collect their data before doing a thorough literature review in which qualitative research tradition?

A) Phenomenology B) Grounded theory C) Ethnography D) Naturalism Ans: B

Feedback: Grounded theory researchers often collect their data and develop their grounded theory before thoroughly reviewing the literature. Phenomenologists usually undertake a search for relevant materials about the phenomenon of interest at the outset of a study. Ethnographers often review the literature relating to the cultural problem being studied before going out into the field. Naturalism is not a qualitative research tradition—it is an alternative name for constructivism, the paradigm associated with qualitative research.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 01 Page and Header: 91, Types of Information to Seek for a Research Review 3. What is the most important type of information to include in a literature review?

A) Clinical anecdotes B) Opinions from experts C) Case reports from relevant clinical settings D) Findings from prior studies Ans: D Feedback: Findings from prior studies are the most important type of information for a research review. Anecdotes, opinions, and case reports seldom play a role in a research literature review.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 01, 05 Page and Header: 91, Types of Information to Seek for a Research Review 4. For a research literature review, what is a primary source?

A) A description of a study written by the researchers who did the study B) A summary of a study written by someone other than the researchers who conducted it

C) Any reference focused primarily on the topic of interest D) Sources such as case reports, editorials, or anecdotes Ans: A Feedback: A primary source is the original description of a study prepared by the researchers who conducted it. A secondary source is a description of the study by others—for example, in a literature review. Some references that focus on the topic of interest are not primary research sources—for example, case reports and anecdotes are not research-based and would not be considered primary sources for a literature review.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 01, 05 Page and Header: 91, Types of Information to Seek for a Research Review 5. What is a secondary source for a research literature review?

A) A description of a study written by researchers who did the study B) A summary of a study written by someone other than the researchers who conducted it C) Any reference focused on the topic of interest D) Sources such as case reports, editorials, or anecdotes Ans: B Feedback: A secondary source for a research literature review is a description of the study by an individual unconnected with it. For example, a summary of a study in a literature review would be a secondary source. A primary source is the original description of a study prepared by the researcher who conducted it. A source focused on the topic of interest may be considered neither a secondary nor a primary source if the source is not a research report (e.g., an anecdote or case report).

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning

Objective: 01 Page and Header: 91, Types of Information to Seek for a Research Review 6. Which of the following would be a primary source for a research literature review?

A) A meta-analysis appearing in the Journal of Advanced Nursing B) A metasynthesis published in the journal Qualitative Health Research C) An experimental study published in the journal Research in Nursing & Health D) A systematic review published in the journal Nursing Research Ans: C Feedback: A primary source is the original description of a study prepared by the researcher who conducted it, such as an experimental study described in an article in the journal Research in Nursing & Health. A secondary source is a description of aspects of a study prepared by another person. A meta-analysis appearing in the Journal of Advanced Nursing, a metasynthesis published in Qualitative Health Research, and a systematic review published in the journal Nursing Research are examples of secondary sources.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 91, Major Steps and Strategies in Doing a Literature Review 7. Which statement about conducting a high-quality research literature review is true?

A) A good literature review is based primarily on secondary sources.

B) Nonresearch references such as case reports can play a vital role in a research literature review.

C) Reviewers should ensure that their reviews include recently published studies.

D) Doing a research literature review is a linear process, without feedback loops.

Ans: C Feedback: New research evidence is published daily, so it is imperative that reviewers include very recently published studies in their review to ensure that it will be up-to-date.

Good literature reviews are based mainly on primary, not secondary, sources.

Nonresearch references are seldom relevant in a research review, and the review process typically involves many feedback loops.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 91, Major Steps and Strategies in Doing a Literature Review 8. In which way is doing a research literature review similar to doing a qualitative study?

A) Both reviewers and qualitative researchers rely on a mix of primary and secondary sources.

B) Both reviewers and qualitative researchers depend on a relatively small sample of sources.

C) Both reviewers and qualitative researchers begin with a preestablished plan and stick to it throughout the process.

D) Both reviewers and qualitative researchers have a flexible, creative approach to collecting information.

Ans: D Feedback: Both reviewers and qualitative researchers pursue leads in a flexible and creative manner as they consider new opportunities for further information, without being constrained by a preestablished plan. Research reviews may involve a large “sample” of sources for topics that have been extensively researched. Qualitative researchers rely on “primary sources” in the sense that they gather data directly from people with relevant experiences.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 91, Major Steps and Strategies in Doing a Literature Review 9. What is the first step in conducting a literature review?

A) Identifying the question to be addressed

B) Selecting the bibliographic database to use C) Specifying the keywords to use in the search D) Extracting information from sources Ans: A Feedback: Conducting a literature review is a little bit like doing a full-fledged study: A reviewer must start with a question, such as a well-worded clinical question for EBP (Chapter 1) or a question for a new study (Chapter 5). Selecting a bibliographic database, specifying the keywords, and extracting information from relevant studies are later steps in the literature review process.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 91, Major Steps and Strategies in Doing a Literature Review 10. Which is an important characteristic of a high-quality literature review?

A) The references are restricted to those published in nursing journals.

B) The references are restricted to those published after 2010.

C) There is an emphasis on interpretation and opinions.

D) The review is reproducible, with clear decision rules.

Ans: D Feedback: Research literature reviews should be systematic, with explicit guidelines about which studies to include; in this fashion, another diligent reviewer would be able to apply the same decision rules and come to similar conclusions about the state of evidence on the topic. High-quality reviews should include both very recent studies as well as older ones, and they can (depending on the topic) rely on studies in disciplines other than nursing. Literature reviews usually do not include opinions, because opinions do not constitute evidence.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process

Objective: 01, 05 Page and Header: 92, Developing a Search Strategy 11. Several strategies for finding studies on a research question have been developed. What is the ancestry approach?

A) Searching for articles that summarize prior research in a bibliographic database B) Reading abstracts to determine whether the article is pertinent to the topic C) Tracking down studies cited in the reference list of a relevant research report D) Using a pivotal study to search forward to subsequent studies that cited it Ans: C Feedback: The ancestry approach (also called “footnote chasing”) involves using citations from relevant studies to track down earlier research on which the studies are based (the “ancestors”). Other strategies for finding studies include the use of bibliographic databases and using a pivotal study to “search forward.” Reading abstracts, although necessary in conducting a literature review, is not a search strategy.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 01, 05 Page and Header: 92, Developing a Search Strategy 12. One of several strategies for locating completed studies on a research question is called the descendancy approach. What does this approach entail?

A) Searching for articles that summarize prior research in a bibliographic database B) Reading abstracts to determine whether the article is pertinent to the topic C) Tracking down earlier studies cited in the reference list of a relevant research report D) Using a pivotal study to search forward to subsequent studies that cited it Ans: D Feedback: The descendancy approach involves identifying a key early study and then using citation indexes to locate later studies that cite the original study. Other strategies for finding studies include the use of bibliographic databases and tracking down earlier studies cited in a reference list of a report (“footnote chasing”). Reading abstracts, although necessary in conducting a literature review, is not a search strategy.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 92, Searching Bibliographic Databases 13. In conducting a subject search in an electronic database, the researcher would most likely initiate the search by typing which of the following into the data field?

A) An author’s name B) The research question C) A keyword D) An ancestor or descendant Ans: C Feedback: Most searches involve undertaking a subject search, most often by inserting a keyword into the search field. You could conduct a search by entering an author’s name, but this would not be a subject search. Searchers do not enter an entire research question but rather the keywords than embody key elements of the question, such as key research variables or the population. An “ancestor” or “descendant” is a previously conducted study; neither is used as entries in the search field for a bibliographic subject search.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 05 Page and Header: 93, Getting Started With an Electronic Search 14. In electronic literature searches, bibliographic software usually has the capability of locating relevant references when the researcher does not know the precise subject codes used in the database. This software feature is called: A) searching.

B) mapping.

C) expanding.

D) delimiting.

Ans: B

Feedback: Mapping is a “translation” feature that allows people to search for topics using their own keywords rather than needing to use a term that is exactly the same as a subject code in the database. Searching is a generic activity. Expanding a search involves placing fewer restrictions on a search, and delimiting can be used to restrict a search for certain features; these features are not a capability relating to translating keywords to subject codes.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 02 Page and Header: 92–93, Getting Started with an Electronic Search 15. What of the following would be a reasonable keyword for the question “Among patients with cancer, are men or women more likely to comply with dietary guidance?”?

A) Male B) Female C) Masculinity D) Gender Ans: D Feedback: In the research question, the independent variable is gender—that is, the question is whether gender is an influence on patients’ compliance with dietary guidance.

“Male” and “female” are not variables—they are two possible categories for the variable gender. “Masculinity” is not a factor that was under study in this example.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 02 Page and Header: 93, Getting Started with an Electronic Search 16. Which Boolean operator delimits a search in a bibliographic database?

A) BUT B) AND C) OR D) IF Ans: B Feedback: The Boolean operator AND delimits a search—both terms on either side of the “AND” must be present in the search fields of articles that are retrieved. Another Boolean operator is OR. BUT and IF are not Boolean operators.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 02 Page and Header: 93, Getting Started with an Electronic Search 17.Which Boolean operator expands a search in a bibliographic database?

A) OR B) AND C) IF D) NOT Ans: A Feedback: The Boolean operator OR expands a search—either of the terms on the two sides of the “OR” must be present in the search fields of articles that are retrieved. Two other Boolean operators are AND and NOT. IF is not a Boolean operator.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 02 Page and Header: 93, Getting Started with an Electronic Search 18. If a person entered “foli*” into the search field for an electronic bibliographic search, what would happen?

A) There would be an error message.

B) The search would retrieve all citations that have “folic” in the text fields of records.

C) The search would retrieve only citations having an author whose last name was Foli.

D) The search would turn on the mapping capabilities of the database software.

Ans: B Feedback: In electronic searches, the truncation symbol—in most cases an asterisk—expands a search term to include all forms of a root. In this example, the root is “foli,” and so the search would retrieve all records with such words as folic, foliate, folio, and folinic in text fields. The search would also retrieve papers written by authors with the name “Foli,” but such papers would not be the only records identified. The use of an asterisk would not result in an error message, but its use turns off mapping capabilities in some databases.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 93, Getting Started with an Electronic Search 19. With regard to a search for quantitative studies on a research question in a bibliographic database, which statement is most accurate?

A) The best place to begin a search is to use a search engine such as Yahoo or Bing.

B) The primary keyword to start the search typically would be the population of interest.

C) The primary keywords to start the search typically would be the independent and dependent variables.

D) Subject searches and textword searches yield the same results.

Ans: C Feedback:

For quantitative studies, the most productive keywords are usually the independent or dependent variables (i.e., the “I,” “C,” and “O” of the PICO components).

Searching for a specific population might limit the records retrieved too narrowly or expand it too broadly. Internet search engines such as Yahoo and Bing are not the best places to search for primary research evidence. Subject searches involve searches for citations that are specifically coded in a certain manner, and textword searches retrieve records with the designated words in their fields of text (e.g., in the abstract).

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 93, Getting Started with an Electronic Search 20. Which statement is true?

A) A search for brain tumor and “brain tumor” in a bibliographic database would likely yield different results.

B) A search for brain tumor would yield the same results in any bibliographic database.

C) A search for brain OR tumor would yield fewer results than brain AND tumor.

D) A search for brain tumor, because there are two words, would turn off the mapping feature in most databases.

Ans: A Feedback: Placing quotation marks around a phrase restricts the search to records where the words in quotes are used together, so the use of quotes would result in fewer (but perhaps more relevant) records. The use of the Boolean operator “OR” expands a search, whereas “AND” restricts a search. The use of a phrase, rather than a single word, does not turn off mapping capabilities.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02 Page and Header: 94, The CINAHL Database

21. The electronic database that focuses on the nursing and allied health literature is: A) CINAHL. B) EMBASE. C) Web of Knowledge.

D) MEDLINE. Ans: A Feedback: The CINAHL (Cumulative Index to Nursing and Allied Health Literature) database specifically focuses on literature of relevance to nurses and those in allied health professions. Other useful bibliographic databases include MEDLINE, Web of Knowledge, and EMBASE (the Excerpta Medica database), but these are all useful to broad audiences of health care professionals.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 94, The CINAHL Database 22. In the following CINAHL citation, to what does the “6” refer? “Nursing Research, Nov/Dec 2021; 70 (6): 406-411.”

A) The journal volume B) A journal issue in a given year C) The month of issue D) A page number Ans: B Feedback: The citation is for a journal article published in the sixth issue (6) of the 70th volume of the journal Nursing Research. The article was published in November/December of the year 2021. The page numbers range from 406 to 411.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning

Objective: 02 Page and Header: 94, The CINAHL Database 23. Which statement is true?

A) The CINAHL database includes only journal articles.

B) The CINAHL database includes about 26 million records.

C) The CINAHL database uses the controlled vocabulary called MeSH to index entries.

D) Subject headings in CINAHL include substantive topics and methodologic topics.

Ans: D Feedback: CINAHL covers references to hundreds of nursing and allied health journals as well as to books, book chapters, and dissertations. Records in the database are coded for both substantive topics (e.g., dementia) and methodologic topics (e.g., experimental studies). CINAHL contains more than 6 million records but not 26 million. It is MEDLINE, not CINAHL, that uses the controlled vocabulary called MeSH to index entries.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 95, The MEDLINE Database 24. Which statement is true?

A) The MEDLINE database can only be accessed through a subscription with a commercial vendor.

B) PubMed provides access to MEDLINE free of charge to Internet users.

C) PubMed does not allow users to find “Similar articles” for a previously identified record in MEDLINE. D) MEDLINE entries are translated into more than 20 languages.

Ans: B Feedback: MEDLINE can be accessed for free on the Internet through the PubMed website and does not require a paid subscription. After you have found a study that is a good exemplar of what you are looking for in MEDLINE, you can identify “similar articles” in the database in a panel of the screen for each record. The database has some entries in non-English journals, but English-language entries are not translated.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 02, 05 Page and Header: 95, The MEDLINE Database 25. Which does the MEDLINE database use to provide a consistent way to retrieve information for which authors might have used different terms?

A) Textwords B) MeSH C) Boolean operators D) Scopus reviews Ans: B Feedback: MeSH (Medical Subject Headings) is the controlled vocabulary used in MEDLINE; it provides a means of retrieving records that may use different terminology for the same concepts. A textword search looks for keywords in the text fields of the records (e.g., in the title and abstract). Boolean operators (such as “AND” and “OR”) can be used to expand or restrict a search and is not unique to MEDLINE. Scopus is an alternative bibliographic database.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 96, Google Scholar 26. Which of the following statements is true about Google Scholar (GS)?

A) GS is accessed by paying an annual subscription fee.

B) GS is unlike other bibliographic databases in that Boolean operators cannot be used.

C) The GS database includes articles in journals in all disciplines as well as books and technical reports.

D) GS is the most widely respected bibliographic search engine for health research.

Ans: C

Feedback: The Google Scholar database includes articles published in professional journals in a wide range of disciplines (not just health-related) as well as books and technical reports. Similar to MEDLINE and CINAHL, GS permits the use of Boolean operators.

It is available free of charge over the Internet. Although GS has been gaining in popularity in the field of medicine, GS remains somewhat controversial in academic circles.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Easy Integrated Process: Nursing Process Objective: 03, 05 Page and Header: 97, Screening and Gathering References 27. Which of the following statements about open-access journal articles is true?

A) They can be downloaded for free over the Internet.

B) They are available for free to users from institutions that have paid a subscription fee.

C) They can be retrieved only by using the resource called Research Gate.

D) They are called “open” because they have not been peer-reviewed.

Ans: A Feedback: Open-access journal articles can be downloaded free of charge by anyone with an Internet connection. Open-access journals do not involve a subscription fee.

Research Gate is a resource for retrieving an article (often by communicating with researchers/authors to request a copy), but open-access articles do not require using Research Gate. Open-access articles are usually peer-reviewed.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 97, Screening and Gathering References 28. The researcher has identified 66 potential references for a literature review through electronic database searches and a descendancy search. What would most likely be the next step?

A) Coding the characteristics of each study B) Entering information onto a literature review protocol C) Reading each article in detail D) Reviewing the abstracts for relevance Ans: D Feedback: After the initial identification of potential references, the researcher would need to screen the articles to make sure they are truly relevant to the research question.

Reading all articles in their entirety would allow the researcher to evaluate relevance but reviewing the abstracts first would be more efficient. Researchers sometimes enter information from each reference onto a protocol or code the attributes of the relevant studies, but these would be later steps, completed after the references are screened for relevance.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 97, Documentation in Literature Retrieval 29. What is the primary purpose of documenting steps in the literature retrieval process?

A) To ensure approval by the Institutional Review Board (IRB) B) To minimize the risk of duplication of effort C) To provide a list of useful search words D) To simplify the preparation of the reference list Ans: B Feedback: Documentation helps reviewers to conduct a more efficient search by preventing unintended duplication and also helps them to assess what other search strategies need to be tried. Although documentation does provide a list of useful search words and may ultimately simplify the preparation of the reference list, neither of these is the primary purpose. Documentation is unrelated to approvals by an Institutional Review Board (IRB), who would seldom be concerned with the literature review aspects of a study.

Format: Multiple Choice Chapter: 6

Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 98, Appraising Studies for a Review 30. In evaluating primary studies for a literature review, what is the key question that a reviewer needs to consider?

A) Was the research question in the study appropriate?

B) Did the authors include an adequate literature review in their research report?

C) Did the authors cite appropriately from the previously published literature related to the problem under study?

D) To what extent are the study findings based on sound research methods and thus reflect the true state of affairs?

Ans: D Feedback: In literature reviews, an assessment of each study must be made with an eye to answering a broad question: To what extent do the findings reflect the truth (the true state of affairs)—that is, do flaws in the methods used undermine the believability of the evidence? A reviewer would not critique the appropriateness of the research question and would not focus primarily on the quality of the references or the literature review in each article under review because flaws are unlikely to have a bearing on the quality of the study’s evidence.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 98, Analyzing and Synthesizing Evidence 31. In analyzing evidence from the primary studies in the review, reviewers often look for distinctive patterns and themes. Which of the following is not a type of theme that a reviewer might explore?

A) Substantive B) Ethical C) Methodologic D) Generalizability/transferability Ans: B

Feedback: Reviewers would not look for ethical themes in the primary studies—unless the focus of the research was on research ethics, which would then make ethics a substantive issue. Substantive themes—the pattern of evidence for the research question under review—are the most commonly analyzed themes, but reviewers might examine methodologic themes (Which methods have been used to address the research question?) and generalizability/transferability themes (To which populations does the evidence apply?)

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 99, Content of the Written Literature Review 32. Which of the following statements about a written literature review is not true?

A) In a written review, it is useful to include a lot of direct quotes from the primary studies in the review.

B) In a review, studies with similar findings can often be summarized together (e.g., “Several studies have found . . . .”).

C) Literature reviews in the introduction of a research report usually conclude with a summary of why existing evidence supports the need for a new study.

D) Inconsistencies in the research evidence should be reported in the review and analyzed objectively.

Ans: A Feedback: The research evidence should be summarized in the reviewer’s own words rather than stringing together quotes from the primary studies. It is true that similar findings in several primary studies can often be summarized together. If the review is written as part of the introduction for an article reporting a new study, the review should conclude with a summary of how the evidence demonstrates the need for the new research. In an unbiased review, inconsistencies are reportedly candidly and analyzed objectively.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate

Integrated Process: Nursing Process Objective: 04 Page and Header: 99, Style of a Research Review 33. Which sentence is appropriately worded for a research review?

A) Five recent studies have proved that men are less well able to cope with the loss of a spouse than women.

B) The HIV epidemic has been the cause of considerable anxiety in the gay community.

C) Research has consistently found that infants’ sleeping position is related to the risk of sudden infant death syndrome.

D) Nurses and physicians struggle with the decision about whether to work in environments where abortion services are offered.

Ans: C Feedback: Written research reviews should provide an objective, organized synthesis of current research findings (evidence) on a research question and should use language that suggests the absence of bias (e.g., “studies have found . . . ”). The sentence “The HIV epidemic has been the cause of considerable anxiety in the gay community” does not summarize evidence, nor does the sentence “Nurses and physicians struggle with the decision about whether to work in environments where abortion services are offered.” Studies cannot prove that men have more difficulty coping with widowhood than women.

Format: Multiple Choice Chapter: 6 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 99, Style of a Research Review 34. Which sentence would be least acceptable in a research literature review?

A) All of these studies suggest that patients’ health behaviors can be modified through nurse-led interventions.

B) Results from several studies are consistent with the conclusion that interruptions are a major cause of medication errors.

C) Several studies have found that a diagnosis of idiopathic pulmonary fibrosis is associated with increased depressive symptoms.

D) The findings from many studies demonstrate that daytime sleepiness lowers a person’s quality of life.

Ans: D Feedback: Findings from previous studies—no matter how many of them there are—cannot “demonstrate” or “prove” that relationships exist. Moreover, this sentence about the effect of daytime sleepiness on quality of life uses language suggesting a causeand-effect relationship, which would be difficult to verify. The other sentences use appropriate tentative language.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01, 05 Page and Header: 105, Theories 1. An abstract generalization that explains how phenomena are interrelated is a: A) traditional theory.

B) descriptive theory.

C) grounded theory.

D) conceptual model.

Ans: A Feedback: As classically defined, a theory is an abstract generalization that explains how phenomena are interrelated. Descriptive theory thoroughly describes a phenomenon and does not involve interrelationships. Conceptual models involve loose organization among abstractions, but they do not involve a structured system of propositions that explain relationships among phenomena. A grounded theory, which is developed in the qualitative grounded theory tradition, does not explain interrelationships among phenomena.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 105, Theories 2. The power of traditional theories lies in their ability to: A) provide guidance on how to test hypotheses statistically.

B) minimize the number of words required to explain phenomena, eliminating semantic problems.

C) prove that relationships exist among the phenomena studied.

D) articulate and explain the nature of relationships among phenomena.

Ans: D Feedback:

Page 1

A theory is an abstract generalization that purports to systematically explain relationships among phenomena, but a theory does not offer proof of these relationships. Theories are elaborated with words, but some theories can be summarized graphically in a schematic model. Theories do not provide guidance for testing hypotheses deduced from theory—researchers’ ingenuity must be used to deduce hypotheses and to develop research methods and analytic approaches for testing hypotheses.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 01 Page and Header: 105, Theories 3. What are the basic building blocks of a theory?

A) Propositions B) Relationships C) Concepts D) Hypotheses Ans: C Feedback: The basic building blocks of a theory are concepts, which are abstractions inferred from observations about phenomena. Propositions, relationships, and hypotheses play a role in theories, but they are not the basic building blocks.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01, 05 Page and Header: 105, Theories 4. Descriptive theory plays an important role in which type of studies?

A) Intervention studies B) Experimental studies C) Qualitative studies D) Inductive studies

Ans: C Feedback: Descriptive theory plays an important role in qualitative research: Qualitative researchers often strive to develop rich descriptive conceptualizations of phenomena, grounded in actual observations. Descriptive theory does not play a role in intervention studies or experimental studies. There is no such thing as an “inductive study,” although induction plays a role in qualitative studies.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01 Page and Header: 105, Theories 5. Traditional theories provide a mechanism for generating: A) hypotheses, through induction.

B) hypotheses, through deduction.

C) a descriptive theory.

D) a conceptual model.

Ans: B Feedback: Classical theories comprise a set of propositions that indicate relationships among the concepts, and the propositions form a logically interrelated system from which hypotheses can be deduced. Classical theories do not provide a basis for developing descriptive theories or for developing a conceptual model.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01, 02 Page and Header: 105, Theories 6. What is an example of a theory that has been described as a grand theory in nursing?

A) Comfort Theory (Kolcaba) B) Uncertainty in Illness Theory (Mishel) C) Health Promotion Model (Pender) D) Humanbecoming Paradigm (Parse) Ans: D Feedback: Grand theories purport to explain large segments of human experience. Many nursing theories have been developed, but most of them would not be considered “grand theories.” For example, Kolcaba’s Comfort Theory, Mishel’s Uncertainty in Illness Theory, and Pender’s Health Promotion Model are considered middle-range theories. A nursing theory that has been described as a grand theory is Parse’s Humanbecoming Paradigm.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01, 05 Page and Header: 105, Theories 7. Theories differ in their level of generality and abstraction. What term is used to designate a theory that attempts to explain specific phenomena, such as stress, adaptation, and unpleasant symptoms?

A) Descriptive theory B) Grand theory C) Middle-range theory D) Reinforcement theory Ans: C Feedback: Middle-range theories attempt to explain specific phenomena. In nursing, there are hundreds of examples of middle-range theories—such as middle-range theories of stress, comfort, health promotion, and unpleasant symptoms. Descriptive theories are not “explanatory” but may be a precursor to an explanatory middle-range theory. Grand theories purport to describe and explain large segments of the human experience. Reinforcement theory is a specific theory, not the generic term to describe a class of theories.

Format: Multiple Choice Chapter: 7

Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 01 Page and Header: 105, Models 8. What is the major similarity between traditional theories and conceptual models?

A) They both use concepts as their building blocks.

B) They both involve a logically interrelated system of propositions.

C) They both can be either descriptive or explanatory.

D) They both can be classified as either grand or middle-range.

Ans: A Feedback: The basic components of both theories and conceptual models are concepts. Only traditional theories involve a logically interrelated system of propositions. Neither traditional theories nor conceptual models are purely descriptive—they involve relationships among phenomena. Conceptual models are not usually classified as grand; conceptual models more closely align with middle-range theories of specific phenomena (e.g., health promotion).

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01, 05 Page and Header: 105, Models 9. The figure below depicts a conceptualization of the risk of falling in hospitalized patients. What would such a figure be called?

Visual acuity

Age

Risk of a fall

Sedation

A) A descriptive theory B) A middle-range theory C) A conceptual framework

Prior falls

D) A conceptual map Ans: D Feedback: A conceptual map is a visual representation that depicts the relationships among concepts, and uses a minimal amount of words, as in this example. An alternative term for such a figure is schematic model, but such figures are not called descriptive theories, middle-rage theories, or conceptual frameworks.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01 Page and Header: 106, Frameworks 10. Which statement is true?

A) All nursing studies are based on a theory or conceptual model.

B) All nursing studies have a framework.

C) Nursing intervention studies do not require a conceptual model or theory.

D) Grand theories are a greater source of inspiration to researchers than middlerange theories.

Ans: B Feedback: All nursing studies have a framework—that is, a conceptual rationale—although the framework is not always made explicit. Not all studies are based on a theory or a conceptual model, but many intervention studies have a strong conceptual or theoretical basis. Middle-range theories are more likely than grand theories to inspire research about a phenomenon of interest.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01 Page and Header: 106, Frameworks 11. Nurse researchers seeking to clarify conceptual definitions for a study may:

A) develop a conceptual map.

B) search for a grand theory.

C) undertake a concept analysis.

D) undertake a deductive analysis.

Ans: C Feedback: A concept analysis can be useful for clarifying conceptual definitions of phenomena under study. Conceptual maps and grand theories would not be used to develop conceptual definitions of key concepts. Deductive analyses might lead to hypotheses to be tested but not to conceptual definitions.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 107, The Nature of Theories and Conceptual Models 12. Which is true of both theories and conceptual models?

A) They are invented or created, not discovered.

B) For nursing studies, they need to be borrowed from other disciplines.

C) They both contain a set of logically interrelated propositions.

D) They both can be proved or disproved through research.

Ans: A Feedback: Theories and conceptual models are invented or created—they are not “out there” awaiting discovery. A theory, but not a conceptual model, consists of concepts and a set of propositions that form a logically interrelated system. Nurses have developed theories and conceptual models and do not rely exclusively on those borrowed from other disciplines. Research cannot “prove” or “disprove” the validity of theories or conceptual models, but findings from research can lend support to them.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning

Objective: 01 Page and Header: 107, The Nature of Theories and Conceptual Models 13. Which statement about theories and research is true?

A) Systematic reviews of research findings are based on theories.

B) The relationship between theory and research is reciprocal.

C) Theories are proved when there is sufficient research evidence confirming them.

D) Theories, once there is sufficient research evidence, are considered fixed and enduring.

Ans: B Feedback: Theory and research have a reciprocal relationship. Theories are built inductively from research findings, and the theory in turn is tested by deducing research hypotheses that are then subjected to research inquiry. Systematic reviews of research are not based on theories. Theories are invented and are never proved.

Because theories cannot be “proved,” they are not fixed or “enduring.” Theories often evolve and are discarded as new research evidence comes to light or, as sometimes happens, there are changes in social or cultural values (e.g., Freudian theory came to be disputed with the rise of feminism).

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02 Page and Header: 107, Conceptual Models of Nursing 14. Several conceptual models and theories of nursing have been developed, and four concepts play key roles in most of them. Which of the following is one of those concepts?

A) Adaptation B) Social support C) Self-efficacy D) Environment Ans: D Feedback: The concepts central to models of nursing are human beings, environment, health, and nursing. Social support, adaptation, and self-efficacy are not concepts that are central to models of nursing.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 108, Conceptual Models of Nursing 15. The nurse theorist Roy developed which nursing model?

A) Uncertainty in Illness Model B) Health Promotion Model C) Adaptation Model D) Comfort Theory Ans: C Feedback: An example of a model of nursing used by nurse researchers is Sister Callista Roy’s Adaptation Model. Other nurses developed the Uncertainty in Illness Model (Mishel), Comfort Theory (Kolcaba), and the Health Promotion Model (Pender).

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 02 Page and Header: 108, Conceptual Models of Nursing 16. Which conceptual model or theory would best serve as the conceptual base for research on the recovery and coping processes of young adults following posttraumatic amputation of a lower extremity?

A) Bandura’s Social Cognitive Theory B) Prochaska’s Transtheoretical Model C) Becker’s Health Belief Model D) Sister Callista Roy’s Adaptation Model Ans: D Feedback:

In Roy’s Adaptation Model, humans are considered adaptive systems that cope with change through adaptation, a process that would be necessary for patients with an amputation of a lower extremity. None of the other models or theories would be particularly relevant for understanding the recovery process of patients with an amputation.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 108, Middle-Range Theories Developed by Nurses 17. The Health Promotion Model would best be described as which type of theory?

A) A descriptive theory B) A grand theory C) A grounded theory D) A middle-range theory Ans: D Feedback: Pender’s Health Promotion Model (HPM) is an example of a widely used middlerange theory (not a grand theory) developed by a nurse; middle-range theories are specific to certain phenomena, such as health-promoting behavior. Descriptive theory thoroughly describes a phenomenon, and the HPM goes beyond description.

Some qualitative researchers seek to develop grounded theories, explanations to account for phenomena that are grounded in actual observations—but the HPM is not a grounded theory.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 108, Middle-Range Theories Developed by Nurses 18. Which middle-range theory developed by a nurse focuses on a person’s inability to understand the meaning of illness-related events?

A) Mishel’s Uncertainty in Illness Theory

B) Beck’s Theory of Postpartum Depression C) Pender’s Health Promotion Model D) Kolcaba’s Comfort Theory Ans: A Feedback: Mishel’s Uncertainty in Illness Theory focuses on uncertainty—the inability of a person to determine the meaning of illness-related events. Uncertainty and interpreting the meaning of illness-related events is not the central construct in the other middle-range theories, such as Beck’s Theory of Postpartum Depression, Pender’s Health Promotion Model, or Kolcaba’s Comfort Theory.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 109, Other Models Used by Nurse Researchers 19. Self-efficacy is a widely used construct that was originally developed within: A) the Transtheoretical Model.

B) the Theory of Planned Behavior.

C) Social Cognitive Theory.

D) the Uncertainty in Illness Theory.

Ans: C Feedback: Bandura’s Social Cognitive Theory, which is sometimes called self-efficacy theory, offers an explanation of human behavior using the concepts of self-efficacy, outcome expectations, and incentives. The other three response options—Mishel’s Uncertainty in Illness Theory, Ajzen’s Theory of Planned Behavior, and Prochaska’s Transtheoretical Model—do not incorporate the concept of self-efficacy into their models/theories.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02

Page and Header: 109, Other Models Used by Nurse Researchers 20. Which construct is a core concept in the Transtheoretical Model?

A) Stress and coping B) Stages of change C) Outcome expectations D) Health beliefs Ans: B Feedback: Prochaska and colleagues’ Transtheoretical Model has “stages of change” as its core construct, around which other dimensions are organized. The Transtheoretical Model does not focus on stress and coping, outcome expectations, or health beliefs—these are core constructs in other theories or models that nurse researchers have used.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 02 Page and Header: 109, Other Models Used by Nurse Researchers 21. Which of the following is a key construct in several health-related models and theories and is often conceptualized as an important mediating variable in behavior change interventions?

A) Health beliefs B) Motivational readiness C) Adaptation D) Self-efficacy Ans: D Feedback: Self-efficacy, a construct in Bandura’s Social Cognitive Theory, has been identified as a key mediating variable in several theories, such as Pender’s Health Promotion Model. Self-efficacy enhancement is often an intermediate goal in interventions designed to change people’s health-related behaviors. Health beliefs, adaptation, and motivational readiness are constructs in health-relevant models and theories but have not been found as broadly useful as self-efficacy.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 109, Other Models Used by Nurse Researchers 22. Which is an example of a theory used by, but not developed by, nurse researchers?

A) Bandura’s Social Cognitive Theory B) Pender’s Health Promotion Model C) Mishel’s Uncertainty in Illness Theory D) Beck’s Theory of Postpartum Depression Ans: A Feedback: Bandura’s Social Cognitive Theory is one of the several nonnursing models or theories frequently used in nursing studies—and is sometimes called a “shared” theory. All of the other choices are theories or models developed by nurses.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 109, Other Models Used by Nurse Researchers 23. A nurse researcher studied adults’ intentions to donate blood as well as their actual donation behavior. Which theory or model did the nurse researcher likely use?

A) The Health Belief Model B) The Transtheoretical Model C) The Theory of Planned Behavior D) Social Cognitive Theory Ans: C Feedback:

According to the Theory of Planned Behavior, behavior that is volitional is determined by a person’s intention to perform that behavior, and intentions are affected by other factors (e.g., perceived social pressure). None of the other choices are theories or models that focus on people's intentions.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 109, Other Models Used by Nurse Researchers 24. A nurse researcher studied how a woman’s practice of breast self-examination is affected by her perception of the risk of breast cancer. Which theory or model did the nurse researcher likely use?

A) The Health Belief Model B) The Transtheoretical Model C) The Theory of Planned Behavior D) Social Cognitive Theory Ans: A Feedback: Becker’s Health Belief Model (HBM) is a framework for explaining health behaviors, such as breast self-examination, and a key construct in the HBM is people’s perception of a health risk. None of the other choices are theories or models that focus on people’s perceptions of a health risk.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 109, Other Models Used by Nurse Researchers 25. Which is not one of the stages of change in Prochaska’s Transtheoretical Model?

A) Precontemplation B) Transition C) Action D) Contemplation

Ans: B Feedback: The Transtheoretical Model postulates five stages of change: precontemplation, contemplation, preparation, action, and maintenance. Transition is not a stage of change in this model.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 110, Theories and Qualitative Research 26. Which is a prominent theoretical underpinning of grounded theory?

A) Substantive theory B) Ideational theory C) Materialistic theory D) Symbolic interactionism Ans: D Feedback: The most prominent theoretical system in grounded theory is symbolic interaction (or interactionism), which concerns how meaning arises in the context of human interactions. Grounded theory research may develop substantive theories (about specific phenomena), but they are not the broad theoretical underpinning of grounded theory studies. Ideational theory and materialistic theory are relevant in ethnography, not in grounded theory.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 110, Theories and Qualitative Research 27. Which of the following is a type of cultural theory that can help to shape an ethnographic inquiry?

A) Grand theories B) Materialistic theories C) Substantive theories D) Grounded theories Ans: B Feedback: Ethnographers adopt one of two cultural theories: ideational theories, which suggest that cultural conditions and adaptation stem from mental activity and ideas, or materialistic theories, which view material conditions as the source of cultural development. Substantive theory is a conceptualization of a specific phenomenon under study and does not help to shape ethnographic research.

Grounded theory is a qualitative research tradition and is not related to ethnographic theories. “Grand theory” is a theory that purports to explain large segments of human experience and is not an ethnographic term.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 110, Theories and Quantitative Research 28. Which of the following statements about using theory in quantitative studies is true?

A) Theory testing relies on inductive processes.

B) Intervention studies do not involve testing hypotheses deduced from a theory.

C) Fitting a research question to a theory after the fact is often a productive approach.

D) Theories are often not tested directly in a study but rather are used as an organizing structure.

Ans: D Feedback: Many researchers use theories and models as an organizational or interpretive tool rather than testing the theory directly. Intervention studies are increasingly theorybased. Testing a theory involves a deductive process, not an inductive one— hypotheses that can be tested with research data are deduced from the theoretical propositions. It is rarely productive to attempt to create an after-the-fact linkage between a research question and a theory or model.

Format: Multiple Choice Chapter: 7 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 04 Page and Header: 112, Critical Appraisal of Frameworks in Research Reports 29. Which of the following statements about appraising frameworks in research reports is not true?

A) In a critical appraisal of quantitative studies, one question to ask is whether stated hypotheses truly flow from the theory that was specified.

B) Quantitative studies that do not mention a theoretical framework are inherently flawed and cannot yield useful evidence.

C) Some researchers present a theoretical rationale in their reports that seems contrived.

D) In grounded theory studies, one question to ask concerns whether the raw data (e.g., excerpts from interviews) provides convincing evidence of the grounded theory.

Ans: B Feedback: Although many studies benefit from an explicit theoretical or conceptual framework, some research questions are so pragmatic that the absence of an explicit framework would not be considered a flaw. Ideally, hypotheses would flow from the theory or model that was stated as the inspiration, and it is important to examine whether this is true in critically appraising a study. Another important question in grounded theory studies is whether sufficient supporting evidence in support of the grounded theory has been provided. It is true that sometimes the connection between a theoy rand the research question seems contrived and artificial.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 118–119, Key Research Design Features 1. The research design for a quantitative study involves decisions concerning all of the following except: A) which conceptual framework to use.

B) whether there will be an intervention.

C) what types of comparisons will be made.

D) how many times data will be collected.

Ans: A Feedback: The research design is the overall plan for answering research questions. In quantitative studies, the design incorporates decisions about whether there will be an intervention, what type of comparisons will be made, and how many times data will be collected. The selection of a conceptual framework is not a design-related decision.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01, 08 Page and Header: 118, Key Research Design Features 2. A nurse researcher tested whether sucrose (vs. sterile water) had a beneficial effect on infant pain during immunizations. Neither those administering the intervention nor the parents of the infants knew which infants received the sucrose.

This strategy is an example of: A) randomization.

B) attrition.

C) crossing over.

D) blinding.

Ans: D

Feedback: Blinding involves concealing information from participants (here, the parents) and research staff (those administering the sucrose or sterile water) to enhance objectivity and minimize the risk of bias. Randomization is a strategy designed to control confounding variables, as is the use of a crossover design. There is no indication that these strategies were used in this example. Attrition refers to the loss of participants and is not a research strategy.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 118, Key Research Design Features 3. When researchers withhold information from the people collecting research data (e.g., information about who received an intervention and who did not), the researchers are taking steps to minimize which type of bias?

A) Selection bias B) Attrition bias C) Expectation bias D) History bias Ans: C Feedback: Blinding (masking) involves concealing information from participants and staff to minimize the risk of biases stemming from people’s expectations about the study outcomes. Research staff’s expectations can result in changes in what they see, what they hear, and what they say to participants. Selection bias (or selection threat) refers to preexisting differences between groups being compared. Attrition bias results from the differential loss of participants from study groups. A history bias occurs when an external event co-occurs with an intervention and obscures the intervention’s effect.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01, 08 Page and Header: 118, Key Research Design Features

4. When researchers decide what to use as a counterfactual, they are making a decision about: A) the type of comparison that will be made.

B) where the study will take place.

C) how confounding variables will be controlled.

D) when and how often the data will be collected.

Ans: A Feedback: A counterfactual is what would happen if people are simultaneously exposed and not exposed to an intervention. When evaluating an intervention, researchers must select a comparison strategy to represent the “not exposed” situation. Other design decisions concern where to conduct the study, how confounders will be controlled, and how often data will be collected, but these are unrelated to designing a suitable counterfactual.

Format: Multiple Choice Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01 Page and Header: 118, Key Research Design Features 5. Which of the following is a question that researchers should ask when deciding how to control confounding variables?

A) From whom should information about the design be withheld?

B) When will the research data be collected?

C) What factors, other than the independent variable, could affect the outcome?

D) Where and how often will data collection occur?

Ans: C Feedback: When developing a plan to control confounding variables, researchers often need to answer the question “What other variables could influence the outcomes?” The other options, which all relate to important design decisions, are not relevant to the issue of controlling confounding variables.

Format: Multiple Choice Chapter: 8

Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 119, Causality 6. Which of the following is an important criterion for making a causal inference about the relationship between two variables?

A) The absence of ambiguity about how outcomes will be measured B) The absence of ambiguity about which variable occurred first C) The ability to randomly assign study participants to groups D) The ability to blind study participants and research staff Ans: B Feedback: A key criterion for establishing causality is ensuring that the cause (the independent variable) preceded the effect (the outcome). A causal inference does not depend on blinding or on how outcomes will be measured. Randomization is a strategy for facilitating causal inference, but it is not a criterion for the inference.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 119, Causality 7. The causes of health-related phenomena (e.g., obesity) are usually: A) probabilistic.

B) deterministic.

C) prognostic.

D) counterfactual.

Ans: A Feedback: Causes of health-related phenomena usually are not deterministic but rather are probabilistic—that is, a cause increases the probability that an effect will occur rather than determining that it absolutely will occur. Causes are not “prognostic” (predictive) or “counterfactual.”

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02 Page and Header: 119, Causality 8. An important function of research design strategies in a quantitative study is to exert control over: A) outcome variables.

B) mediating variables.

C) carryover variables.

D) confounding variables.

Ans: D Feedback: Confounding variables can obscure the relationship between the independent and dependent variables; they need to be controlled to enhance causal inferences.

Outcome variables and mediating variables are variables in which researchers are interested and do not need to be controlled. There is no such thing as a “carryover variable.”

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 08 Page and Header: 119, Causality 9. A hypothetical condition embodying what would have happened to people if they were simultaneously exposed and not exposed to a causal factor is: A) a cause.

B) an effect.

C) a confounder.

D) a counterfactual.

Ans: D Feedback:

In a research context, a counterfactual is what would have happened to the same people exposed and not exposed simultaneously to a causal factor. A counterfactual can never be realized, but it is a good model to keep in mind in designing a study to address cause-probing questions. An effect is the difference between what actually did happen with the exposure (the cause) and what would have happened without it. A confounder is a variable or influence that is extraneous to the research question and that needs to be controlled.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02 Page and Header: 119, Causality 10. There are three well-established criteria for inferring a causal relationship, attributed to John Stuart Mill. Which is one of those criteria?

A) A cause and effect must occur simultaneously.

B) A counterfactual must be known and controlled for in the research design.

C) The relationship between the cause and the effect cannot be explained as being caused by a third factor.

D) The relationship between the cause and the effect must be deterministic.

Ans: C Feedback: One of the criteria for a causal relationship is that the effect cannot be caused by a third variable, i.e., a confounder. Confounding variables must be controlled and ruled out. A cause must precede the effect (not occur simultaneously).

Counterfactuals are not controlled, confounders are. Causes are almost always probabilistic, not deterministic (i.e., they increase the likelihood that the effect will occur).

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02 Page and Header: 120, Research Questions and Research Design 11. For which broad category of research questions is causality not an issue?

A) Therapy B) Meaning C) Prognosis D) Etiology/harm Ans: B Feedback: Questions about meaning are addressed using qualitative approaches and are not focused on causality. Many research questions, however, are about causes and effects, including Therapy questions, Prognosis questions, and Etiology/harm questions.

Format: Multiple Choice Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 120, Characteristics of True Experiments 12. Which of the following is not a standard feature of a true experimental design?

A) An intervention B) A placebo C) Randomization D) Control Ans: B Feedback: A true experimental design is characterized by having an intervention, control (a control condition), and randomization. Placebos are sometimes used in experimental design, but they are not a standard feature.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 03 Page and Header: 120–121, Characteristics of True Experiments

13. In a true experimental design, what does the researcher manipulate?

A) The independent variable B) The dependent variable C) The confounding variable D) The mediating variable Ans: A Feedback: Experimenters manipulate the independent variable by administering an intervention to some participants and withholding it from others. Experimenters deliberately vary the independent variable (the presumed cause) and observe the effect on the outcome. They do not manipulate dependent, confounding, or mediating variables.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03, 08 Page and Header: 120–121, Characteristics of True Experiments 14. The use of randomization for assigning participants to conditions eliminates: A) systematic bias.

B) ethical problems.

C) the need for a control group.

D) the need for manipulation.

Ans: A Feedback: Random assignment is done using methods that give every participant an equal chance of being in any group, such as by flipping a coin. In this fashion, the risk of systematic bias is eliminated. Randomization is the most reliable method for equating groups on all characteristics that could affect study outcomes—that is, for approximating the ideal but impossible counterfactual. Randomization does not eliminate ethical problems, the need for a control group, or the need to manipulate the independent variable.

Format: Multiple Choice Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 120, Experimental Design: Randomized Controlled Trials 15. Which statement is true?

A) Random assignment is accomplished with random sampling.

B) Grouping participants with similar features together is the best way to achieve random assignment.

C) The assignment of participants to different conditions at random is a signature of a true experiment.

D) Recruiting participants from different neighborhoods results in random assignment.

Ans: C Feedback: A true experiment requires randomly assigning participants to different groups or conditions; randomization is a signature of a true experimental design. Random sampling is a method of selecting people for a study and is not used to accomplish randomization to groups. Grouping participants with similar features and recruiting participants from different neighborhoods are not random methods; they are flawed methods for achieving comparable groups.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 03 Page and Header: 121, Experimental Designs 16. A pretest in a pretest–posttest design corresponds to: A) an outcome measure.

B) a baseline measure.

C) a measure of attitudes toward the intervention.

D) a measure of the independent variable.

Ans: B

Feedback: In pretest–posttest designs, data on the dependent variable are collected both before the intervention (a baseline measure) and after it (an outcome measure). In an experimental study, the independent variable typically is not “measured”; it is the variable manipulated by the researcher (e.g., receipt vs. nonreceipt of an intervention). Researchers do not often measure attitudes toward an intervention, and in any event, they would not be measured at the pretest stage of the project.

Format: Multiple Choice Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03, 08 Page and Header: 122, Experimental Designs 17. Which statement is true?

A) A crossover design allows participants to choose the intervention they will receive.

B) A crossover design is useful for eliminating crossover effects.

C) A crossover design is not a true experimental design.

D) A crossover design achieves the highest possible equivalence among participants exposed to different conditions.

Ans: D Feedback: In crossover designs, people are exposed to more than one condition and serve as their own controls—resulting in the highest possible equivalence among those being compared. Crossover designs, which are true experimental designs, do not allow participants to choose interventions they will receive. Crossover designs can be susceptible to carryover effects—that is, being influenced in the second condition by what participants experienced in the first.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 122, Experimental Designs

18. A nurse researcher tested two different head-of-bed elevations for the prevention of ventilator-associated pneumonia. In this 2-day trial, patients were randomly assigned to receive either the 30-degree elevation or the 45-degree elevation on the first day, and the other elevation on the second day. What type of design was used?

A) Crossover B) Pretest–posttest design C) Delay of treatment D) Time series Ans: A Feedback: In this crossover design, all patients received both treatment conditions, in a randomized order. In a delay of treatment design, control group members are offered the intervention after being put on a wait-list, which did not occur in this example. Pretest–posttest designs involve multiple groups of participants randomized to different treatment conditions, which is not the case in this example.

A time-series design is quasi-experimental and does not involve randomization.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 03 Page and Header: 120, Experimental Design: Randomized Controlled Trials 19. Which statement is true about RCTs? A) The control condition in an experiment corresponds to the “I” in PICO-format questions.

B) The control group condition is a proxy for an ideal counterfactual.

C) Control groups never receive the experimental intervention.

D) The most common control group condition in nursing research is a “no treatment” control group.

Ans: B Feedback: In a true experiment or RCT, researchers use the control group as a proxy for an ideal (but physically impossible) counterfactual. The control condition corresponds to the “C” in PICO-format questions, not the “I.” Control groups do sometimes get the experimental intervention, for example, in a wait-list design. A “no treatment”

control group is rare in nursing research because care is seldom withheld altogether—“usual care” is a frequently used counterfactual.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 121, Experimental Designs 20. An RCT could use any of the following designs, except a: A) crossover design.

B) nonequivalent control group design.

C) randomized posttest-only design.

D) randomized pretest–posttest design.

Ans: B Feedback: An RCT (the acronym for a randomized controlled trial) always involves randomization, which is a signature of a true experiment. The only answer option that does not involve randomization is the nonequivalent control group design, which is quasi-experimental.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 122, Experimental and Control Conditions 21. A researcher randomized nursing home residents to a fall prevention intervention or to “usual care.” After outcome data were collected, control group members were offered the chance to receive the intervention. This control group strategy is called: A) a “usual care” control group.

B) an attention control group.

C) a wait-listed control group.

D) an alternative treatment control group.

Ans: C Feedback: It is true that the control group received “usual care” during the study, but the most prominent feature of this delayed treatment (wait-list) design is that people in the control group were able to receive the intervention at a later date. There was no alternative treatment in this example, and there is no indication that control group members got special attention during the intervention.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 122, Experimental and Control Conditions 22. To test the effect of a Hatha yoga intervention on blood pressure, 100 prehypertensive adolescents were randomly assigned to either Hatha yoga classes or to an art class. This control group strategy is called: A) a “usual care” control group.

B) an attention control group.

C) a wait-listed control group.

D) an alternative treatment control group.

Ans: B Feedback: In this example, the art class was offered to students as a way of giving adolescents the same amount of special attention as those in the treatment group, without any of the hypothesized active ingredients of Hatha yoga. The art class was not “care as usual,” and there is no indication that the control group eventually received the yoga intervention. The art class is not especially likely to affect the adolescents’ blood pressure and so is not an alternative treatment.

Format: Multiple Choice Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 123, Advantages and Disadvantages of Experiments

23. Which of the following is a major strength of true experimental designs?

A) They are less artificial than other designs.

B) They are undertaken with a strong theoretical underpinning.

C) They tend to be less costly than other designs.

D) They permit greater confidence in making causal inferences than other designs.

Ans: D Feedback: The great strength of experimental studies lies in the confidence with which causeand-effect relationships can be inferred. Through the controls imposed by manipulation, control, and randomization, alternative explanations for group differences on the outcomes can usually be discredited. Limitations of experimental designs include that they may be more (not less) artificial than other designs, and they are often quite costly. Not all experimental studies are undertaken with a guiding theoretical framework.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 123, Advantages and Disadvantages of Experiments 24. Which statement is true?

A) RCTs are in the middle of most evidence hierarchies for Therapy questions.

B) RCTs are more susceptible to confounding variables than quasi-experiments.

C) Many variables of interest to nurse researchers cannot be experimentally manipulated.

D) RCTs are the most often used design for studying the effect of cigarette smoking on lung cancer.

Ans:C Feedback: A large number of human attributes cannot be randomly assigned to people (e.g., blood pressure, age, fatigue), and so experiments are not always feasible.

Nevertheless, RCTs are near the top of evidence hierarchies for Therapy questions, only one rung down from systematic reviews of RCTs. Quasi-experiments are lower down on evidence hierarchies for Therapy questions because they are more susceptible to confounding influences than RCTs. The link between lung cancer and smoking has never been studied in an RCT because it would be unethical to randomize people to a smoking or nonsmoking group.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 03, 08 Page and Header: 124, Quasi-Experiments 25. Which of the following is invariably a feature of quasi-experimental research?

A) A control group B) An intervention C) Matching D) Randomization Ans: B Feedback: Quasi-experiments (trials without randomization) involve an intervention but lack randomization and, sometimes, lack a control group. Matching of subjects is a method of controlling confounding variables by consciously forming comparable groups; this strategy is used in some, but not all, quasi-experiments.

Format: Multiple Choice Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 124, Quasi-Experiments 26. Which of the following statements is true?

A) A signature of quasi-experiments is that they involve randomization.

B) Quasi-experiments sometimes—but not always—involve an intervention.

C) A hallmark of quasi-experiments is that they involve a comparison group.

D) In a nonequivalent control group design, it cannot be assumed that any groups being compared are equivalent at the outset.

Ans: D Feedback:

One weakness of a nonequivalent control group design is that researchers cannot assume that groups being compared in terms of outcomes at the end of the study are comparable at the outset—there could potentially be many confounding variables. Quasi-experiments never involve randomization, and some do not involve a comparison group, but they do always involve an intervention.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 125, Quasi-Experimental Designs 27. A researcher initiated an innovative cigarette cessation intervention. Seventy participants received the intervention, and their cigarette smoking 3 months later was compared to smoking at baseline. What type of design is this?

A) A crossover design B) A nonequivalent control group pretest–posttest design C) A one-group pretest–posttest design D) A time-series design Ans: C Feedback: The researcher in this example used a very weak one-group pretest–posttest design. There was no repeated collection of data (so, not a time-series design), and no comparison group (thus, not a nonequivalent control group design). A crossover design is an experimental design that involves randomly assigning people to orderings of alternative treatments, which did not occur in this example.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 125, Quasi-Experimental Designs 28. A team of researchers evaluated a protocol designed to reduce medication errors. Data on medication errors were obtained for each month in the 12 months preceding the intervention, and for each month in the 12 months following the intervention. What type of design is this?

A) A crossover design B) A nonequivalent control group pretest–posttest design C) A one-group pretest–posttest design D) A time-series design Ans: D Feedback: A time-series design involves the collection of outcome data over an extended period, during which time an intervention is introduced, as in this example. In a one-group pretest–posttest design, data are collected twice, whereas in this example, data were collected 24 times. There is no comparison group, so this is not an example of a nonequivalent control group design. A crossover design is an experimental design that involves randomly assigning people to orderings of alternative treatments, which did not occur in this example.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 125, Advantages and Disadvantages of Quasi-Experiments 29. Compared to true experiments, quasi-experiments are more susceptible to: A) rival hypotheses about causality.

B) ethical transgressions.

C) feasibility problems.

D) recruitment difficulties.

Ans: A Feedback: A major disadvantage of quasi-experiments is that they are susceptible to rival hypotheses—that is, alternative plausible explanations for what caused the outcomes, rather than the intervention of interest. Quasi-experimental research is not more prone to ethical transgressions than true experiments, and in most cases, quasi-experiments are more feasible (not less feasible) than RCTs. Some people are reluctant to be randomized, and so it is often easier to recruit participants for a quasi-experimental study than for an RCT. Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care

Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 03 Page and Header: 126 Nonexperimental Studies 30. What is a central feature of nonexperimental (observational) studies?

A) Researchers do not manipulate the independent variable.

B) Researchers do not manipulate the dependent variable.

C) Data are collected through the observation of participants’ behaviors.

D) Their ability to elucidate cause-and-effect relationships is unparalleled.

Ans: A Feedback: In nonexperimental (observational) research, the researchers do not intervene— that is, they do not manipulate the independent variable to test its effect on the dependent variable. Data for nonexperimental studies may come from the direct observation of participants’ behaviors, but this is not always true and is not a central feature. Nonexperimental studies are relatively weak in terms of their ability to support causal inferences.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 126, Types of Nonexperimental/Observational Studies 31. A sample of both users and nonusers of electronic cigarettes was followed over a 10-year period to assess whether the e-cigarettes had any long-term adverse effects. What type of design was this?

A) Time-series B) Case-control C) Prospective D) Crossover Ans: C Feedback:

Prospective (cohort) designs begin with a presumed cause (here, electronic cigarettes) and look forward in time for its effects. Retrospective designs, such as case-control designs, begin with the outcome and look back in time for antecedent causes. Both time-series and crossover designs involve an intervention, and there is no intervention in this example.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03, 08 Page and Header: 126, Types of Nonexperimental/Observational Studies 32. Women with and without lymphedema following breast cancer surgery were compared in terms of their presurgical weight, as measured by their body mass index (BMI). Which design did the researcher use?

A) Time-series B) Case-control C) Prospective D) Crossover Ans: B Feedback: In this example, the researcher began with the outcome, the presence or absence of lymphedema, and then they looked back in time to see if being overweight or obese was a potential risk factor. This is a retrospective case-control design.

Prospective design studies begin with a presumed cause (e.g., weight) and look forward in time for its effects on outcomes of interest. Both time-series and crossover designs involve an intervention, and there is no intervention in this example.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03, 08 Page and Header: 127, Types of Nonexperimental/Observational Studies

33. A researcher collected cross-sectional data to estimate the percentage of community-dwelling older people who were at risk of malnutrition. What type of study is this?

A) A descriptive correlational study B) A prospective study C) A retrospective study D) A prevalence study Ans: D Feedback: Prevalence studies document the prevalence rate of a condition or problem at a single point in time. There is only one variable in this example (risk of malnutrition), and so it is neither a descriptive correlational study, a retrospective study, nor a prospective study, all of which involve examining relationships among two or more variables.

Format: Multiple Choice Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 126, Nonexperimental Studies 34. A nurse researcher plans a study to compare the occurrence of anxiety disorders in military personnel deployed overseas with those who were never deployed overseas. What research design would the researcher use?

A) A crossover design B) A time-series design C) A nonequivalent control group design D) A nonexperimental design Ans: D Feedback: The researcher would need to use a nonexperimental design because there is no intervention in this example. Existing groups (those who did or did not deploy overseas) are being compared in terms of anxiety disorders. All of the other answer options are research designs for studies that involve an intervention.

Format: Multiple Choice Chapter: 8

Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03, 08 Page and Header: 127, Types of Nonexperimental/Observational Studies 35. If a researcher studied the relationship between women’s age and their frequency of performing breast self-examination, what type of design would be used?

A) Descriptive correlational B) Quasi-experimental C) Longitudinal D) Experimental Ans: A Feedback: Nonexperimental (observational) research includes descriptive correlational studies that are aimed at describing relationships among variables without a goal of elucidating causal connections, as in this example. Experimental and quasiexperimental studies involve interventions, and both are aimed at facilitating causal inferences. In this example, data on age and breast self-examination would be gathered once, and so this study would not be longitudinal.

Format: Multiple Choice Chapter: 8 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 127, Advantages and Disadvantages of Nonexperimental Research 36. What is a major weakness of correlational studies?

A) They tend to be expensive.

B) They tend to be artificial.

C) They are weak in their ability to support causal inferences.

D) They are impractical.

Ans: C Feedback:

A weakness of correlational studies is that they can harbor biases due to selfselection into groups being compared, which in turn hinders causal inferences.

Correlational studies can be costly, but often they are not. They are less artificial than studies involving interventions and are often practical to implement.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 04, 08 Page and Header: 128, The Time Dimension in Research Design 37. Researchers collect data at a single point in time in which type of study?

A) Time-series studies B) Cross-sectional studies C) Longitudinal studies D) Crossover studies Ans: B Feedback: Cross-sectional designs involve data collection at one point in time, whereas longitudinal designs involve data collection at two or more times over an extended period. In a time-series design, outcome data are collected over a period of time before and after introducing an intervention—often from different people. In crossover designs, people are exposed to more than one experimental condition in random order, and in such designs, data are collected from the same people multiple times.

Format: Multiple Choice Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 04 Page and Header: 128, Cross-Sectional Designs 38. A nurse researcher is studying the attitudes of high school students toward bullying at Metro High School during the past school year. What type of study is this?

A) A time-series study

B) A cross-sectional study C) A longitudinal study D) A follow-up study Ans: B Feedback: In this study, data focused on the students’ opinions about bullying would be collected once, and so this is a cross-sectional study. If the study examined changes in student’s attitudes over time, the study would be longitudinal—data would have to be collected two or more times. Follow-up studies are also longitudinal, typically focused on the long-term effects of an intervention or a health condition. Time-series designs involve an intervention, and this study did not involve an intervention.

Format: Multiple Choice Chapter: 8 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 04 Page and Header: 129, Longitudinal Designs 39. In a study examining the quality of life of patients who had undergone coronary artery bypass surgery, the research team collected data on patients’ quality of life 2 months after the surgery and then 2 years later. What type of study is this?

A) Cross-sectional B) Crossover C) Follow-up D) Retrospective Ans: C Feedback: In a follow-up study, data are gathered at two or more points in time from a welldefined group, such as people who have a certain illness or experience. This study involves two periods of data collection, and so it is not cross-sectional. There is no intervention in this study, so it could not be a crossover study. Retrospective studies involve looking for a cause of an outcome by looking back in time for possible antecedents, which is not the case in this study.

Format: Multiple Choice Chapter: 8 Client Needs: Psychosocial Integrity

Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 04, 08 Page and Header: 129, Longitudinal Designs 40. Which of the following is a major challenge specific to longitudinal designs?

A) Loss of research control B) Deterioration of participants’ health C) Inferential challenges D) Attrition Ans: D Feedback: A major problem in longitudinal designs is attrition—the loss of participants from the study sample over time. Participants’ health may deteriorate over the course of a longitudinal study, but it may also improve over time. Research control is no more likely to be threatened in longitudinal than in cross-sectional studies.

Inferential challenges face all researchers, regardless of design.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 05 Page and Header: 130, Controlling the Study Context 41. Which strategy can promote constancy of conditions in implementing an intervention?

A) Using standardized research protocols B) Using a prospective rather than retrospective design C) Maximizing statistical power D) Using a homogeneous sample Ans: A Feedback:

The careful development of standard protocols is an important strategy for enhancing constancy of conditions in implementing an intervention. In carefully controlled quantitative research, steps are taken to achieve constancy in the study conditions so that researchers can be confident that outcomes reflect the influence of the independent variable and not the study context. All intervention research is prospective and not retrospective. The use of a homogeneous sample is used to control participant factors, not the study context, and maximizing statistical power enhances statistical conclusion validity, not constancy of conditions.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 05 Page and Header: 130, Controlling Participant Factors 42. There are several alternative strategies for controlling confounding participant characteristics. Which method is the most effective?

A) Using a homogeneous sample B) Statistically controlling confounders C) Matching participants on confounding variables D) Randomizing participants to conditions Ans: D Feedback: Randomization is the most effective method of controlling participant characteristics because it controls all possible confounding variables. Other control techniques, which are less effective, include homogeneity (minimizing variation on the confounding variables), matching (deliberately making groups comparable on one or more confounding variable), and statistical control procedures.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 05 Page and Header: 132, Evaluation of Control Method

43. Randomization within a crossover design is a powerful strategy for controlling confounding participant characteristics. What problem can potentially arise in such a design?

A) Intervention effects B) Carryover effects C) Rival hypothesis effects D) Causal effects Ans: B Feedback: Crossover designs are often susceptible to the risk of carryover effects, which occur when the people who are exposed to two different conditions are influenced in the second condition by their experience in the first condition. Intervention effects are what researchers hope to find, they are not a problem. The terms “rival hypothesis effects” and “causal effects” are not research terms.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 05 Page and Header: 130, Controlling Participant Factors 44. Researchers do not need to know in advance which confounding variables should be controlled for which control strategy?

A) Matching B) Randomization C) Statistical control D) Homogeneity Ans: B Feedback: Randomization is the most effective method of research control because it controls all possible confounding variables without researchers having to identify them.

Other control strategies, such as matching, statistical control, and homogeneity, require researchers to identify in advance the confounders that need to be controlled.

Format: Multiple Choice Chapter: 8

Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 05, 08 Page and Header: 131, Homogeneity 45. Homogeneity is a principle that can be used to control extraneous variation from participant characteristics. What does homogeneity entail?

A) Randomly assigning participants to homogeneous groups B) Not allowing important confounders to vary in the research sample C) Making the treatment conditions as homogeneous as possible D) Creating homogeneous groups of participants through matching Ans: B Feedback: One way to control confounding participant characteristics is to not allow them to vary—that is, to select participants who are homogeneous with respect to confounders. Participants are not randomized to homogeneous groups, and homogeneity of treatment conditions is the opposite of what needs to occur to make the design powerful. The use of matching is unrelated to the strategy of minimizing variation in the sample with respect to confounders.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 05, 08 Page and Header: 131, Matching 46. In a retrospective case-control study of the relationship between (1) having versus not having a herniated disc and (2) patients’ prior history of trauma in a sample of 200 men and women, the researcher would most likely use which method to control the gender distribution in the two groups?

A) Having patients serve as their own controls B) Randomizing patients to groups C) Matching cases and controls on gender D) Maintaining homogeneity of the sample Ans: C Feedback:

Matching is a common control procedure in case-control studies. In this example, the researcher would match patients with and without a herniated disc with respect to gender. Randomization is not used in case-control studies, and participants are used as their own controls only in crossover designs. Homogeneity could have been used to control gender by restricting the sample to either men or to women, but this was not done in this example.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 05 Page and Header: 131, Statistical Control 47. A researcher used a two-group quasi-experimental (nonequivalent control group) design to test the effect of a Tai Chi intervention on the quality of life in residents of two different nursing homes, one of which got the intervention. The researchers used analysis of covariance to control residents’ age. What strategy for controlling participant characteristics did the researcher use?

A) Statistical control B) Matching C) Randomization D) Homogeneity Ans: A Feedback: Analysis of covariance is a method of statistical control that could be used to remove the effect of age on the residents’ quality of life—which would be desirable if those getting versus not getting the intervention were of different ages. In this quasi-experimental study, the groups were not formed through randomization.

Nothing in the description suggests that participants were restricted to a certain narrow age range (homogeneity) or that they were matched on age.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 06 Page and Header: 132, Statistical Conclusion Validity

48. Four types of validity affect the rigor of a quantitative study. Which type concerns the validity of inferences that an empirical relationship between variables exists?

A) Statistical conclusion validity B) Internal validity C) Construct validity D) External validity Ans: A Feedback: Statistical conclusion validity concerns the validity of inferences that there is a true relationship (a correlation) between variables—for example, between a presumed cause and its effect. Internal validity concerns inferences that outcomes were caused by the independent variable rather than by confounding factors. Construct validity concerns inferences from the particular exemplars of a study to the higher order constructs they are intended to represent. External validity concerns inferences about the generalizability of study results.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 06 Page and Header: 132, Internal Validity 49. There are four types of validity that affect the rigor of a quantitative study.

Which type of validity does a researcher specifically address in choosing to use a true experimental design?

A) Statistical conclusion validity B) Internal validity C) Construct validity D) External validity Ans: B Feedback: Internal validity concerns inferences about causality—that outcomes were caused by the independent variable, rather than by other factors. A true experimental design offers the strongest evidence about cause-and-effect relationships. Other forms of validity (construct, external, and statistical conclusion validity) are not specifically about causal relationships.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 06 Page and Header: 132, Statistical Conclusion Validity 50. Which of the following can result in a threat to statistical conclusion validity?

A) Temporal ambiguity B) Maturation C) Small sample size D) Selection bias Ans: C Feedback: Inadequate statistical power is a major threat to statistical conclusion validity, and small samples tend to yield insufficient power to give research hypotheses a fair test. Temporal ambiguity, maturation, and selection bias are threats to internal validity.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 05, 08 Page and Header: 130, Controlling the Study Context 51. A nurse researcher tested the effectiveness of a telephone intervention to reduce anxiety among family caregivers of patients with Alzheimer’s disease.

During the trial, the researcher performed an assessment and found that staff were not following the established intervention procedures. The assessment focused on: A) statistical power.

B) intervention fidelity.

C) risks for participant attrition.

D) maturation threats.

Ans: B Feedback:

Intervention fidelity concerns the extent to which the implementation of an intervention is faithful to its plan. Intervention infidelity can be a threat to statistical conclusion validity, as can low statistical power. The researcher’s assessment did not focus on participant attrition or maturation threats.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 06, 07 Page and Header: 133, Threats to Internal Validity 52. In their cross-sectional correlational study, researchers hypothesized that stress was a risk factor for depression among college students. The researchers found a correlation between stress and depression, consistent with the hypothesis. Which is a possible threat to the internal validity of this study?

A) Selection B) Mortality C) Maturation D) Temporal ambiguity Ans: D Feedback: In this cross-sectional study, it is impossible to tell if being stressed “caused” higher levels of depression, or if being depressed “caused” higher stress levels—or if a third factor contributed to (or caused) both. Without knowing which came first (temporal ambiguity), alternative explanations are possible. Selection is not relevant in this study, as groups of students are not being compared—there is only one group. There is no indication that mortality (attrition) was a problem, and maturation is not relevant in this example.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 06, 07 Page and Header: 133, Threats to Internal Validity

53. Using a one-group pretest–posttest design, nurse researchers studied the effect of quiet music on sleep efficiency in low-birth-weight infants. Which threat to internal validity would be especially salient in this study?

A) Selection B) Mortality C) Maturation D) Temporal ambiguity Ans: C Feedback: In this example, the intervention (quiet music) is competing with normal processes of development in infants (maturation) as the cause of changes in sleep efficiency.

With one-group designs, selection is not a threat. Mortality (attrition) might be a threat, but loss of participants was not noted and would be less of a threat than maturation. In intervention studies such as this one, there is no temporal ambiguity: The intervention was delivered and then sleep efficiency was measured.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 06, 07 Page and Header: 133, Threats to Internal Validity 54. Nurse researchers randomly assigned 50 participants to a 3-month smoking cessation intervention and 50 to a no-intervention control group. At the end of the study, there were 40 in the intervention group and 32 in the control group. Which threat to internal validity would be especially salient in this study?

A) Selection B) Mortality C) Maturation D) Temporal ambiguity Ans: B Feedback: In this example, attrition from the study (the mortality threat) could lead to an analysis of a biased subset of participants from the original sample of 100. Attrition could potentially nullify the initial equivalence of the randomized groups. In experimental studies using randomized design, none of the other threats (selection, maturation, temporal ambiguity) is relevant.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 06, 07 Page and Header: 133, Threats to Internal Validity 55. A nurse researcher implemented a physical fitness program for nurses in one hospital and used nurses in another hospital as the comparison group. Which threat would be the most serious to internal validity in this study?

A) Selection B) Mortality C) Maturation D) Temporal ambiguity Ans: A Feedback: The selection threat reflects biases stemming from preexisting differences between groups. Selection bias is the most serious threat to internal validity in studies not using an experimental design, such as in the nonequivalent control group design used in this example. There would be no risk of temporal ambiguity—outcomes would be measured after initiating the intervention. Mortality (differential attrition) could be a problem, but it is not as serious a threat as selection. Maturation is not relevant in this example.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 06 Page and Header: 133, Threats to Internal Validity 56. Which threat to internal validity can emerge when external events co-occurring with the independent variable affect outcomes?

A) Maturation B) Selection C) Mortality D) History Ans: D

Feedback: The history threat involves the occurrence of events concurrent with the independent variable that can affect the outcome. The maturation threat arises when outcomes are affected by the passage of time (e.g., growth, fatigue), competing with the independent variable as a potential cause. The selection threat reflects biases stemming from preexisting differences between groups being compared. The mortality threat involves effects on outcomes that result from attrition from the study.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 06 Page and Header: 133, Threats to Internal Validity 57. Which of the following is usually the most serious threat to the internal validity of RCTs? A) Mortality B) Selection C) Maturation D) History Ans: A Feedback: Mortality is the threat that arises from differential attrition in groups being compared. RCTs avoid the selection threat through random assignment to groups, but people drop out of the study in a nonrandom manner, which can result in groups that are no longer equivalent. RCTs are not typically susceptible to history threats (co-occurring events) or maturation threats (the effects of the passage of time) because both treatment and control group subjects are equally exposed to both.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 06 Page and Header: 134, External Validity

58. Using homogeneity as a strategy for controlling confounding variables can reduce which type of validity?

A) Statistical conclusion validity B) Internal validity C) External validity D) Construct validity Ans: C Feedback: External validity concerns inferences about whether relationships found for study participants might hold true for different people, conditions, and settings—in other words, generalizability. Using a homogeneous sample is easy, but one problem is that this strategy limits the generalizability of the results. Homogeneity usually helps to increase, not decrease, internal validity because confounders are controlled. Using a homogeneous sample is unlikely to affect statistical conclusion validity or construct validity.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 06 Page and Header: 135, Construct Validity 59. Construct validity concerns inferences from the particular exemplars in a study to the higher order constructs that they are intended to represent. The absence of which strategy in an RCT could undermine construct validity?

A) Randomization B) Statistical control C) Matching D) Blinding Ans: D Feedback: The absence of blinding could affect construct validity because it may be unclear whether outcomes are affected by the intervention itself or by participants’ expectations about the intervention; the outcomes might not be replicated outside the context of the research. The other answers refer to strategies to reduce threats to internal validity, not construct validity.

Format: Multiple Choice Chapter: 8 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 06 Page and Header: 134, External Validity 60. Which of the following statements is true?

A) External validity is reduced in multisite studies.

B) The goals of internal validity and external validity can sometimes conflict.

C) External validity is higher in quasi-experimental than in experimental studies.

D) Internal validity is more important to EBP than external validity.

Ans: B Feedback: There is often tension between the demands required to achieve internal validity (where tight control enhance causal inferences) and external validity (where tight controls might introduce artificial circumstances that can limit generalizability).

External validity is often enhanced in multisite studies if results are replicated in diverse settings. For EBP, external validity—the ability to generalize evidence to new settings—is very important. External validity is not necessarily higher in quasiexperimental studies.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 11 Page and Header: 141, Populations 1. Which of the following is a population?

A) Four hundred nurses selected from a membership roster of the American Nurses’ Association B) All patients with COVID-19 infections hospitalized in intensive care units in California in 2021 C) Caregivers recruited into a study because they are caring for patients with Parkinson’s disease D) Study participants diagnosed with COPD who currently smoke Ans: B Feedback: All patients with COVID-19 infections who were hospitalized in intensive care units in California in 2021 is a population—the entire group of interest. The other answers are samples, not populations.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 11 Page and Header: 141, Populations 2. A nurse researcher identified her accessible population as women with high-risk pregnancies in the state of New York. Which group might be the researcher’s target population?

A) All pregnant women in the state of New York B) All women with high-risk pregnancies in the United States C) All women with high-risk pregnancies in the city of Albany, New York D) All pregnant women in the northeastern United States Ans: B Feedback:

The accessible population is the aggregate of cases that conform to designated criteria and that are accessible—in this case, women with high-risk pregnancies in the state of New York. The target population is a broader group meeting the same eligibility criteria—the aggregate of cases about which the researcher would like to generalize the findings. In this case, the broader group would be women with highrisk pregnancies in the United States. Women who do not have high-risk pregnancies would not meet the criterion for being in the study. Women with highrisk pregnancies in a specific city (Albany) are not a broader group than those in the entire state.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 11 Page and Header: 141, Populations 3. A nurse researcher is studying fear of falling in community-dwelling elders.

Which would be a reasonable exclusion criterion?

A) People age 65 years or younger B) People who live in their own homes C) People who have periods of dizziness D) People who are married Ans: A Feedback: The study is focused on community-dwelling elders, and so it would be important to exclude people below a certain age limit (here, age 65 years). The researcher is thus defining “elder” as someone older than 65 years. One inclusion (rather than exclusion) criterion might be living independently in one’s own home. There would be no apparent reason to exclude married people or people who experience dizziness (which could contribute to fear of falling).

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 11 Page and Header: 141, Samples and Sampling 4. In the context of a study, what is sampling?

A) Identifying a set of criteria for selecting study participants B) Determining who is eligible to participate in a study C) Selecting a subset of the population to represent the entire population D) Ensuring that every element in the population has an equal chance of being included in the study Ans: C Feedback: Sampling is the process of selecting a portion of an entire population. Eligibility criteria are used to define population characteristics, and the application of those criteria is used to identify people who could participate in a study. Some sampling strategies (probability sampling) ensure that every element in the population has a chance to be sampled, but most strategies used by nurse researchers do not.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 11 Page and Header: 141, Samples and Sampling 5. If a population was defined as military veterans in Texas, an element would be: A) An Army veteran hospitalized in Houston B) All residents of Texas C) Texans who are military veterans D) A soldier currently serving in the Army Ans: A Feedback: An element is the basic unit in the population—in this case, a person who previously served in the army and is hospitalized in a city in Texas, Houston. A soldier currently in the Army would not meet the criterion stipulated for the population— i.e., not a veteran. “All residents of Texas” is neither an element (a basic population unit) and is missing the eligibility criterion of being a military veteran. “Texans who are military veterans” is a restatement of the population and is not an element.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate

Integrated Process: Teaching/Learning Objective: 11 Page and Header: 141, Samples and Sampling 6. What is sampling bias in quantitative studies?

A) Lack of variability in the population on the attribute of interest B) Sample selection using probability sampling methods C) The margin of error in the data obtained from samples D) Systematic overrepresentation or underrepresentation of a key attribute vis-àvis the population Ans: D Feedback: Sampling bias is the systematic overrepresentation or underrepresentation of some segment of the population. Sampling bias is unrelated to how varied (heterogeneous) the population is and is not the margin of error in data from a sample. Probability sampling (in which elements are selected by random methods) is not as susceptible to sampling bias as nonprobability methods.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 11 Page and Header: 141, Samples and Sampling 7. In quantitative studies, what is a key criterion for evaluating sample quality?

A) How representative the sample is of the population B) How easy it is to recruit sample members C) How convenient it is to the researchers D) How ethically sound the recruitment strategy is Ans: A Feedback: A key consideration in assessing the quality of a sample in a quantitative study is its representativeness of the population; another is the size of the sample. Ease of recruitment, convenience, and ethical appropriateness are important factors in a sampling strategy, but they do not contribute to the quality of the sample itself.

Format: Multiple Choice

Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 141, Samples and Sampling 8. A nurse researcher is studying medication compliance in hypertensive patients.

Among those recruited to participate in the study, 50% of the women and 20% of the men agreed to participate. This situation is likely to lead to: A) revised eligibility criteria.

B) a power analysis.

C) a revised definition of the target population.

D) sampling bias.

Ans: D Feedback: Sampling bias is the systematic overrepresentation or underrepresentation of a population segment on a characteristic relevant to the research question. In this case, it appears that men will be systematically underrepresented, and a person’s gender might play a role in medication compliance. The situation described would not lead to revisions of the eligibility criteria or in how the target population is defined. A power analysis is used to identify sample size needs, not to address imbalances in the sample.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 11 Page and Header: 142, Strata 9. Which statement about sampling is true?

A) The most basic units of a population are referred to as strata.

B) Strata are a means of equating the accessible population with the target population.

C) In a population of geriatric patients, those with and without a diagnosis of dementia would comprise two strata.

D) The use of strata in a sampling strategy can reduce the representativeness of the sample.

Ans: C Feedback: Strata are subpopulations, such as older patients with and without dementia. The use of strata in sampling can improve (not reduce) the sample’s representativeness. The most basic unit of a population is not called a stratum—it is called an element. Strata have no role in equating accessible and target populations.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 11 Page and Header: 142, Nonprobability Sampling 10. A nurse researcher recruits study participants by placing a recruitment poster at the entrance to a neurology clinic. What type of sampling did the researcher use?

A) Convenience sampling B) Quota sampling C) Purposive sampling D) Consecutive sampling Ans: A Feedback: In this example, the researcher used the most conveniently available people as study participants. The use of a recruitment poster meant that only people who entered the neurology clinic, took notice of the poster, and then volunteered for the study would become participants. This is not an example of quota, purposive, or consecutive sampling.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01, 02, 11 Page and Header: 143, Nonprobability Sampling 11. A nurse researcher is studying emergency department visits by parents of children who were low-birth-weight infants. Every parent who brought a low-birth-

weight child to the emergency department over a 12-month period was invited to participate in the study. What type of sampling did the researcher use?

A) Convenience sampling B) Quota sampling C) Purposive sampling D) Consecutive sampling Ans: D Feedback: In this example, the researcher consecutively recruited every person who met the study eligibility criteria over a 12-month period. This is not an example of quota, convenience, or purposive sampling.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01, 02 Page and Header: 143, Nonprobability Sampling 12. Which nonprobability sampling design would be most likely to yield a representative sample?

A) Consecutive sampling B) Convenience sampling C) Purposive sampling D) Quota sampling Ans: A Feedback: Consecutive samples are least likely to result in biased samples because all eligible people over a certain time period are invited to participate. Quota sampling is an improvement over convenience sampling in terms of yielding a representative sample, but sampling bias remains a problem. Purposive sampling is seldom representative of the population because subjective judgment is used to select participants—not every expert, for example, would have an equal chance of being selected from a population of experts on a topic.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care

Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02 Page and Header: 142, Nonprobability Sampling 13. Strata are incorporated into the design of which sampling approach?

A) Consecutive B) Purposive C) Quota D) Convenience Ans: C Feedback: Quota sampling divides the population into homogeneous strata (subpopulations) to ensure representation of different subgroups in the sample; within each stratum, people are sampled by convenience. Purposive sampling involves “handpicking” participants; there could be strata in purposive sampling, but this does not typically happen. Consecutive sampling involves sampling all people from an accessible population who meet the eligibility criteria.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 142, Nonprobability Sampling 14. A researcher is studying the relationship between stress and diet among college students. The researcher recruits students by sending out an e-mail blast and then includes in the sample the first 100 male and 100 female students who volunteer to participate. What type of sampling did the researcher use?

A) Convenience sampling B) Quota sampling C) Purposive sampling D) Consecutive sampling Ans: B Feedback:

Quota sampling is similar to convenience sampling, except that the researcher recruits from distinct strata of the population—in this example, strata defined by students’ gender. This is not an example of purposive or consecutive sampling.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02 Page and Header: 142, Nonprobability Sampling 15. Which is the weakest form of sampling for quantitative studies?

A) Convenience sampling B) Quota sampling C) Purposive sampling D) Consecutive sampling Ans: A Feedback: Convenience sampling uses the most readily available or convenient group of people—people who may be atypical of the population; the price of convenience is the risk of bias. The other answers are also forms of nonprobability sampling; they are weaker than methods of probability sampling but are stronger than convenience sampling.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02, 11 Page and Header: 143, Probability Sampling 16. A researcher conducting a survey randomly selected 500 people from a list of 10,000 people in an accessible population. What is the technical name for the list of the 10,000 names?

A) A stratum B) A sampling network C) A sampling frame D) A sampling quota

Ans: C Feedback: Researchers can sometimes establish a sampling frame (a list of all elements in the population) for the purposes of random sampling. A stratum is a subdivision of a population, not a listing of elements. “Quota” is a term used for a type of sampling, not the name of a listing. The term “sampling network” is not a research term.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 01, 02 Page and Header: 144, Probability Sampling 17. Which of the following is a probability sampling method?

A) Convenience sampling B) Systematic sampling C) Consecutive sampling D) Quota sampling Ans: B Feedback: Systematic sampling is the selection of every kth case from a list or a setting (for example, every 10th person on a list); it is an example of a probability sampling method when the first case is sampled at random. All of the other responses are for nonprobability sampling methods that do not involve an element of randomness.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 143, Probability Sampling 18. A researcher was studying nurses’ attitudes toward evidence-based practice and sent a questionnaire to a sample of nurses on a membership roster of a professional organization, using probability methods to select the members. What type of sampling did the researcher use?

A) Simple random sampling B) Stratified random sampling C) Multistage sampling D) Systematic sampling Ans: A Feedback: In this example, the sampling method is simple random sampling, the most basic form of probability sampling. No mention is made of dividing the sample into distinct strata (stratified random), of first sampling larger units such as schools of nursing (multistage sampling), or of selecting elements at fixed intervals from a sampling frame (systematic sampling).

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity

Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01 Page and Header: 143, Probability Sampling 19. Simple random sampling is to stratified random sampling what convenience sampling is to: A) purposive sampling B) systematic sampling C) multistage sampling D) quota sampling Ans: D Feedback: Quota sampling is the nonprobability analog of stratified random sampling, in that they both involve the selection of sample members from mutually exclusive population strata. The division of a population into strata is not a feature of purposive, systematic, or multistage sampling.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 10 Page and Header: 144, Evaluation of Nonprobability and Probability Sampling 20. Which term is used for the difference between sample values and population values?

A) Sampling error B) Sampling rate C) Sampling bias D) Sampling frame Ans: A Feedback: Sampling error refers to differences between sample values (e.g., the percentage female in the sample) and population values (e.g., the percentage female in the population). Sampling bias refers to problems that stem from having a sample that is not representative of the population. A sampling frame is a list of all population elements. “Sampling rate” is not a research term.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 144, Sample Size in Quantitative Studies 21. Which is a consequence of having too small sample?

A) Lack of control over confounding variables B) Insufficient power to detect differences in groups being compared C) Lack of ability to stratify the sample D) Sampling bias Ans: B Feedback: When a sample is too small, the study may lack sufficient power to detect group differences in the sample at a statistically significant level, even if the differences exist in the population. Sample size does not affect control over confounding variables, nor does it limit stratification. Sampling bias is not necessarily a consequence of sample size but rather a consequence of the method used to select a sample (e.g., a nonprobability method).

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 145, Sample Size in Quantitative Studies 22. A nurse researcher studied the levels of stress of smokers compared to nonsmokers. Which would be a factor affecting the sample size requirements for this study?

A) The type of sampling used (e.g., convenience, random) B) The number of eligible people in the sampling pool C) The size of the target population D) How large the group differences on stress levels are in the population Ans: D Feedback:

If group differences on an outcome of interest (here, stress levels) are large, the sample size does not need to be very large to detect it. Sample size requirements do not depend on the type of sampling plan used, the number of eligible people, or the size of the population.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03, 11 Page and Header: 144, Sample Size in Quantitative Studies 23. What procedure do researchers use to estimate how large a sample they need?

A) Randomization B) Screening C) Power analysis D) Stratification Ans: C Feedback: In quantitative studies, researchers often use a power analysis to estimate sample size needs, which is a strategy for avoiding problems with statistical conclusion validity. Screening (e.g., for eligibility) and stratification (to enhance representativeness) are not relevant to sample size estimation. Randomization is not a sampling term—it refers to a strategy used to achieve comparable groups in experimental studies.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 145, Critical Appraisal of Sampling Plans 24. A sampling plan would typically designate all of the following except: A) what type of sampling approach will be used to select study participants.

B) what the eligibility criteria for sample selection will be.

C) how many study participants are needed to achieve adequate power.

D) whether the accessible and target population will be the same.

Ans: D Feedback: A sampling plan specifies in advance how best to gain information from a sample.

This includes the sampling approach that will be used, how sample members will be recruited, and how many sample members the researcher needs to achieve adequate power. The target population and accessible population are virtually never the same.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 145, Critical Appraisal of Sampling Plans 25. Out of a population of 1,000 hospice care nurses, a researcher recruited 200 to be in a study, using an available sampling frame. Out of those who were randomly sampled, 40 refused to participate and another 10 could not be located. The response rate in this study was: A) 75%.

B) 25%.

C) 20%.

D) 15%.

Ans: A Feedback: The response rate is the number of people who actually participated in study, relative to those who were sample. Here, the response rate is 150 study participants divided by the 200 who were sampled: 75%.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 04 Page and Header: 146, Overview of Data Collection and Data Sources 26. Which data collection method is the most widely used by nurse researchers?

A) Records B) Self-reports C) Observation D) Biophysiological measures Ans: B Feedback: The three principal data collection methods for nurse researchers are self-reports, observations, and biophysiological measures (biomarkers). Existing records can sometimes be used in nursing studies as well. Self-reports, which involve directly questioning study participants, are the most widely used method of collecting data for nursing research, in both quantitative and qualitative studies.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 04, 11 Page and Header: 146, Overview of Data Collection and Data Sources 27. Data from self-reports are sometimes called: A) interview data.

B) questionnaire data.

C) observational data.

D) patient-reported outcome data.

Ans: D Feedback: Self-report data are sometimes called patient-reported outcome data, especially in the medical literature. Interviews and questionnaires yield self-report data, but they are not synonyms for self-report data. Observations are an alternative method to self-reports for certain variables.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 05, 06, 11

Page and Header: 147, Question Form and Wording 28. Which is a major advantage of closed-ended questions?

A) They are easy to construct.

B) They are relatively easy to analyze.

C) They encourage in-depth responses.

D) They are not subject to response biases.

Ans: B Feedback: Good closed-ended questions are more difficult to construct than open-ended ones but easier to analyze. Closed-ended questions do not encourage in-depth responses. A disadvantage of closed-ended questions is that they are often subject to response biases (e.g., people may not answer honestly in an effort to “look good”).

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 05, 06 Page and Header: 147, Question Form and Wording 29. Which of the following is an example of an open-ended question?

A) Are you male, female, or other?

B) Do you take a daily multivitamin?

C) What types of support did you feel you needed after your surgery?

D) How many hours of sleep do you get on a typical night?

Ans: C Feedback: Open-ended questions are questions that allow people to give full expression to their thoughts and viewpoints, in a narrative fashion in their own words—using as many words as they need. All the other questions are closed-ended ones that would have limited options for responding, such as “male,” “yes,” (to taking a daily multivitamin), and “seven” (number of hours of sleep).

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care

Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 05 Page and Header: 148, Interviews Versus Questionnaires 30. Why are interviews usually preferable to questionnaires for collecting research data?

A) They are less expensive.

B) They yield data that are easier to analyze.

C) Response rates are usually higher.

D) They offer the possibility of anonymity.

Ans: C Feedback: Interviews are usually preferable to questionnaires because response rates tend to be higher—it is easier to ignore a questionnaire than to refuse to talk to an interviewer. Questionnaires are less costly than interviews and offer the possibility of anonymity. Data from interviews are no easier to analyze than data from questionnaires.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 05 Page and Header: 148, Interviews Versus Questionnaires 31. Which statement about interviews and questionnaires is true?

A) Questionnaires are feasible with most people.

B) Questionnaires offer the possibility of anonymity.

C) Questionnaires are more costly to administer than interviews.

D) Interviews can more readily be used to gather data from geographically dispersed samples.

Ans: B Feedback:

Questionnaires can be distributed and collected without knowing the identity (or characteristics) of individual respondents, but the same is not true of interviews.

Compared to questionnaires, interviews can be used with broader populations (e.g., people who cannot read or cannot see). However, interviews tend to be more costly than questionnaires because of the expense of hiring interviewers, and such expenses are magnified if the sample is geographically dispersed. Questionnaires can be distributed to people in wide geographic areas at low costs, especially over the Internet.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 06, 11 Page and Header: 148, Summated Rating Scales 32. A questionnaire included this statement: “During my hospital stay, staff were respectful of my needs as an individual.” Participants were asked to indicate, on a 5-point scale, the degree to which they agreed or disagreed with the statement.

This question represents: A) a forced-choice question.

B) an open-ended question.

C) a visual analog scale.

D) an item on a Likert scale.

Ans: D Feedback: Likert scales consist of several declarative statements (items) that express a viewpoint on a topic, like the one in this example. Respondents are asked to indicate how much they agree or disagree with each statement. Visual analog scales measure subjective experiences. This is not an example of an open-ended question (where respondents answer the question in their own words) or a forcedchoice question (which gives respondents two choices from which to choose).

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 06 Page and Header: 148–149, Summated Rating Scales

33. On a 20-item Likert scale with five response alternatives, the range of possible scores is: A) 0 to 100.

B) 20 to 80.

C) 20 to 100.

D) 1 to 20.

Ans: C Feedback: Likert scales (a type of summated rating scales) present respondents with a series of items worded favorably or unfavorably toward a phenomenon; responses indicating the degree of agreement or disagreement with each statement are scored (here, on a 5-point scale, from 1 to 5) and then summed into a composite score. With 20 items, the minimum score is 20 (20 × 1) and the maximum is 100 (20 × 5). None of the other responses is correct in showing the potential range of total scores.

Format: Multiple Choice Chapter: 9 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 06, 11 Page and Header: 150, Summated Rating Scales 34. What is the name of a brief self-report method used to measure subjective experiences such as pain and fatigue?

A) Composite scales B) Dichotomous questions C) Visual analog scales D) Likert scales Ans: C Feedback: A visual analog scale (VAS) is used to measure subjective experiences (e.g., pain, fatigue) along a 100-mm line designating a bipolar continuum (e.g., no pain at all, pain as bad as it could be). Likert scales involve multiple items, scored together; these are sometimes called composite scales. Dichotomous questions (only two response options) are not ideal for measuring subjective experiences that occur along a continuum.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 06, 11 Page and Header: 150, Summated Rating Scales 35. The social desirability response set bias is least likely to be a problem on scales incorporated into which?

A) Anonymous questionnaires B) Face-to-face interviews C) Telephone interviews D) All options are equally susceptible.

Ans: A Feedback: Social desirability response set bias—a tendency to misrepresent attitudes or traits by giving answers that are consistent with prevailing social views—would least likely be a problem with anonymous questionnaires because people would not have to worry about what others thought of their answers. The risk of social desirability bias is higher in interviews because the interviewer would be aware of the person’s answers.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 06, 11 Page and Header: 150, Summated Rating Scales 36. Structured self-reports are susceptible to several types of response bias. What is the name of the response bias that results when people agree with items, regardless of their content?

A) Social desirability B) Extreme response C) Naysayers D) Acquiescence Ans: D

Feedback: When “yea-sayers” agree with items, regardless of the content of the items, the bias is called acquiescence bias. Other types of response bias include social desirability, extreme response, and naysayers bias, which is the opposite of acquiescence (people disagree with an item regardless of content).

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 06, 11 Page and Header: 150, Summated Rating Scales 37. Structured self-reports are susceptible to several types of response bias. What is the name of the response bias that results when people consistently select the “strongly agree” or “strongly disagree” response alternatives?

A) Social desirability B) Extreme response C) Naysayers D) Acquiescence Ans: B Feedback: Extreme responses are a bias reflecting the consistent selection of extreme alternatives (e.g., “strongly agree”). These extreme responses do not necessarily signify the most intense feelings about a phenomenon but rather capture a personality trait of the respondent. Other types of response bias include social desirability, acquiescence, and naysayers bias, but these do not concern the systematic selection of the most extreme response options.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 07, 11 Page and Header: 152, Evaluation of Observational Methods 38. When an observer is not concealed, the observational data may be biased because of:

A) reactivity.

B) ethical problems.

C) lack of mobility.

D) acquiescence bias.

Ans: A Feedback: When data are obtained through direct observation, awareness of being observed may cause people to behave atypically, and this problem is called reactivity. When observers are not concealed, there is no ethical problem (as long as informed consent has been obtained). Mobility of observers or study participants is not an issue when observers are not concealed. Acquiescence bias is a potential problem when data are collected by self-reports, not by observational methods.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 07, 11 Page and Header: 151, Methods of Structured Observation 39. When structured observation is used to collect data, researchers often use a category system to construct: A) a rating scale.

B) an exhaustive system.

C) a nonexhaustive system.

D) a checklist.

Ans: D Feedback: Category systems are the basis for constructing a checklist, which is the instrument that observers use to record observed phenomena. A rating scale is an alternative approach to having a category system for gathering observational data. Category systems can be either exhaustive or nonexhaustive—both can be used to construct a checklist.

Format: Multiple Choice Chapter: 9 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand

Difficulty: Difficult Integrated Process: Nursing Process Objective: 07, 11 Page and Header: 152, Observational Sampling 40. A researcher studying interactions among nursing home residents schedules 5minute observations, with six periods of observation per hour. What sampling strategy is the researcher using?

A) Event sampling B) Quota sampling C) Time sampling D) Consecutive sampling Ans: C Feedback: With time sampling, researchers select time periods during which observations will occur—in this case, there would be six observational sessions of 5 minutes (30 minutes of observation) each hour. Event sampling focuses on a specific type of event (e.g., episodes of severe agitation). Quota sampling and consecutive sampling are terms used primarily with regard to the sampling of participants, not observational periods.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 07 Page and Header: 152, Evaluation of Observational Methods 41. Which of the following is an advantage of observation as a method of data collection in a study?

A) Participants enjoy being observed.

B) Participants can remain anonymous.

C) Observation is less costly than distributing questionnaires.

D) Observation directly captures people’s behaviors.

Ans: D Feedback:

Observation directly captures human behaviors and provides access to data that is often unattainable through self-reports. Participants seldom “enjoy” being observed and may in fact be nervous during observations. Because observation is laborintensive, it tends to be expensive. People are not anonymous when they are being observed.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Difficulty: Easy Integrated Process: Communication and Documentation Objective: 08 Page and Header: 153, Biomarkers 42. Which statement about biomarkers (biophysiological measures) is true?

A) In vivo measurements are performed outside a participant’s body.

B) Biomarkers are more likely to provide valid measures of the target variables than self-reports.

C) Biomarkers are less accurate and precise than composite scales.

D) Oxygen saturation is an example of an in vitro measurement.

Ans: B Feedback: Biophysiological instruments provide valid measures of targeted variables: Thermometers can be counted on to measure temperature and not oxygen saturation, for example. It is often more difficult to be certain that self-report instruments are really measuring the target concept. In vitro (not in vivo) measurements are performed outside a human body. Oxygen saturation is an example of an in vivo measurement. Composite scales are almost invariably less accurate and precise than biomarkers.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 09 Page and Header: 153, Data Quality in Quantitative Research 43. Which of the following statements about measurement is true?

A) Rules for measuring many health-related constructs have to be invented.

B) When researchers develop a new measure, they must learn what measurement rules apply to it.

C) Most measures of attributes of interest to nurse researchers are free from measurement error.

D) Evaluation of a new measure involves an assessment of 10 distinct measurement properties.

Ans: A Feedback: Measurement involves assigning numbers to represent the amount of an attribute present in an object/person using a specified set of rules—and for many attributes of interest (e.g., resilience, self-efficacy), the rules must be invented. When researchers develop a new measure, they must create the rules, not learn what they are. Virtually all measures are susceptible to measurement error. New measures are typically evaluated using 2 (not 10) measurement properties; 2 additional measurement properties relating to change scores may sometimes be assessed.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 09, 11 Page and Header: 153, Data Quality in Quantitative Research 44. What is the discipline concerned with the theory and methods of measuring psychosocial constructs, such as depression or anxiety?

A) Bibliometrics B) Sociometrics C) Psychometrics D) Econometrics Ans: C Feedback: Psychometrics is the branch of psychology concerned with the theory and methods of psychological measurement; health measurement has been strongly influenced by psychometrics. Bibliometrics, sociometrics, and econometrics are not disciplines related to the focus of this chapter—measurements useful to health researchers.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 10, 11 Page and Header: 153, Reliability 45. Which measurement property concerns the extent to which scores for an attribute are free from measurement error?

A) Validity B) Psychometrics C) Replication D) Reliability Ans: D Feedback: Reliability is the extent to which scores are free from measurement error and consistent across replications. “Replication” is not a measurement property; it is part of a strategy for assessing reliability. Validity is the degree to which a measure captures the construct it purports to measure. Psychometrics is a discipline related to the measurement of psychological phenomena; it is not a measurement property.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 10, 11 Page and Header: 154, Reliability 46. Which action occurs in an assessment of test–retest reliability?

A) Two different raters simultaneously use the same instrument to measure people.

B) A measure is administered once to a sample of people.

C) A measure is administered to the same people on two occasions.

D) Alternative versions of an instrument are administered to the same people.

Ans: C Feedback:

In test–retest reliability assessments, the instrument being assessed is administered to the same people on two separate occasions to evaluate whether scores are stable (reproducible). The other situations occur for different types of reliability assessment.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 10, 11 Page and Header: 154, Reliability 47. A nurse researcher developed a new 10-item scale to measure resilience. The researchers evaluated whether all 10 items were measuring the same trait. Which of the following was being assessed?

A) Interrater reliability B) Internal consistency C) Test–retest reliability D) Content reliability Ans: B Feedback: Internal consistency concerns the extent to which all the items on a composite scale are consistently measuring the same attribute. Test–retest reliability assessments concern the stability of a measure over time and involve two administrations of the measure to the same people. Interrater reliability involves comparing the scores of two people assigning scores (e.g., scores from an observational rating scale). There is no such thing as content reliability.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 10, 11 Page and Header: 155, Validity 48. A nurse researcher developed a new scale to measure preparedness for caregiving among family members of palliative care patients. A panel of experts is convened to assess whether the items on the draft scale adequately reflect the construct. What type of validity is being assessed?

A) Content validity B) Face validity C) Criterion validity D) Construct validity Ans: A Feedback: Content validity is the extent to which a multi-item scale’s content (the items) adequately captures the focal construct. Content validity, unlike criterion or construct validity, is usually assessed with feedback from a panel of experts. Face validity refers to whether the scale looks like it is measuring the target construct and is often assessed by getting feedback from the population for whom the scale is intended.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 10, 11 Page and Header: 155, Validity 49. A nurse researcher developed a new scale to measure cigarette consumption and calculate the correlation between scale scores and a gold standard, salivary cotinine levels. What type of validity is being assessed?

A) Content validity B) Face validity C) Criterion validity D) Construct validity Ans: C Feedback: Criterion validity is the extent to which the scores on a measure are a good reflection of a “gold standard,” which in this example is a biophysiological indicator of cigarette consumption, salivary cotinine levels. Content validity, face validity, and construct validity do not rely on a “gold standard” criterion.

Format: Multiple Choice Chapter: 9 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate

Integrated Process: Communication and Documentation Objective: 10, 11 Page and Header: 155, Validity 50. A nurse researcher developed a new scale to measure the self-care behaviors of adults with type 2 diabetes. The validation effort included a test of the hypothesis that people with high levels of HbA1c have significantly lower scores on the selfcare scale than those with lower levels of HbA1c. What type of validity is being assessed?

A) Content validity B) Face validity C) Criterion validity D) Construct validity Ans: D Feedback: Construct validity often involves testing hypotheses: Researchers test hypotheses about how scores on a measure function in relation to scores on measures of other constructs. Content validity, face validity, and criterion validity do not involve formal tests of hypotheses.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 01 Page and Header: 161, The Design of Qualitative Studies 1. The term emergent design refers to a design that emerges at which point in a qualitative study?

A) During the conduct of a literature review B) While the researcher develops a conceptual framework C) Before the study has begun D) While the researcher is in the field collecting data Ans: D Feedback: Qualitative research involves an emergent design—a design that emerges and evolves in the field as researchers make ongoing decisions based on what they have already learned. A qualitative design does not “emerge” during the conduct of a literature review, while the researcher develops a conceptual framework, or before the study has begun.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01 Page and Header: 162, Characteristics of Qualitative Research Design 2. Which of the following statements is true?

A) Qualitative researchers adjust to what is being learned during data collection.

B) The quality of qualitative studies depends on achieving good internal validity.

C) Qualitative research does not require approval by an Institutional Review Board or an ethical review committee.

D) Qualitative research requires careful control of confounding variables.

Ans: A Feedback:

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Quantitative researchers specify a research design before collecting their data and rarely depart from that design once the study is underway: They design and then they do. In qualitative research, by contrast, the study design typically evolves during the project: Qualitative researchers design as they do. Qualitative researchers do not attempt to control any aspect of the study context, and internal validity is not a concern to qualitative researchers. Ethics approval is necessary for both quantitative and qualitative research.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01 Page and Header: 162, Characteristics of Qualitative Research Design 3. Which is not a characteristic of qualitative research design?

A) It often involves the triangulation of data sources.

B) It tends to be holistic.

C) It is flexible and can be revised during the course of data collection.

D) It involves minimum oversight once the study is underway.

Ans: D Feedback: Qualitative research design requires intense involvement and ongoing vigilance on the part of the researchers. They must constantly formulate and reformulate design, data collection, and sampling strategies. Qualitative design is holistic, flexible, and often involves triangulation of several data sources.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01 Page and Header: 162, Characteristics of Qualitative Research Design 4. Although qualitative research design is emergent, advance planning is needed for which purpose?

A) Identifying personal presuppositions and biases B) Deciding how large the sample will be

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C) Determining the reliability of instruments that will be used D) Developing a coding scheme for the data Ans: A Feedback: Qualitative researchers often attempt to understand their personal biases before moving forward with data collection. Qualitative researchers do not typically know in advance what their sample size will be, and they cannot develop a high-quality coding scheme before collecting their data. They do not “measure” variables, and so the reliability of instruments is not an issue.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 162, Characteristics of Qualitative Research Design 5. Which is not an issue that qualitative researchers attend to in planning a study?

A) Selecting a study site B) Identifying equipment that will be needed for fieldwork C) Selecting scales to measure key concepts D) Deciding whether to embed the study in a qualitative research tradition Ans: C Feedback: Qualitative researchers make advance decisions about a research tradition, the study site, a broad data collection strategy, and the equipment they will need in the field. They do not select scales to measure key constructs; scales are used in quantitative but not qualitative studies.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 162–163, Qualitative Design Features 6. Which design question is relevant in both quantitative and qualitative studies?

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A) How will confounding variables be controlled?

B) How often will data be collected?

C) Will the independent variable be manipulated?

D) Who will be blinded?

Ans: B Feedback: Both quantitative and qualitative research can be either cross-sectional (one data collection point) or longitudinal (multiple data collection points). Qualitative researchers do not use blinding, do not control confounding variables, and do not manipulate any variables.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 162, Qualitative Design Features 7. Which statement about qualitative designs is true?

A) Most qualitative designs involve an explicit, preplanned comparison.

B) Qualitative researchers strive to achieve constancy of conditions in terms of research settings.

C) The goal of many qualitative designs is to permit causal inferences.

D) Qualitative researchers often put together an array of data from a variety of sources.

Ans: D Feedback: Qualitative researchers often assemble and triangulate a complex set of data derived from a variety of sources and methods. Comparisons in a qualitative study are rarely preplanned. Qualitative researchers may make causal inferences based on their findings, but it is seldom a specific goal. Qualitative researchers are unlikely to explicitly pursue constancy of conditions, which is a control strategy used by quantitative researchers.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 02 Page and Header: 163, Ethnography 8. Which qualitative tradition would most likely be the foundation for the following question: “What are the conceptions of care among caregivers of persons living with HIV/AIDS in a rural Ethiopian community?”

A) Grounded theory B) Ethnography C) Phenomenology D) Qualitative description Ans: B Feedback: Ethnographers would seek to understand how culture influences the conceptions and behaviors of a group—here, people living in a rural Ethiopian community.

Phenomenologists seek to discover the essence and meaning of a phenomenon.

Grounded theory researchers try to account for people’s actions by focusing on the main concern that their behavior is designed to resolve. Descriptive qualitative studies are not embedded in a disciplinary tradition.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02 Page and Header: 163, Ethnography 9. Ethnographers strive to: A) understand human cultures.

B) develop an etic perspective.

C) link the etic and emic perspectives into a unified whole.

D) understand the essence of a phenomenon.

Ans:A Feedback:

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Ethnography is a discipline that focuses on the culture of a group of people and relies on extensive, in-depth fieldwork. Ethnographers strive to acquire an emic (insider’s) perspective of a culture rather than an etic (outsider’s) perspective, and they do not seek to link the etic and the emic perspectives. Phenomenologists seek to discover the essence and meaning of a phenomenon as it is experienced by people.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03, 06 Page and Header: 164, Ethnography 10. An ethnographic study of the culture of an urban family planning clinic conducted by someone from outside that culture is an example of: A) an autoethnography.

B) a critical ethnography.

C) a focused ethnography.

D) a macroethnography.

Ans: C Feedback: Ethnographic research sometimes concerns broadly defined cultures (macroethnographies), but ethnographers sometimes study more narrowly defined cultures in a focused ethnography. Ethnographies of cultures to which the researchers themselves belong are called autoethnographies or insider research.

Critical ethnography focuses on raising consciousness among those being studied in the hope of effecting social change.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 06 Page and Header: 164, Ethnography 11. What do ethnographers strive to acquire?

A) An emic perspective of a culture

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B) An etic perspective of a culture C) A focused perspective D) An ethnonursing perspective Ans: A Feedback: Ethnographers strive to acquire an emic perspective of a culture—an insider’s view that is the way members of the culture envision their world. An etic perspective is the outsiders’ interpretation of the experiences of that culture. Focused ethnography focuses on narrowly defined cultures, but it is not a “perspective,” nor is ethnonursing a perspective, but rather an approach to studying people’s viewpoints, beliefs, and practices related to health.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03, 06 Page and Header: 164, Ethnography 12. Which of the following techniques do ethnographers use in studying a culture?

A) Constant comparison B) Participant observation C) Hermeneutics D) Bracketing Ans: B Feedback: Ethnographers typically use a strategy called participant observation in which they make observations of the culture under study while participating in its activities.

Bracketing, used primarily by phenomenological researchers, is the process of identifying and holding in abeyance preconceived beliefs about the phenomenon under study. The term hermeneutics is not a technique but rather a tradition closely aligned with phenomenology. Constant comparison is a technique used in grounded theory studies.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate

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Integrated Process: Communication and Documentation Objective: 03, 06 Page and Header: 164, Ethnography 13. A nurse researcher is studying the culture of the emergency department where she works. What type of study is being undertaken?

A) An ethnonursing study B) A critical ethnography C) A macroethnography D) An autoethnography Ans: D Feedback: Autoethnographies—also referred to as insider research—focus on the group or culture to which the researcher belongs. Ethnographic research is sometimes concerned with broadly defined cultures (macroethnographies); sometimes such studies, if they focus specifically on health and the provision of care, are called ethnonursing studies. Critical ethnographers focus on raising the consciousness of people in a culture in the hope of effecting social change.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 165, Phenomenology 14. Within which qualitative tradition would the following question be addressed?

“What is the essence of men’s experiences of chemotherapy treatment for prostate cancer?”

A) Grounded theory B) Ethnography C) Phenomenology D) Qualitative description Ans: C Feedback:

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Phenomenology is the qualitative research tradition that focuses on the essence of a phenomenon as lived by the people who experience it. Grounded theory researchers try to account for people’s actions by focusing on the main concern that their behavior is designed to resolve. Ethnography focuses on the culture of a group of people. Descriptive qualitative studies are not embedded in a disciplinary tradition.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 03, 06 Page and Header: 165, Descriptive Phenomenology 15. In phenomenological studies, researchers strive to ensure that their own preconceived beliefs and opinions do not influence the emerging data, using which strategy?

A) Constant comparison B) Participant observation C) Hermeneutics D) Bracketing Ans: D Feedback: Bracketing is the process of identifying and holding in abeyance preconceived beliefs and opinions about the phenomenon under study. Ethnographers use a strategy called participant observation to make observations of a culture while participating in its activities. The term hermeneutics is not a technique but rather a tradition closely aligned with phenomenology. Constant comparison is a strategy used in grounded theory studies.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03, 06 Page and Header: 165, Descriptive Phenomenology 16. Which of the following methods facilitates bracketing?

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A) Maintaining a reflexive journal B) Intuiting to remain open to meaning C) Maintaining a phenomenological text D) Exploring being-in-the-world Ans: A Feedback: Phenomenological researchers often maintain a reflexive journal in their effort to bracket, which is the process of holding in abeyance preconceived beliefs and opinions about the phenomenon under study. Phenomenologists would not “explore” being in the world, nor would they “maintain” a phenomenological text as a method of bracketing—they would create such a text through their research.

Intuiting is often the second step in a descriptive phenomenological study.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 165, Descriptive Phenomenology 17. Which is not one of the four steps in descriptive phenomenology?

A) Bracketing B) Inferring C) Analyzing D) Describing Ans: B Feedback: In descriptive phenomenology, which seeks to describe lived experiences, researchers strive to bracket out preconceived views and to intuit the essence of the phenomenon by remaining open to meanings attributed to it by those who have experienced it. Then they analyze and describe the phenomenon. Inferring is not a step in descriptive phenomenology.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning

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Objective: 02, 06 Page and Header: 166, Interpretive Phenomenology 18. Hermeneutics is closely allied with which research tradition?

A) Narrative analysis B) Symbolic interaction C) Grounded theory D) Phenomenology Ans: D Feedback: Phenomenology, with its disciplinary roots in both philosophy and psychology, focuses on lived experiences. A related research tradition is hermeneutics (or interpretive phenomenology), which uses lived experiences as a tool for interpreting what those experiences mean. Narrative analysis is not a tradition but is a type of qualitative inquiry that focuses on stories. Grounded theory researchers strive to account for people’s actions by focusing on the main concern that their behavior is designed to resolve. Symbolic interaction is not a research tradition but is the conceptual basis for some grounded theory studies.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 166, Interpretive Phenomenology 19. A study that focuses on the meaning of sacrifice among wounded military personnel during wartime would likely be rooted in: A) descriptive phenomenology.

B) grounded theory.

C) interpretive phenomenology.

D) ethnography.

Ans: C Feedback: Interpretive phenomenology (hermeneutics) focuses on interpreting the meaning of experiences rather than just describing them. Descriptive phenomenology seeks to describe lived experiences. Grounded theory researchers try to account for people’s actions by focusing on the main concern that their behavior is designed to resolve.

Ethnography focuses on the culture of a group of people.

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Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 166, Interpretive Phenomenology 20. Which qualitative tradition sometimes involves augmenting research data with “data” from such alternative sources as novels or poetry?

A) Interpretive phenomenology B) Grounded theory C) Descriptive phenomenology D) Narrative analysis Ans: A Feedback: Interpretive phenomenologists sometimes augment data from personal interviews through an analysis of supplementary artistic sources, such as novels or poetry.

These types of data sources are unlikely to be used by researchers using other qualitative research traditions.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03, 06 Page and Header: 166, Interpretive Phenomenology 21. Which term is used to describe the interpretive process wherein the parts of a text and the whole of a text must be understood in relation to one another?

A) Bracketing B) Intuiting C) Hermeneutic circle D) Reflexivity Ans: C Feedback:

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Interpretive phenomenologists sometimes describe the interpretive process as a circular relationship—the hermeneutic circle—between the whole of the text and its parts. Bracketing and intuiting are steps in a descriptive phenomenology.

Reflexivity is a broad activity encouraged in all qualitative traditions.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Remember Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 166, Grounded Theory 22. Which name does not belong with the others?

A) Heidegger B) Husserl C) Gadamer D) Glaser Ans: D Feedback: Glaser is a prominent name in grounded theory methods. All of the other names are associated with phenomenology. Heidegger, a student of Husserl, was the founder of interpretive phenomenology or hermeneutics. Gadamer was another interpretive phenomenologist.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03, 06 Page and Header: 166, Grounded Theory 23. Grounded theory research seeks to discover a main concern or problem, and the behavior that is designed to resolve it. The central phenomenon in grounded theory studies is known as the: A) case study.

B) constant comparison.

C) core variable.

D) hermeneutic circle.

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Ans: C Feedback: Grounded theory researchers seek to discover a main concern or problem, and the behavior that is designed to resolve it. A core variable encapsulates the main concern and a recurrent solution. Constant comparison is a strategy used in grounded theory to discover and refine the core variable. The hermeneutic circle is a concept from interpretive phenomenology concerning relationships between the whole and the parts of a text. A case study is a type of qualitative study and is unrelated to grounded theory.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03, 06 Page and Header: 167, Grounded Theory Methods 24. Which procedure do grounded theory researchers use to develop and refine theoretically relevant categories?

A) Bracketing B) Intuiting C) Constant comparison D) Participant observation Ans: C Feedback: Constant comparison is used by grounded theory researchers to develop and refine theoretically relevant categories. Categories developed from the data are constantly compared with data obtained earlier to identify commonalities and variations.

Bracketing and intuiting are used by phenomenologists, and participant observation is used mainly by ethnographers.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03, 06 Page and Header: 166, Grounded Theory

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25. Which of the following is a type of core variable in grounded theory?

A) A basic social process B) Symbolic interaction C) Constant comparison D) Reflexivity Ans: A Feedback: Grounded theory researchers seek to discover a main concern or problem. A core variable encapsulates the main concern and a recurrent solution, and one type of core variable is called a basic social process. Constant comparison is used by grounded theory researchers to develop and refine theoretically relevant categories.

Grounded theory has its theoretical roots in symbolic interaction. Reflexivity is a general strategy used by qualitative researchers to minimize risks of subjective biases.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 166, Grounded Theory 26. Which qualitative tradition focuses on the manner in which people make sense of and resolve problems that arise within social contexts?

A) Phenomenology B) Grounded theory C) Ethnography D) Narrative analysis Ans: B Feedback: Grounded theory tries to account for people’s actions by discovering a main concern or problem and then the behavior people use to resolve it. Social processes are a major focus of this research tradition. Ethnographers seek to understand how a culture influences the conceptions and behaviors of a group. Phenomenologists seek to discover the essence and meaning of a phenomenon. Narrative analysis, which is not a disciplinary tradition, focuses on story as the center of an inquiry.

Format: Multiple Choice

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Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 166, Grounded Theory 27. Which qualitative tradition would be the foundation for the following question?

“What social processes do women use to maintain balance through their menopausal transition?”

A) Grounded theory B) Ethnography C) Phenomenology D) Qualitative description Ans: A Feedback: Grounded theory tries to account for people’s actions by discovering a main concern or problem and then the behavior people use to resolve it. Social processes are a major focus of this research tradition. Ethnographers seek to understand how a culture influences the conceptions and behaviors of a group. Phenomenologists seek to discover the essence and meaning of a phenomenon. Descriptive qualitative studies are not embedded in a disciplinary tradition.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 167, Alternate Views of Grounded Theory 28. Whose approach to grounded theory emphasizes the importance of subjectivity and the researcher’s shared role with participants in interpreting the data?

A) Charmaz’s constructivist grounded theory B) Strauss and Corbin’s grounded theory C) Glaser’s grounded theory D) All approaches are similar in their emphasis on subjectivity and shared interpretive roles.

Ans: A

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Feedback: Charmaz believed that what was missing from traditional, objective grounded theory methods (those of Glaser, Strauss, and Corbin) is the researcher’s influence on the collected data and on the interactions between the researcher and participants. Charmaz coined the term “constructivist” grounded theory to acknowledge the researcher’s involvement in constructing and interpreting data.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 04 Page and Header: 168, Case Studies 29. Which is most likely to be at “center stage” in a case study?

A) A phenomenon, such as attempted suicide B) A culture within an organization, such as a mental health clinic C) A person, such as a person who repeatedly self-harms D) A story, such as the life stories of chronic health problems of refugees Ans: C Feedback: Case studies are intensive investigations of a single entity or a small number of entities, such as individuals or families. Phenomenologists seek to discover the essence and meaning of a lived experience, such as an attempted suicide.

Ethnography focuses on the culture of a group of people. Narrative analysis focuses on story in studies that explore how individuals make sense of events in their lives.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 04 Page and Header: 168, Case Studies 30. Which statement about case studies is true?

A) A case study is essentially an anecdotal description.

B) A strength of case studies is the generalizability of the findings.

C) The entity under study in a case study is always an individual.

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D) A case study design can be cross-sectional or longitudinal.

Ans: D Feedback: Case studies can involve the collection of data from a single point in time but can also be longitudinal to understand how circumstances and conditions evolve. Case studies are not merely anecdotal descriptions. A limitation of case studies is that the findings may not be generalizable. The entity for a case study could be a person, family, institution, or another social unit.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 04 Page and Header: 168, Narrative Analysis 31. A researcher collected stories about how 16 suicide survivors felt when they learned their suicide attempts had failed. What type of qualitative study is this likely to be?

A) Historical research B) Qualitative description C) A case study D) A narrative analysis Ans: D Feedback: Narrative analysis focuses on story in studies in which the purpose is to determine how individuals make sense of events in their lives—here, the stories of those with an unsuccessful suicide attempt. Historical research is the systematic collection and critical evaluation of data relating to past occurrences. Descriptive qualitative studies are not embedded in a disciplinary tradition but use qualitative approaches to describe a phenomenon. Case studies are intensive investigations of a single entity or a small number of entities (e.g., individuals, families).

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning

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Objective: 05 Page and Header: 168, Descriptive Qualitative Studies 32. The terms “content analysis” and “thematic analysis” are usually associated with which of the following?

A) Descriptive phenomenology B) Descriptive qualitative research C) Ethnography D) Hermeneutics Ans: B Feedback: Many qualitative studies are not embedded in a research tradition. When researchers undertake a descriptive qualitative study, they often say that they have undertaken a content analysis or a thematic analysis. These terms are not associated with descriptive phenomenology, ethnography, or hermeneutics—all of which are qualitative research traditions.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 05 Page and Header: 169, Critical Theory 33. Critical research differs from traditional qualitative research in its: A) goal to be transformative.

B) use of interviews as a data source.

C) use of reflexivity.

D) desire to gain an in-depth understanding of phenomena.

Ans: A Feedback: Critical theory is concerned with a critique of existing social structures. Critical researchers conduct studies that involve collaboration with participants and that foster enlightened self-knowledge and transformation. This differs from traditional qualitative research, although critical research also uses qualitative methods. All of the other answers are true of qualitative research in general.

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Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 05 Page and Header: 169, Critical Theory 34. What is the central concern of a critical researcher?

A) A critique of the research methods of a completed study B) A critique of society and social practices C) A critique of existing theories D) A critique of self Ans: B Feedback: A critical researcher is concerned with a critique of society and with envisioning new possibilities. The broad aim of critical social science is to integrate theory and practice such that people become aware of contradictions and disparities in their beliefs and social practices and become inspired to change them. Critical research does not involve a critique of the self, existing theories, or research methods.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 05 Page and Header: 169, Research With Ideological Perspectives 35. Which is not a type of research with an ideological perspective?

A) Critical ethnography B) Constructivist grounded theory C) Participatory action research D) eminist research Ans: B Feedback:

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Constructivist grounded theory is not an approach that is linked to ideological perspectives; all of the other answers are types of research with an ideological perspective. Critical ethnography focuses on raising consciousness in the hope of effecting social change. Feminist research aims at being transformative, with a focus on how gender domination and discrimination shape women’s lives.

Participatory action research (PAR) produces knowledge through close collaboration with groups that are vulnerable to control or oppression by a dominant culture.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 05 Page and Header: 169, Research With Ideological Perspectives 36. Which statement about ideologically based research is true?

A) Critical researchers and feminist researchers interact with participants in collaborative ways that emphasize participants’ expertise.

B) Critical theory has played an especially important role in phenomenology (critical phenomenology).

C) Critical research has often been criticized for being exploitative.

D) Participatory action research is typically undertaken in the organization with which the researcher is affiliated.

Ans: A Feedback: Critical and feminist researchers, as well as participatory action researchers, seek to establish collaborative and nonexploitative relationships with their informants and to conduct research that is transformative. Critical theory has played an especially important role among ethnographers, not phenomenologists.

Participatory action research is conducted with disadvantaged groups or communities that are oppressed by a dominant group, which is not typically the case in organizations with which researchers are affiliated.

Format: Multiple Choice Chapter: 10 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 05

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Page and Header: 170, Participatory Action Research 37. In which approach do researchers work in vulnerable communities and collaborate with participants in defining the problem, selecting research methods, and analyzing and interpreting the data?

A) Critical ethnography B) Participatory action research C) Feminist research D) Critical grounded theory Ans: B Feedback: In participatory action research (PAR), the researchers and study participants— often residents in vulnerable communities—collaborate on a wide range of research activities, including the definition of the problem and various methodological and interpretive decisions. Critical ethnography and feminist research are two other types of research with an ideological perspective, but full collaboration between researchers and participants is not typical. There is no such thing as critical grounded theory.

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Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 01 Page and Header: 175, Sampling in Qualitative Research 1. Which best describes a typical sample in qualitative studies?

A) Large and randomly selected B) Small and randomly selected C) Large and not selected at random D) Small and not selected at random Ans: D Feedback: Qualitative samples tend to be small, nonrandom, and intensively studied.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 176, The Logic of Qualitative Sampling 2. In thinking about sampling for a qualitative study, a researcher might ask which question?

A) How many people do I need to achieve adequate power?

B) Who would be a rich information source for my study?

C) Will my sample be representative of the target population?

D) To which group will I be able to generalize my findings?

Ans: B Feedback: Qualitative researchers seek a relatively small number of study participants who will be rich sources of information about the phenomenon of interest. Large, representative samples that provide adequate power and permit generalizability are desirable in quantitative studies.

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Format: Multiple Choice Chapter: 11 Client Needs: Health Promotion and Maintenance Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 176, The Logic of Qualitative Sampling 3. Which statement is true regarding both quantitative and qualitative research?

A) Both involve the development of eligibility criteria before recruiting study participants.

B) Both involve the use of random samples whenever possible.

C) Both rely on power analysis to estimate sample size needs.

D) Generalizability is a major quality criterion in both types of research.

Ans: A Feedback: Both quantitative and qualitative researchers specify the criteria for a population of interest—that is, the characteristics of people would be eligible to participate in the study. Only in quantitative research do researchers use power analysis and select participants randomly if possible. Generalizability is not a quality criterion in qualitative research—although qualitative researchers do attend to the transferability of findings to other settings.

Format: Multiple Choice Chapter: 11 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 02, 07 Page and Header: 176, Types of Qualitative Sampling 4. A qualitative researcher studied women’s decision to delay childbearing until their late 30s. Initial study participants referred friends who had made similar decisions. What type of sample is being used with such referrals?

A) Convenience B) Volunteer C) Snowball D) Purposive Ans: C

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Feedback: Snowball sampling involves asking early participants to refer other study participants who meet the eligibility criteria and have experienced the phenomenon of interest. Convenience sampling (also called volunteer sampling) involves selecting the most readily available persons to participate. Purposive sampling is selecting cases based on the researcher’s judgment about who will be most informative.

Format: Multiple Choice Chapter: 11 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 176, Types of Qualitative Sampling 5. Which is a potential drawback of convenience (volunteer) sampling in qualitative research?

A) Convenience sampling is only useful at the end of the sampling process.

B) Convenience sampling is too expensive.

C) Convenience sampling is inefficient.

D) Convenience sampling may not yield the most information-rich sources.

Ans: D Feedback: Sampling by convenience is efficient and relatively inexpensive but is not a preferred approach, even in qualitative studies because it is not the best way to recruit participants who can maximize the quality of the data. Convenience sampling, if used at all, is best used as a starting point for sampling at the beginning of a study, not at the end of sampling.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 176, Types of Qualitative Sampling 6. Which statement about sampling is true?

A) Convenience sampling is used by both quantitative and qualitative researchers.

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B) Quantitative researchers establish eligibility criteria, but qualitative researchers do not.

C) Another name for snowball sampling is volunteer sampling.

D) Qualitative researchers do not need to be as concerned as quantitative researchers about the quality of their samples.

Ans: A Feedback: Convenience sampling is used by both quantitative and qualitative researchers, but it is not the preferred approach by either group. Both quantitative and qualitative researchers identify eligibility criteria for their studies, and both are concerned about the quality of their samples (although they use different criteria for deciding what a “good” sample is). Another name for snowball sampling is network sampling, not volunteer sampling.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 02, 07 Page and Header: 176, Types of Qualitative Sampling 7. Qualitative sampling may begin with volunteer participants, but many studies eventually evolve to a broad sampling strategy in which the researcher focuses on the study’s information needs. What is the name of that broad strategy?

A) Convenience sampling B) Consecutive sampling C) Snowball sampling D) Purposive sampling Ans: D Feedback: Purposive sampling is a broad category of sampling that is a purposeful approach— that is, it is focused on the selection of cases that will best meet the substantive demands of the study. Convenience sampling and snowball sampling are methods that do not rely on the researcher’s judgments about whom to sample next.

Consecutive sampling is used in quantitative studies, not qualitative ones.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care

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Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 177, Purposive Sampling 8. A nurse researcher studied barriers to smoking cessation among pregnant women. The study involved in-depth interviews with 22 women who were selected to be different in terms of their parity, education, and length of time as a smoker.

Which sampling method was used?

A) Maximum variation sampling B) Typical case sampling C) Extreme case sampling D) Criterion sampling Ans: A Feedback: There are several types of purposive sampling, one of which (maximum variation sampling) involves purposefully selecting participants with variation on several key dimensions. In this example, the researcher deliberately included participants with a wide range of traits, who presumably would face diverse barriers to smoking cessation during their pregnancy. The other answers are for other forms of purposive sampling, but these methods were not used in this example.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 02, 07 Page and Header: 177, Purposive Sampling 9. A nurse researcher studied nursing students’ experiences of bullying in clinical placements, using a case study design with multiple cases. The researcher selected cases that involved persistent, severe bullying. Which sampling method was used?

A) Maximum variation sampling B) Typical case sampling C) Extreme case sampling D) Criterion sampling Ans: C Feedback:

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There are several types of purposive sampling, one of which (extreme case sampling) involves an effort to learn from the most unusual or extreme cases. In this example, the researcher selected cases that had experienced severe bullying and studied them in depth. The other answers are for other forms of purposive sampling, but these methods were not used in this example.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 02, 07 Page and Header: 177, Purposive Sampling 10. A nurse researcher studied how men coped with a diagnosis of prostate cancer.

The researcher concluded that early adjustment to the diagnosis involved a process provisionally described as “reframing.” The researcher then deliberately tried to sample people for whom reframing was not apparent. Which sampling method was used toward the end of this study?

A) Criterion sampling B) Sampling disconfirming cases C) Extreme case sampling D) Maximum variation sampling Ans: B Feedback: Sampling disconfirming cases, which tends to be used toward the end of data collection, is a purposive approach that involves searching for cases that challenge researchers’ interpretations. The negative cases may be exceptions that refute earlier conceptualizations and suggest rival explanations about the phenomenon.

The other answers are for other forms of purposive sampling, but these sampling strategies do not involve a search for “disconfirming” cases.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 02, 07 Page and Header: 176, Purposive Sampling 11. Which of the following is not a type of purposive sampling?

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A) Extreme case sampling B) Maximum variation sampling C) Snowball sampling D) Typical case sampling Ans: C Feedback: There are several variants of purposive sampling, but snowball sampling is not one of them. Snowball sampling uses referrals from early study participants to recruit new participants and is not “purposeful.” All the other answers are types of purposive sampling.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 176, Types of Qualitative Sampling 12. Which statement about sampling in qualitative research is true?

A) Convenience sampling is considered the most appropriate method of selecting sample members.

B) Larger samples are considered more useful than smaller samples.

C) Using randomness in the sampling process is desirable, especially at the beginning of the study.

D) The type of sampling approach can change and evolve over the course of data collection.

Ans: D Feedback: In qualitative studies, the sampling strategy can change over the course of a study.

Qualitative sampling may begin with a convenience sample, but many studies evolve to a purposive strategy in which researchers choose the types of cases that will best contribute to the conceptualization. Sampling by convenience is not a preferred approach, even in qualitative studies. Qualitative researchers avoid random samples because they are not the best method of selecting people who will make good informants. Small samples are preferred because sample members can be studied intensively.

Format: Multiple Choice

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Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 02 Page and Header: 177, Theoretical Sampling 13. Which qualitative research tradition relies on theoretical sampling?

A) Ethnography B) Descriptive phenomenology C) Interpretive phenomenology D) Grounded theory Ans: D Feedback: Theoretical sampling is a sampling approach used primarily by grounded theory researchers, not by ethnographers or phenomenologists. The goal in a grounded theory study is to select informants who can best contribute to the evolving theory.

Format: Multiple Choice Chapter: 11 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 177, Theoretical Sampling 14. Qualitative researchers use theoretical sampling to: A) find cases that meet a predetermined criterion of importance.

B) select participants who will help to develop and refine the emerging conceptualization.

C) learn about the phenomenon under study from the most unusual or extreme cases.

D) ensure diversity about characteristics deemed important to the phenomenon under study.

Ans: B Feedback:

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Theoretical sampling involves making decisions about where to find the best data to develop and refine an emerging theory or conceptualization. Sampling that involves studying cases that meet a predetermined criterion of importance is called criterion sampling. Extreme (deviant) case sampling provides opportunities for learning from the most unusual or extreme informants. The purposive strategy designed to ensure diversity on important characteristics is called maximum variation sampling.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 03, 07 Page and Header: 178, Sample Size in Qualitative Research 15. What is data saturation?

A) Sampling to the point at which new information continues to be obtained B) Sampling to the point at which the target population is saturated with requests for data C) Sampling to the point at which redundancy of information is achieved D) Sampling to the point at which maximum variation is achieved Ans: C Feedback: Data saturation occurs at the point at which no new information is obtained by adding new study participants and when redundancy is achieved (not when new information is still being gathered). Data saturation does not concern maximum variation or saturating the population with data requests.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 178, Sample Size in Qualitative Research 16. Which statement about sample size in qualitative research is true?

A) New researchers who have a fresh eye on phenomena can get by with smaller samples than more experienced researchers.

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B) If the quality of data being collected is exceptionally strong, a smaller sample may suffice than when data quality is mediocre.

C) Typical case sampling requires more participants than maximum variation sampling.

D) Sampling for qualitative studies should stop before information becomes redundant.

Ans: B Feedback: With rich, high-quality data, fewer cases may be needed to achieve a good understanding of the phenomenon of interest. New researchers usually need a larger (not a smaller) sample than experienced researchers, who are likely to be more adept at eliciting high-quality data. Maximum variation samples are typically larger than typical case samples. Qualitative researchers need to achieve redundancy of information to recognize when sampling can stop.

Format: Multiple Choice Chapter: 11 Client Needs: Psychosocial Integrity Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 178, Sampling in Ethnography 17. Which statement about sampling in ethnographic studies is true?

A) Ethnographers sample not only people but also events, records, artifacts, and other features of a culture.

B) Ethnographers usually have at least 100 key informants in their samples.

C) Ethnographers avoid conversing with many people, restricting their sample to a few expert cultural consultants.

D) Ethnographers select key informants using convenience sampling.

Ans: A Feedback: To fully understand a culture, ethnographers sample not only people but also other things to observe, such as activities and products of the culture. Ethnographers typically work with a relatively small sample of key informants, but they often begin by having conversations with dozens of members of the culture. Key informants are then selected purposively, using a framework that helps the researchers understand the types of people needed to understand the culture.

Format: Multiple Choice

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Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 178, Sampling in Phenomenological Studies 18. Ten women participated in a nurse researcher’s study of the experience of alcohol-related intimate partner abuse. This is most likely to be the sample for which type of study?

A) A phenomenological study B) A grounded theory study C) An ethnography D) A descriptive qualitative study Ans: A Feedback: Phenomenologists tend to rely on very small samples of participants—typically 15 or fewer. Samples are typically larger in ethnographic, grounded theory, and descriptive qualitative studies.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 178, Sampling in Phenomenological Studies 19. Which statement about sampling in phenomenological studies is true?

A) The sample size in phenomenological studies varies widely, from a single participant to 50 or more, depending on the phenomenon of interest.

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B) Phenomenological researchers sample not only people but also events, activities, diaries, and records relating to the target phenomenon.

C) The sample size in phenomenological studies is typically 15 or fewer participants.

D) An eligibility criterion for a phenomenological study is that participants must belong to a particular culture or social group.

Ans: C Feedback: In a phenomenological study, the sample is typically very small (15 or fewer). A key eligibility criterion is that the participants must be people who have experienced the phenomenon of interest. Unlike ethnographers, phenomenologists primarily sample people, with whom they have in-depth discussions rather than activities, events, or artifacts. Participants do not have to be members of a particular culture or social group in a phenomenological study.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 179, Sampling in Phenomenological Studies 20. Which is a key criterion for being included in a sample for a phenomenological study?

A) The person must belong to a particular culture or social group.

B) The person must have considerable factual knowledge about the phenomenon being studied.

C) The person must be willing to be exposed to the phenomenon under study.

D) The person must have experienced the phenomenon being studied.

Ans: D Feedback: Two principles guide the selection of a sample for a phenomenological study: (1) All participants must have experienced the phenomenon and (2) they must be able to articulate what it is like to have lived that experience. Having considerable factual knowledge about the phenomenon is not a key criterion, nor is being a member of a particular social or cultural group. Willingness to experience the phenomenon is not relevant—the experience must already have happened.

Format: Multiple Choice

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Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 179, Sampling in Grounded Theory Studies 21. Which statement about sampling in grounded theory studies is true?

A) Grounded theory researchers start with theoretical sampling and then later evolve to a snowballing approach.

B) In a grounded theory study, sampling, data collection, data analysis, and theory construction occur concurrently and iteratively.

C) Grounded theory researchers do not use the principle of data saturation in their sampling approach.

D) Grounded theory studies typically involve samples of 50 to 60 people.

Ans: B Feedback: In a grounded theory study, researchers typically move through several sampling strategies—while collecting and analyzing their data—to find people who best contribute to an evolving theory. They may start with convenience sampling, but they eventually use theoretical sampling as the theory emerges. Grounded theory studies typically involve 20 to 30 participants. Saturation is the principle used in grounded theory studies (and other qualitative studies) to guide decisions about when to stop sampling new participants.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 03, 07 Page and Header: 179, Critically Appraising Qualitative Sampling Plans 22. Which of the following is used to support the transferability of qualitative research findings?

A) Thick description B) Data saturation C) Key informants D) Disconfirming cases Ans: A

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Feedback: Thick description is a term that refers to richly thorough depictions of research settings and the sample of study participants (or events); thick description is needed in qualitative reports to support transferability of findings to other settings or groups. Data saturation, key informants, and disconfirming cases are not strategies that support transferability.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 179, Critically Appraising Qualitative Sampling Plans 23. There are different approaches to sampling in qualitative research, but several key features characterize most sampling strategies. Which is one of these features?

A) They all rely on samples with 15 or fewer informants.

B) The use of random or consecutive sampling is especially desirable.

C) Sampling plans are specified before the study gets underway.

D) Sample selection is driven by conceptual requirements, not by a desire for representativeness.

Ans: D Feedback: Qualitative researchers strive to meet conceptual requirements in selecting informants; representativeness is not a goal, and so qualitative samples are rarely randomly or consecutively selected. Qualitative sampling is emergent, not specified in advance of the study. Some qualitative studies have 15 or fewer participants, but many have 20 or more.

Format: Multiple Choice Chapter: 11 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Difficulty: Easy Integrated Process: Nursing Process Objective: 04 Page and Header: 180, Data Collection in Qualitative Studies 24. Which statement about data collection in qualitative studies is true?

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A) Qualitative researchers are as likely as quantitative researchers to gather biophysiological data.

B) Qualitative researchers typically incorporate scales into their data collection protocols.

C) The main source of data for qualitative studies is in-depth interviews.

D) The research tradition that uses the greatest diversity of data sources is phenomenology.

Ans: C Feedback: In all qualitative traditions, in-depth interviews are used to gather data and are a leading data source. Qualitative researchers rarely collect biophysiological data or use psychosocial scales. Ethnographers rather than phenomenological researchers rely on a great diversity of data sources—they use interviews and participant observation and also gather information from records, photographs, and other cultural artifacts.

Format: Multiple Choice Chapter: 11 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 181, Types of Qualitative Self-Reports 25. A nurse researcher is studying parents’ experiences of having a child diagnosed with leukemia. The researcher began the interview by asking “Can you tell me what it was like when you first learned that your child had leukemia?” This is an example of which type of question?

A) A focused question B) A grand tour question C) A brainstorming question D) A topical question Ans: B Feedback: The question in this example is a broad, unstructured question designed to launch an in-depth discussion of the parents’ feelings and experiences relating to their child’s diagnosis. Such a question is called a “grand tour” question and would be followed by more focused questions. It is not a “brainstorming question” or a “topical question”—these are not research terms.

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Format: Multiple Choice Chapter: 11 Client Needs: Psychosocial Integrity Cognitive Level: Apply Difficulty: Moderate Integrated Process: Caring Objective: 04 Page and Header: 181, Types of Qualitative Self-Reports 26. A nurse researcher is interviewing participants who survived a major earthquake. Which is the best example of a grand tour question for this study?

A) At what point did you evacuate the area?

B) What kind of damage did your home sustain?

C) What was it like to live through an earthquake?

D) Where were you at the time the earthquake occurred?

Ans: C Feedback: A grand tour question is a broad question asked early in an unstructured interview to gain a general overview of a phenomenon, from which more focused questions are asked—here, a question about what it was like to experience an earthquake.

The other questions are much more focused and in some cases would be more appropriate in a structured interview for a quantitative study (e.g., the question about where the person was when the earthquake occurred, for which response options could be created).

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 04, 07 Page and Header: 181, Types of Qualitative Self-Reports 27. A nurse researcher is studying nurses’ experiences with ethically difficult situations and has a list of question areas that need to be covered in each interview. What is that list called?

A) A photo elicitation B) A topic guide C) An interview schedule D) A questionnaire Ans: B

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Feedback: A topic guide is a list that includes the question areas or topics that the researcher wishes to cover in the course of a semistructured interview. Unlike questionnaires and interview schedules, which are used in quantitative studies, topic guides do not dictate the order in which questions are to be asked or the specific wording of questions. Photo elicitation is an interview technique involving photographs, and it is not a list of question areas.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 181, Types of Qualitative Self-Reports 28. Which statement about topic guides is true?

A) Topic guides are the backbone of ethnographic interviews.

B) Topic guides include a mix of open-ended and closed-ended questions.

C) The first question on topic guides is a grand tour question.

D) Topic guides are often used to guide discussions in focus group interviews.

Ans: D Feedback: Topic guides are used in focus group interviews to ensure that all topics of interest to the researcher are discussed. Topic guides are sometimes used in ethnographic studies, but unstructured interviews without a topic guide are more typical. Topic guides almost always include only open-ended questions. The first question on a topic guide is not necessarily a grand tour question—topic guides include a list of question areas but do not dictate the order in which questions are asked.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 181, Types of Qualitative Self-Reports 29. Which statement about focus groups is true?

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A) Focus group interviews involve going around the room and asking each person in the group the same question.

B) The person guiding a focus group interview is called a moderator.

C) Focus groups are less efficient than individual interviews.

D) Focus group sessions typically involve about 20 people.

Ans: B Feedback: Moderators lead focus group discussions and play a crucial role in the quality of focus group data. Focus group interviews are discussions among group members and do not involve asking everyone in the room the same question. Focus groups are more efficient than individual interviews because data from many people are gathered simultaneously. Most focus group sessions involve groups of 5 to 10 people.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 04, 07 Page and Header: 182, Types of Qualitative Self-Reports 30. An ethnographer is studying the culture of a refugee community in Toronto. The interviews take place in the participants’ homes, and the interviewer asks participants to talk about family pictures and souvenirs that are on display. What type of interview is this?

A) A focus group interview B) Photovoice interview C) A photo elicitation interview D) A structured interview Ans: C Feedback: Photo elicitation involves an interview stimulated and guided by existing photographic images, as is the case in this example. It is not an example of photovoice, which involves the researcher asking participants to take photographs of their world and interpreting those pictures for the researcher. This is not a focus group interview or structured interview.

Format: Multiple Choice Chapter: 11

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Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 182, Gathering Qualitative Self-Report Data 31. Which statement about collecting self-report data in qualitative research is true?

A) Most qualitative researchers audiorecord their interviews for later transcription.

B) The most common method of conducting in-depth qualitative interviews is over the telephone.

C) Interviews for qualitative studies are conversational, so researchers avoid doing any preparation that could reduce spontaneity.

D) When interviewing participants, qualitative researchers ask their questions in a predetermined order to avoid bias.

Ans: A Feedback: The best way to have a good record of what participants say in an in-depth interview is to record the interview and then have the recording transcribed.

Qualitative researchers do not have a set of questions that must be asked in a specific order. Although qualitative interviews are conversational, interviewers benefit from advance planning, such as learning how best to word questions to match participants’ world view and language. Qualitative interviews are seldom conducted over the telephone because it is more difficult to establish rapport and trust over the telephone than in person.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 05 Page and Header: 183, Qualitative Observational Methods 32. Which statement about unstructured observation is true?

A) Unstructured observation is synonymous with participant observation.

B) Participant observation involves prolonged periods of social interaction between researchers and participants.

C) Researchers seek to gain “front stage” knowledge of the group or culture under study.

D) Participant observation is a technique unique to ethnographers.

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Ans: B Feedback: Participant observation can only be successful when researchers spend prolonged periods of time in the field and gain the trust of members of the group being studied. Not all observation for qualitative studies involves participation, and so unstructured observation is not synonymous with participant observation.

Observers seek not to be restricted to “front stage” knowledge, which typically involves a protective façade against outsiders. Qualitative traditions other than ethnography (e.g., grounded theory) sometimes use participant observation as a method of data collection.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 05 Page and Header: 183, Gathering Participant Observation Data 33. Which statement about participant observation is true?

A) Participant observers usually maintain the same level of participation throughout the study.

B) In a participant observation study, participants are observed but not questioned.

C) Participant observers typically use a combination of strategies for positioning themselves during observations.

D) Participant observers most commonly record their observations by videotaping the events and transactions they observe.

Ans: C Feedback: Participant observers often use a combination of positioning approaches, such as staying in a single location (single positioning), moving around the site (multiple positioning ), or following a person (mobile positioning). The level of participation usually evolves over the course of a study, with growing levels of participation as trust is gained. Participant observers seldom video record their observations, as this would undermine their status as a participating member. Participant observation almost always involves gathering self-report as well as observational data.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care

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Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 05, 07 Page and Header: 184, Gathering Participant Observation Data 34. A nurse researcher undertakes participant observation in an intensive care unit.

On 10 consecutive days, the researcher shadows a different staff member and observes his or her behavior and actions. This is an example of which type of positioning?

A) Single positioning B) Multiple positioning C) Mobile positioning D) Selective positioning Ans: C Feedback: Mobile positioning involves following a person throughout a given activity or period—in this example, a different member of the ICU staff each day. Single positioning involves staying in a single spot to observe behaviors in that location.

Multiple positioning involves moving around the site to observe behaviors from different locations. The term selective positioning is not used in connection with participant observation.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Easy Integrated Process: Nursing Process Objective: 05 Page and Header: 184, Gathering Participant Observation Data 35. Participant observers can gather a wide range of information about a group or setting under study. Which question is least likely to be considered relevant from a substantive point of view in a participant observation study?

A) What are the key activities of this group and how often do they occur?

B) What are the roles and characteristics of the people being observed?

C) How often do people communicate and interact with each other?

D) Where will I be able to charge the electronic devices needed for data collection?

Ans: D Feedback:

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Researchers address various questions of substantive interest in their observations of a group or community under study, such as how communication is patterned, what the group’s activities are, and what roles people play in the group. Being able to charge one’s electronic devices may well affect the study, but it is not a substantive concern.

Format: Multiple Choice Chapter: 11 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 05, 07 Page and Header: 184, Recording Observations 36. What information is kept in an observational log?

A) Reflective notes about the observer’s personal experiences and reflections B) An interpretation of what the observer witnessed C) Notes on what the observer would like to pursue the next day D) A record of what the observer did in the field each day Ans: D Feedback: A log (or field diary) is a daily record of events and conversations in the field. It is a chronological listing of how researchers spent their time. The other answers are recorded in field notes. Field notes are broader and more interpretive than logs— they represent the observer’s efforts to record information and to synthesize and understand the data as well as to make note of suggested strategies for future data collection.

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Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 190, Rationale for Mixed Method Research 1. Mixed methods research offers several advantages. Which is one of those advantages?

A) The potential for enhanced validity B) The cost-effectiveness of using two methods simultaneously C) The opportunity for multiple publications D) The ability to complete the study fairly quickly Ans: A Feedback: When a hypothesis is supported by complementary types of data in a mixed methods (MM) study, researchers can be more confident about the validity of their conclusions. MM studies are typically time-consuming and expensive. MM research might lead to many publications, but this is not a specific advantage; single-strand studies can also lead to numerous publications.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 190, Rationale for Mixed Method Research 2. The integration of quantitative and qualitative approaches in a single study constitutes a form of: A) hypothesis testing.

B) theory generation.

C) triangulation.

D) methodological research.

Ans: C Feedback:

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Triangulation involves the use of multiple approaches to converge on the truth, and that is what occurs in mixed methods research. When a hypothesis or model is supported by multiple and complementary types of data, researchers can be more confident about their inferences. Hypothesis testing and theory generation do not require the integration of quantitative and qualitative approaches. Methodological research entails investigations of the methods for conducting rigorous research; most methodological research is quantitative.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 190, Rationale for Mixed Method Research 3. Which of the following statements is true of mixed methods research?

A) Quantitative and qualitative methods are complementary and can help researchers avoid the limitations of a single approach.

B) A mix of qualitative and quantitative research should be used in all research studies.

C) Using mixed methods is not as popular as a research strategy as it was a decade ago.

D) An advantage of mixed methods research is that people are more likely to participate because the experience is enjoyable.

Ans: A Feedback: Quantitative and qualitative approaches are complementary. By using mixed methods, researchers might avoid the limitations of a single approach. Mixed methods research can be useful but is not needed or appropriate for all studies.

Mixed methods research is growing, not waning, in popularity. It is no easier to recruit participants for a mixed methods study than for other studies—and it may be more difficult if the time demands are greater.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 01, 05 Page and Header: 190, Rationale for Mixed Method Research

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4. What paradigm has most often been associated with mixed methods research?

A) Positivism B) Constructivism C) Pragmatism D) Postpositivism Ans: C Feedback: The paradigm called pragmatism is most often associated with mixed methods research. Pragmatist researchers consider that the questions in which researchers are interested should drive the inquiry and that the questions are more important than the methods needed to answer them. Positivism and postpositivism are the paradigms associated with quantitative research, and constructivism is the paradigm associated with qualitative research.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 190, Purposes and Applications of Mixed Methods Research 5. Which of the following is an important application of mixed methods research?

A) Measuring costs and benefits of an intervention B) Instrument development C) Planning a pilot study D) Assessing the reliability of a new instrument Ans: B Feedback: New instruments are often developed by combining qualitative and quantitative data collection approaches. Mixed methods research is often used in developing an intervention but not for undertaking a cost/benefit analysis, which relies on quantitative methods. Mixed methods may be used in a pilot study but not in planning for one. Assessing the reliability of an instrument relies on quantitative methods.

Format: Multiple Choice Chapter: 12

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Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 190, Purposes and Applications of Mixed Methods Research 6. Several situations lend themselves particularly well to mixed methods research.

Which situation is not one of them?

A) An intervention needs to be developed with input from stakeholders, and then a rigorous, formal evaluation will be needed.

B) The complexity of the problem makes a single approach inadequate.

C) The creation of a formal instrument is desired, but first, the concepts need to be better understood.

D) The qualitative results are puzzling, and quantitative results will help to explain them.

Ans: D Feedback: If qualitative results are puzzling, it is unlikely that quantitative results would help to interpret them—although the reverse is true. The other situations are ones that lend themselves very well to mixed methods research.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 190, Purposes and Applications of Mixed Methods Research 7. A nurse researcher conducted a mixed method (MM) study about elders who delayed responding to symptoms of heart failure. One research question was “Among elderly patients with heart failure, what are the most frequent symptoms?”

Which of the following would be a particularly likely second research question in this MM study?

A) “What are the characteristics of people who delay in responding to their symptoms?”

B) “Which symptom is associated with the longest delays in responding to the symptom?”

C) “How long a delay is associated with the symptom of dyspnea?”

D) “Why do elderly patients delay responding to heart failure symptoms?”

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Ans: D Feedback: The first question in this example calls for quantitative data (Which symptoms are most frequent?). In a mixed method study, the second question would be qualitative. Of the four response options, only the question that asks why elderly patients delay responding to a symptom calls for in-depth qualitative data.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 191, Design Decisions and Notation 8. Which of the following is a key design decision in mixed methods studies?

A) Whether to collect both quantitative and qualitative data B) How the quantitative and qualitative strands should be sequenced C) How to combine sequential and concurrent strands D) Whether to tell participants that the study is mixed methods Ans: B Feedback: The sequencing of strands is a major design decision—i.e., whether to collect quantitative and qualitative data simultaneously or in a specified sequence. By definition, a mixed methods study involves collecting both quantitative and qualitative data. There is no such thing as a sequential or a concurrent “strand.”

Telling people about the study design is not a design decision—and most laypeople would not understand the “mixed methods” terminology.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 05 Page and Header: 191, Design Decisions and Notation 9. Some mixed methods designs are sequential. What is a sequential design?

A) The two strands occur in a single simultaneous phase.

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B) The two strands occur prior to informing the third and fourth strands.

C) The first strand occurs prior to the second strand.

D) The sequencing of strands is selected at random.

Ans: C Feedback: In terms of sequencing, mixed method designs are either concurrent (wherein the quantitative and qualitative strands are undertaken in one simultaneous phase) or sequential (wherein one strand occurs prior to the second strand and informs that second strand). There are only two strands—qualitative and quantitative—not three or four, although there may be three or more phases in a sequential design. The sequencing of strands is purposeful and not selected at random.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 05 Page and Header: 191, Design Decisions and Notation 10. Which are the options for prioritization in a mixed methods study?

A) Concurrent and sequential B) Quantitative and qualitative C) Equal and dominant D) Explanation and exploration Ans: C Feedback: Researchers design a mixed methods study such that either the qualitative and quantitative strands have equal priority, or one of the strands is more dominant than the other. Concurrent and sequential are options for sequencing, not for prioritization. Two specific mixed methods designs are explanatory and exploratory, but these are not options for prioritization of strands.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02

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Page and Header: 191, Design Decisions and Notation 11. In the standard notation for mixed methods designs, what does the following notation signify? QUAN -> qual A) An equal priority concurrent design B) An equal priority sequential design C) A sequential design with the qualitative strand dominant D) A sequential design with the quantitative strand dominant Ans: D Feedback: The arrow indicates that the design is sequential, with the quantitative strand being implemented first. The strand in all caps (here, QUAN) indicates the dominant strand (i.e., the quantitative strand).

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 191, Specific Mixed Methods Designs 12. In the standard notation for mixed methods designs, what does the notation QUAL + QUAN signify?

A) An equal priority concurrent design B) An equal priority sequential design C) A sequential design with the qualitative strand dominant D) A sequential design with the quantitative strand dominant Ans: A Feedback: The plus sign indicates that the design is concurrent (all data collected in a single phase). Both strands are in all caps, which indicates the equal priority of the qualitative and quantitative strands.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult

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Integrated Process: Teaching/Learning Objective: 02, 05 Page and Header: 191, Specific Mixed Methods Designs 13. A nurse researcher used a QUAL + QUAN design to explore anxiety and depression among adults who had an older parent in hospice care in a distant location. Using the Creswell and Plano Clark design terminology, which specific design did the researcher use?

A) Explanatory design B) Convergent design C) Exploratory design D) Embedded design Ans: B Feedback: In a convergent design, researchers obtain different, but complementary, data about the central phenomenon under study. In this design, qualitative and quantitative data are collected simultaneously and with equal priority. Explanatory and exploratory designs are not concurrent. “Embedded” is a term used to designate a design in which the second strand is subservient to the dominant strand, but it is no longer considered a type of design in the Creswell and Plano Clark typology.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 02, 05 Page and Header: 192, Specific Mixed Methods Designs 14. A nurse researcher studied HIV risk factors and protective behaviors among bisexual men using a QUAN -> qual design. Data were initially collected from 80 men using a structured questionnaire. In-depth follow-up interviews were then conducted with a subsample of 20 men to help build on, explain, and interpret the results. Using the Creswell and Plano Clark design terminology, which specific design did the researcher use?

A) Explanatory design B) Convergent design C) Exploratory design D) Case-control design Ans: A

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Feedback: Explanatory designs are sequential designs with quantitative data collected in the first phase, followed by qualitative data collected in the second phase—typically with QUAN being dominant. A convergent design is concurrent, and in an exploratory design, qualitative data are collected in the initial phase. Case-control designs are not typically mixed methods studies and are not part of the Creswell and Plano Clark design typology.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 05 Page and Header: 192, Sampling and Data Collection in Mixed Methods Research 15. A nurse researcher studied HIV risk factors and protective behaviors among bisexual men using a QUAN -> qual design. Data were initially collected from 80 men using a structured questionnaire. In-depth follow-up interviews were then conducted with a subsample of 20 men to help build on, explain, and interpret the results. Which sampling design did the researcher use?

A) Quota sampling B) Snowball sampling C) Consecutive sampling D) Nested sampling Ans: D Feedback: In this nested sampling design, participants in the qualitative strand are a subset of the participants in the quantitative strand. Nested sampling is an especially common sampling approach in mixed methods studies with an explanatory design, as in this example. There is no information about how the 80 men were originally sampled—we have no information to suggest it was consecutive, quota, or snowball sampling.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02

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Page and Header: 192, Sampling and Data Collection in Mixed Methods Research 16. In terms of data collection in mixed methods studies, an option is for researchers to use: A) intramethod mixing.

B) interdisciplinary mixing.

C) no mixing.

D) exploratory mixing.

Ans: A Feedback: Many mixed methods studies use intramethod mixing—for example, using both structured and unstructured self-reports. Another alternative in MM studies is intermethod mixing—for example, biomarkers and unstructured interviews. There is always some type of mixing in mixed methods research. Interdisciplinary mixing of team members often occurs but not in terms of data collection. There is no such term as exploratory mixing.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 195, Quality Improvement Approaches 17. A researcher used the Plan-Do-Study-Act model to develop and assess a perioperative hand-off tool and standardized process for improving communication.

What type of inquiry was this?

A) A secondary analysis B) A methodological study C) A quality improvement study D) A survey Ans: C Feedback: The Plan-Do-Study-Act (PDSA) model was designed as a tool for supporting quality improvement initiatives. PDSA is not a tool used in secondary analyses, methodological studies, or surveys.

Format: Multiple Choice

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Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 193, Quality Improvement 18. What do quality improvement projects, research, and EBP projects have in common?

A) They all require approval from an ethics board (e.g., an Institutional Review Board).

B) They all use systematic methods to address health problems and to foster improvement in health care.

C) They are all specifically designed to yield generalizable knowledge.

D) They have all been a major force in health care for over a century.

Ans: B Feedback: Quality improvement (QI), evidence-based practice (EBP) projects, and scientific research in health fields all have a goal of generating information that can be used to improve the delivery of health care or solve health care problems using systematic methods. Most QI and EBP projects do not need approval from an ethics board. Only research has an explicit goal of yielding generalizable knowledge. EBP and QI are fairly recent developments, both gaining tremendous momentum within the past 30 years.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 194, Quality Improvement Planning Tools 19. Quality improvement (QI) teams often undertake which of the following to identify underlying process deficiencies?

A) A lean analysis B) A process analysis C) A time-series analysis D) A root cause analysis

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Ans: D Feedback: QI teams often undertake a root cause analysis that involves efforts to identify underlying causes of problems and deficiencies. “Lean” is the name of a model to guide the overall conduct of a QI project. A process analysis is a term used in connection with evaluation research, not QI. Times-series designs are powerful designs in QI projects, but they are not used to identify process deficiencies.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 04 Page and Header: 196, Clinical Trials 20. Clinical trials to test new interventions often adhere to a sequence of phases.

Which phase of a clinical trial is a full test of the intervention’s efficacy in controlled settings, typically involving the use of a true experimental design?

A) Phase I B) Phase II C) Phase III D) Phase IV Ans: C Feedback: Phase III is a rigorous test of the new treatment under controlled conditions, involving the use of a randomized design. Phase I involves initial tests for safety, phase II involves pilot tests of the intervention, and phase IV involves efforts to find evidence of broader effectiveness.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 04 Page and Header: 196, Clinical Trials

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21. Clinical trials to test a new intervention often adhere to a sequence of phases.

Which phase of a clinical trial focuses on the generalizability of findings?

A) Phase I B) Phase II C) Phase III D) Phase IV Ans: D Feedback: Phase IV studies focus on the effectiveness of an intervention in a broad population; the emphasis in this phase is on external validity (generalizability) and cost-effectiveness. Phase I involves initial tests for safety, phase II involves pilot tests of the intervention, and phase III is a rigorous test of intervention effectiveness using a randomized design.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 04, 05 Page and Header: 197, Evaluation Research 22. In a process analysis, which would most likely be the researcher’s goal?

A) To assess whether a program was meeting its objectives B) To describe how a program was implemented and how it functions C) To evaluate the program’s effectiveness D) To weigh a program’s benefits against its monetary costs Ans: B Feedback: Evaluation research could address all of the objectives listed as answers, but in a process analysis, the researcher seeks descriptive information about the process by which a program gets implemented and how it actually functions.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning

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Objective: 04, 05 Page and Header: 197, Evaluation Research 23. In an economic analysis, which would most likely be the researcher’s goal?

A) To assess whether a program was meeting its objectives B) To describe how a program was implemented C) To evaluate the program’s effectiveness D) To weigh a program’s benefits against its monetary costs Ans: D Feedback: Evaluation research could address all of the objectives listed as answers, but in an economic analysis, the researcher seeks to assess whether the benefits (i.e., the positive effects of a program or intervention) outweigh its monetary costs. Without such assessments, administrators cannot decide whether an effective intervention is viable financially.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 197, Evaluation Research 24. A nurse researcher wanted to assess the effectiveness of a program for encouraging adolescent mothers to avoid a second pregnancy. What type of research would this be considered?

A) A survey B) An evaluation C) A methodological study D) A secondary analysis Ans: B Feedback: Evaluation research assesses the effectiveness of a program or policy, usually with the overall goal of assisting decision makers in choosing a course of action (e.g., whether to keep or modify it). Survey research examines people’s characteristics and opinions by asking them to answer questions. In methodological research, investigators develop and assess methodological strategies. Secondary analyses are studies in which researchers analyze previously collected data.

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Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 04 Page and Header: 197, Evaluation Research 25. Which statement about evaluation research is true?

A) Evaluation studies often use mixed methods designs.

B) An evaluation study would not use an experimental design.

C) Evaluations rely on quantitative data exclusively.

D) Cost analyses are undertaken at the beginning of an evaluation.

Ans: A Feedback: Evaluations often involve the collection of both qualitative data (e.g., in process analyses) and quantitative data (e.g., in cost analyses). For questions about the effectiveness of a program or policy, a true experimental design is often used. Cost analyses are undertaken near the end of an evaluation—after evidence about effectiveness has been gathered.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04, 05 Page and Header: 197, Nursing Intervention Research 26. Which typically occurs in nursing intervention research?

A) The development of an intervention theory B) The generation of data amenable for use in secondary analyses C) The inclusion of a methodological research component D) The use of a structure/process/outcomes framework Ans: A Feedback:

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The construct validity of a new intervention is enhanced through efforts to develop an intervention theory that articulates what must be done to achieve desired outcomes. Intervention can sometimes yield data for secondary analysis, but this is not necessarily the case. Some intervention research could involve a methodological component (e.g., developing a new scale), but this is not typical.

The structure/process/outcomes framework is a feature of outcomes research, not evaluation research.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 04 Page and Header: 198, Nursing Intervention Research 27. Which of the following is a central issue during the pilot phase of an intervention project?

A) Cost-effectiveness B) Feasibility C) Efficacy D) Utility in real-world settings Ans: B Feedback: A key issue in the second phase of an intervention project is whether the intervention can be implemented as conceptualized—that is, whether it is feasible.

Cost-effectiveness and efficacy are issues of concern during the main evaluation phase. Broad effectiveness and utility in real-world settings are the focus in the final phase.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 04 Page and Header: 198, Nursing Intervention Research 28. The development and testing of a complex intervention involve several phases.

Which phase involves an assessment of such issues as recruitment and retention?

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A) The methodological phase B) The pilot testing phase C) The theory development phase D) The efficacy study phase Ans: B Feedback: A pilot test involves assessing the feasibility of implementing a new intervention, including an assessment of factors that affect implementation, such as recruitment and retention. The efficacy phase focuses on whether the new intervention yields significant benefits to those who receive it. An intervention theory, as well as the intervention itself, is developed in the initial phase. There is no “methodological phase” in intervention research.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 04 Page and Header: 197, Nursing Intervention Research 29. During the development phase of an intervention, which type of validity is especially salient?

A) Construct validity B) Internal validity C) Statistical conclusion validity D) External validity Ans: A Feedback: During the development phase, effort is devoted to establishing the construct validity of the intervention—especially in the development of intervention features consistent with an intervention theory. Internal validity and statistical conclusion validity play a prominent role during the evaluation of a new intervention, not during its development. External validity is most relevant after an intervention has been evaluated and found to have benefits for those in the full experimental test.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 04, 05 Page and Header: 198, Comparative Effectiveness Research 30. Which type of research is specifically designed to examine the benefits and harms of alternative interventions to prevent or treat a health condition?

A) Outcomes research B) Comparative effectiveness research C) Evaluation research D) Survey research Ans: B Feedback: Comparative effectiveness research (CER) involves direct comparisons of two or more health interventions. Neither outcomes research nor survey research involve tests of an intervention. Evaluation research evaluates the effectiveness of a program or policy, but it does not involve a direct comparison with an alternative program or policy.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04, 05 Page and Header: 199, Health Services and Outcomes Research 31. Which type of research has the goal of documenting and appraising health care and nursing services?

A) A process analysis B) Outcomes research C) An economic analysis D) Methodological research Ans: B Feedback:

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Outcomes research (a subset of health services research) is undertaken to document the quality and effectiveness of health care and nursing services. Process analyses describe the process by which a particular program gets implemented and how it functions in practice. Economic analyses involve assessments of whether the benefits of a particular program or intervention outweigh the monetary costs. In methodological research, investigators focus on the development and assessment of methodological strategies.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 199, Health Services and Outcomes Research 32. Donabedian created a widely used framework for outcomes research. Which of the following was not a factor in the original Donabedian framework?

A) Outcomes B) Interactions C) Processes D) Structures Ans: B Feedback: Donabedian created a framework for outcomes research that incorporated three factors: structure, process, and outcomes. Interaction was not a factor in the framework.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 04 Page and Header: 199, Health Services and Outcomes Research 33. Which statement relating to outcomes research is true?

A) Attributing patient outcomes to nursing actions is fairly straightforward because of the emergence of classification systems.

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B) The American Academy of Nursing rejected Donabedian’s framework and created the Nursing Outcomes Model as an alternative.

C) Nursing-sensitive outcomes are patient outcomes that are affected by the quality and quantity of nursing care.

D) In the Donabedian’s framework, nursing process variables include nursing skill mix and nursing experience.

Ans: C Feedback: Nursing-sensitive outcomes are patient outcomes that improve if there is a greater quantity or quality of nurses’ care (e.g., patient falls, pressure ulcer incidence). The attribution of patient outcomes to nursing outcomes is difficult because of the complexity of actions by the health care team. The American Academy of Nursing modified (but did not reject) Donabedian’s framework and developed the Quality Health Outcomes Model. Nursing skill mix and nursing experience are structural variables, not process variables.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 200, Survey Research 34. A nurse researcher gathered data from a national sample of nurses regarding fatigue and burnout by sending out a mailed questionnaire. This is an example of: A) a survey.

B) an evaluation.

C) outcomes research.

D) a secondary analysis.

Ans: A Feedback: Surveys involve the collection of quantitative data about the prevalence, distribution, and interrelations of variables within a population—here, a population of nurses. Evaluation research assesses the effectiveness of a program or policy.

Secondary analyses are studies in which researchers analyze previously collected data. Outcomes research involves efforts to understand and assess the effectiveness of health care services.

Format: Multiple Choice

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Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 200, Survey Research 35. Which is a major limitation of Internet surveys?

A) They tend to be more expensive than other methods of doing surveys.

B) They involve a lot of personnel time.

C) They are not appropriate for longitudinal studies.

D) They tend to have low response rates.

Ans: D Feedback: Internet surveys are economical and do not require a lot of personnel time, but a major drawback is that response rates tend to be low, which in turn means that there is likely to be sampling bias. Internet surveys can be used for both crosssectional and longitudinal studies.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 04, 05 Page and Header: 200, A Few Other Types of Research 36. A researcher used data from the 2021 U.S. National Health Interview Study to test hypotheses about the correlation between smoking and depression. What type of study would this be called?

A) A quality improvement study B) A survey C) A Delphi survey D) A secondary analysis Ans: D Feedback:

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The National Health Interview Study involves a continuing survey of thousands of U.S. households; in this example, the researcher used previously gathered data from that survey for secondary analysis to answer new questions. It is not an example of an original survey, a Delphi survey, or a quality improvement project.

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 04, 05 Page and Header: 200, A Few Other Types of Research 37. A researcher sends out three rounds of questionnaires to 15 experts to elicit their opinions about nurses’ role in addressing the needs of patients with Parkinson’s disease. This type of study would be called a: A) secondary analysis.

B) process analysis.

C) Delphi survey.

D) methodological study.

Ans: C Feedback: A Delphi survey involves asking a panel of experts to complete several rounds of questionnaires focusing on their judgments, in this case about nurses’ roles vis-àvis patients with Parkinson’s disease. In a Delphi survey, multiple iterations of questioning are used to achieve consensus. This is not an example of a secondary analysis (data were newly gathered for the study), or a process analysis, which involves a study of how a program gets implemented. It is also not a study focused on ways to improve research methods (i.e., a methodological study).

Format: Multiple Choice Chapter: 12 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 04, 05 Page and Header: 200, A Few Other Types of Research 38. A researcher tested whether a reminder postcard was more effective than a reminder e-mail in encouraging study participants to return to the study site for follow-up data collection. This type of study would be called a:

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A) secondary analysis.

B) survey.

C) Delphi survey.

D) methodological study.

Ans: D Feedback: In this example, the researcher was testing alternative research methods to reduce the rate of dropping out of a study, and so this would be called methodological research. This is not an example of a secondary analysis, a survey, or a Delphi survey.

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Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 208, Levels of Measurement 1. In a study on patients’ fear of falling, a nurse researcher administered a questionnaire; one question asked about the participants’ educational attainment (1 = high school, 2 = some college, 3 = college degree, 4 = graduate degree). In this example, what is the level of measurement of the variable educational attainment?

A) Nominal B) Ordinal C) Interval D) Ratio Ans: B Feedback: The researcher operationalized educational attainment as an ordinal-level variable.

Respondents were asked to choose one of several categories that were rank ordered according to the amount of education attained. The numbers associated with the categories do not indicate how much greater one category is than the other (i.e., this is not interval and ratio measurement). Unlike nominal measurement, however, the numbers (1, 2, 3, and 4) do convey quantitative information.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 208, Levels of Measurement 2. In a study on patient compliance, a nurse researcher administered a questionnaire and asked about the participants’ marital status. What is the level of measurement of the variable marital status?

A) Nominal B) Ordinal C) Interval D) Ratio

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Ans: A Feedback: A person’s marital status would be “measured” by providing respondents with several mutually exclusive categories (e.g., 1 = never married, 2 = married, 3 = divorced/separated, 4 = widowed). The numbers associated with each category have no quantitative meaning, which is true of nominal measurements. All other measurement levels involve numeric values with quantitative meaning.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 208, Levels of Measurement 3. Which measure exemplifies ratio-level measurement?

A)Scores on a depression scale B) Apgar scores C) Urine output in milliliters per hour D) Employment status Ans: C Feedback: Urine output in milliliters per hour is measured on a ratio-level scale; it has a rational zero, and values would be equidistant. Scores on a depression scale would likely be considered interval-level, Apgar scores are ordinal, and employment status could be nominal (e.g., working/not working) or ordinal (e.g., not working, working part-time, working full-time).

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 01 Page and Header: 208, Levels of Measurement 4. A nurse researcher administered a 30-item scale that measured the severity of caregiver burden. What is the level of measurement of the scores on the scale?

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A) Nominal B) Ordinal C) Interval D) Ratio Ans: C Feedback: Scores on a psychosocial scale are considered to be interval-level measures. The scores are ordered to indicate increasing amounts of caregiver burden in equal intervals (and so, not ordinal measurement), but there is no rational zero point (and so, not ratio measurement). Unlike nominal measurement, the numbers in this example (scores) would convey quantitative information.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 208, Levels of Measurement 5. There are four levels of measurement. What is ordinal measurement?

A) A level in which characteristics are classified into discrete, mutually exclusive categories B) A level with equal distances between ordered values and a true meaningful zero point C) A level in which an attribute is ordered on a scale with equal distances between points on the scale but with no rational zero D) A level in which an attribute is rank ordered on a scale with unequal distances between points on the scale.

Ans: D Feedback: Ordinal measurement assigns numerical values that are rank ordered (unlike nominal measurement), but the distances between points on the scale are not equal (interval measurement), nor is there a rational zero point (ratio).

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand

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Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 208, Levels of Measurement 6. There are four levels of measurement. Variables measured at which two levels are often called continuous variables?

A) Interval and ratio B) Nominal and ordinal C) Ordinal and interval D) Ordinal and ratio Ans: A Feedback: Continuous variables are ones that take on a range of values, like the scores on a scale (interval) or weight (ratio). Neither nominal-level nor ordinal-level level measures would be considered continuous.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 09 Page and Header: 209, Descriptive Statistics 7. Which of the following is a parameter?

A) The average birth weight of a sample of 2,000 infants B) The average age of an accessible population of 50,000 nursing home residents in New York City C) The percentage of male and female in a sample of 5,000 patients D) The grade point average of nursing students responding to an Internet survey Ans: B Feedback: Parameters are descriptive indexes (such as averages and percentages) calculated using data from a population. All of the other responses reference data obtained from a sample. A descriptive index from a sample is called a statistic.

Format: Multiple Choice Chapter: 13

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Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 02, 09 Page and Header: 210, Frequency Distributions 8. A researcher administered a self-esteem scale to a sample of 500 12-year-old children. The bulk of scores were at the upper end of the distribution. How would the frequency distribution for the scores be described?

A) Normal B) Bimodal C) Positively skewed D) Negatively skewed Ans: D Feedback: When more people are at the upper end of the distribution, the longer tail points to the left, and the distribution has a negative skew, not a positive skew. A normal distribution is symmetric, which is not true in this example. There is nothing in the description to suggest that the distribution is bimodal, with two peaks.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 02 Page and Header: 210, Frequency Distributions 9. Which of the following would be an example of a positively skewed attribute in general populations?

A) Age at diagnosis of dementia B) Typical number of hours of sleep C) Number of years of education D) Age at retirement Ans: C Feedback:

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With a positive skew, the bulk of values are at the lower end of the distribution.

Educational attainment is typically positively skewed—most people have low or moderate amounts of education, whereas fewer people have advanced degrees such as a PhD, DNSc, or MD, which involve many years of schooling. Age at diagnosis of dementia, typical number of hours of sleep, and age at retirement are attributes that are most often negatively skewed, with most values in the upper ranges and the tail pointing to the left.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 211, Frequency Distributions 10. Which of the following is the most likely distribution for the variable height in a population of adults?

A) Bimodal B) Positively skewed C) Negatively skewed D) Normally distributed Ans: D Feedback: A normal distribution is symmetric, unimodal, and not very peaked. Many human attributes, such as height, approximate a normal curve, with most people having “average” height, and comparable percentages being much shorter or much taller than average. Such distributions are not skewed, nor are they bimodal (two peaks, or values with high frequencies).

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 09 Page and Header: 211, Frequency Distributions 11. What is the technical name for a distribution that is sometimes referred to as a bell-shaped curve?

A) Normal

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B) Multimodal C) Bimodal D) Skewed Ans: A Feedback: A normal distribution is a “bell-shaped” distribution that is symmetric, unimodal, and not too peaked. Normal distributions are not bimodal, multimodal, or skewed.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 211, Frequency Distributions 12. In a sample of 250 patients with cancer, the scores on a scale that measured resilience ranged from 10 to 70. There were two peaks in the distribution, at the scores of 25 and 55. What would this distribution be called?

A) Unimodal B) Bimodal C) Asymmetric D) Normal Ans: B Feedback: A bimodal distribution has two high peaks, which in this example occurred at the scores of 25 and 55. Normal distributions are unimodal, and a unimodal distribution only has one peak. The distribution of scores in this example might be asymmetric, but there is no information about whether this is the case.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02, 09 Page and Header: 211, Central Tendency 13. What is the most frequently occurring score in a distribution called?

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A) Average B) Mode C) Median D) Mean Ans: B Feedback: There are several indexes of central tendency. The mode is the value that occurs most frequently in a distribution, the median is the point above and below which 50% of the cases fall, and the mean is the arithmetic average of all scores (called the “average” in lay terms).

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 02 Page and Header: 211, Central Tendency 14. A researcher reported the age of onset of Alzheimer’s disease in a sample of residents in a memory care facility. What index of central tendency is likely to best communicate the information?

A) The average B) The mode C) The median D) The mean Ans: C Feedback: When a distribution is skewed, as it would be for the residents’ age at onset in this sample, the preferred index is the median—the value that divides the cases is half.

The mean, which is the same as the average, is the sum of all values divided by the number of people; the mean would distort what is a “typical” age at onset because there would be a negative skew, with some having an early age at onset but most having a later age. The mode is not the preferred index of central tendency with continuous variables.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze

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Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 211, Central Tendency 15. Here are five score values: 5, 6, 9, 10, 10. Which measure of central tendency for this distribution would have a value of 9?

A) The mode B) The median C) The mean D) The mode, median, and mean would be equal—all would be 9.

Ans: B Feedback: In this example, the median is equal to 9—it is the value above which and below which 50% of the cases fall. The mode in this example is 10, and the mean is 8.0 (40 ÷ 5 = 8.0).

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 212, Central Tendency 16. Which measure of central tendency is the most stable?

A) Mode B) Median C) Mean D) The mode, the median, and the mean are equally stable.

Ans: C Feedback: The mean is usually the preferred measure of central tendency because of its stability. Modes and medians are more likely than means to fluctuate in value from one sample to another drawn from the same population.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care

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Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02 Page and Header: 212, Central Tendency 17. A nurse researcher reported that, for scores on a 12-item scale of empathy, X = 43. What does the symbol X represent?

A) An effect size B) A mean C) Total sample size D) An individual score Ans: B Feedback: In research articles, the mean is often symbolized as M or X . An individual score might be written as X, without the overbar. Total sample size is often designated as N in research reports. There are several effect size indexes (such as the d statistic), but X is not one of them.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 09 Page and Header: 213, Variability 18. Which is an index of variability that takes into account all score values?

A) The range B) The median C) The mean D) The standard deviation Ans: D Feedback:

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The most widely used variability index is the standard deviation. Like the mean, which is a central tendency index and not a variability index, the standard deviation is calculated based on every value in a distribution. The median is not an index of variability. The range is the highest score minus the lowest score in a distribution and does not take all scores into account.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 212, Variability 19. For a distribution of scores on a quality of life scale, the standard deviation was computed to be 4.0. What is the value of the range?

A) 2.0 B) 4.0 C) 16.0 D) Insufficient information to determine Ans: D Feedback: The range is the highest value in the distribution minus the lowest value. The range for the scale in this example cannot be determined with the information provided.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 02 Page and Header: 214, Variability 20. A group of 500 elders completed a test of cognitive functioning. The mean score was 85, the standard deviation was 5, and scores were normally distributed.

Approximately what percentage of the 500 scores fell between 80 and 90?

A) 34% B) 68% C) 95% D) Impossible to determine

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Ans: B Feedback: When scores are normally distributed, about 34% of the scores fall within 1 standard deviation (SD) above the mean, and another 34% fall within 1 SD below the mean. In this case, 34% of the scores would be between 80 and 85 (the mean), and another 34% would be between 85 and 90, for a total of 68% of scores between 80 and 90. About 95% of the scores would be between 75 and 95—that is, 2 SDs above and below the mean of 85.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 214, Variability 21. Which of the following is a characteristic of a normal distribution?

A) 95% of the values are within two standard deviations above and below the mean.

B) The range of scores is from 20 to 80.

C) The values are positively skewed.

D) The mean is 50.0.

Ans: A Feedback: In normal distributions, there are roughly three SDs above and below the mean, and 95% of the scores fall within 2 SDs of the mean. The values in a normal distribution are not skewed. The mean of a normal distribution can be any value— not necessarily 50, and the range can also be any value—not necessarily 20 to 80.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning

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Objective: 02 Page and Header: 212, Variability 22. Which statement about standard deviations (SDs) is true?

A) In a normal distribution, there are roughly 2 SDs above and below the mean.

B) In a normal distribution, 1 SD above the mean accounts for 68% of the cases.

C) The SD represents the average amount of deviation of scores from the mean.

D) An SD of 10 indicates a distribution that is more heterogeneous than one with an SD of 20.

Ans: C Feedback: The SD represents the average amount of deviation from the mean. In normal distributions, there are roughly 3 SDs above and below the mean, not 2, and 1 SD above the mean would account for about 34% of the cases in the sample (68% would be the amount for 1 SD above AND 1 SD below the mean). If a distribution had an SD of 10, it would be less heterogeneous (less varied) than if the SD were 20.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02 Page and Header: 212, Variability 23. In analyzing scores on an anxiety scale, a nurse researcher found the scores were distributed from 62 to 98 in the research sample. What is the range?

A) 36 B) 62 C) 98 D) 160 Ans: A Feedback: The range is simply the highest score minus the lowest score in a distribution. In this example, 98 minus 62 equals 36.

Format: Multiple Choice Chapter: 13

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Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 214, Crosstabulations 24. A nurse researcher wants to describe the relationship between marital status (married vs. unmarried) and having a diagnosis of postpartum depression (yes vs. no). Which of the following would the researcher use to describe the data?

A) Pearson’s product–moment correlation coefficient B) A crosstabs table C) A correlation matrix D) Spearman’s rho Ans: B Feedback: A crosstabs table is a two-dimensional frequency distribution in which the frequencies of two nominal-level variables (or ordinal level variables with few values) are crosstabulated. In this example, both marital status and postpartum depression status are nominal level, which would make Pearson’s r, Spearman’s rho, and a correlation matrix inappropriate.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 215, Correlation 25. Below is a correlation matrix for four variables (labeled A, B, C, and D). For which pair of variables in the matrix is the relationship strongest?

A B C D

A

B

C

.64 –.59 –.65

.45 .52

–.27

D

A) A with B B) B with C C) B with D D) A with D Page 14

Ans: D Feedback: The strongest correlation is between variables A and D: –.65. The minus sign indicates the direction of the relationship (negative), but the absolute value of the number indicates the strength of the relationship, and the largest number in the matrix is .65. All the other correlation coefficients in the matrix indicate weaker relationships.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 215, Correlation 26. A nurse researcher wants to describe the relationship between patients’ age and their scores on a 20-item social support scale. Which of the following would the researcher use in this descriptive analysis?

A) A crosstabulation B) Spearman’s rho C) Pearson’s r D) A correlation matrix Ans: C Feedback: In this example, age is a ratio-level variable, and scale scores would be considered interval level. A correlation could be computed between the two, using Pearson’s r.

Spearman’s rho would be used if both variables were ordinal level. A correlation matrix presents correlation coefficients for three or more variables, not two as in this example. Crosstabs tables are used to describe relationships between two nominal-level variables.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 215, Correlation

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27. In a sample of patients with peripheral neuropathy, a researcher found that the correlation between pain scores and age was .02. What does this mean?

A) The older the patient, the much greater the pain score.

B) Older patients had pain scores 2% higher than younger patients.

C) Older patients had pain scores similar to younger patients.

D) The relationship between pain scores and age was perfect.

Ans: C Feedback: A correlation coefficient communicates both magnitude and direction of a relationship. A correlation of .02 is very small—signifying virtually no relationship at all. Thus, in this analysis, younger and older patients had similar scores. A correlation of 1.00 (or –1.00) signifies a perfect relationship. Correlations do not “translate” to percentages—there is no way to know if scores were 2% higher among older patients.

Format: Multiple Choice Chapter: 13 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 02 Page and Header: 216–217, Describing Risk 28. In a randomized controlled trial testing the effect of a smoking cessation program with 75 experimental group members and 75 control group members, which index would be a measure of the proportion of individuals in the control group who presumably would have stopped smoking had they received the intervention?

A) Absolute risk B) Absolute risk reduction C) Odds ratio D) Number needed to treat Ans: B Feedback:

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The absolute risk reduction index is an estimate of the proportion of people in the control group who could have been spared an undesirable outcome (here, continued smoking) had they been exposed to the intervention. Absolute risk is the proportion of people who experience an undesirable outcome in each group. The odds ratio measures the proportion of subjects who experienced an undesirable outcome relative to those who experienced a desirable outcome. The number needed to treat index estimates how many people would need to receive an intervention to prevent one undesirable outcome.

Format: Multiple Choice Chapter: 13 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 02 Page and Header: 217, Number Needed to Treat 29. A researcher wants to estimate how many people would need to receive a fall prevention intervention to prevent one fall. What index would the researcher compute?

A) Number needed to treat B) Odds ratio C) Absolute risk reduction D) Absolute risk Ans: A Feedback: The number needed to treat (NNT) represents an estimate of how many people would need to receive an intervention (here, a fall prevention intervention) to avoid one undesirable outcome (here, a fall). The other three indexes terms—the odds ratio, absolute risk, and absolute risk reduction—are risk indexes that provide different types of information about risk.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 03 Page and Header: 218, Introduction to Inferential Statistics 30. The use of inferential statistics permits researchers to:

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A) draw conclusions about a population based on data from a sample.

B) describe data obtained from a population.

C) interpret parameters.

D) interpret the laws of probability.

Ans: A Feedback: Inferential statistics, based on the laws of probability, provide a means for drawing conclusions about a population, given data from a sample. Inferential statistics are not used to interpret parameters (descriptive indexes from a population) or the laws of probability. Inferential statistics is used to make inferences about a population, not to describe data from a population—data are almost always from samples, not populations.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 219, Sampling Distributions 31. Which of the following is the standard deviation of a sampling distribution of means?

A) Sampling error B) Standard error of the mean C) Mean difference D) Square of the standard deviation Ans: B Feedback: The standard error of the mean (SEM)—the standard deviation of a theoretical sampling distribution of means—indicates the degree of average error of a sample mean. Sampling error occurs when sample values differ from population values. A mean difference is the difference between two group means and is unrelated to sampling distributions. The square of an SD is another index of variability (known as the variance) and is also unrelated to sampling distributions.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand

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Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03, 09 Page and Header: 218, Sampling Distributions 32. The tendency of sample values (statistics) to fluctuate from one sample to another reflects: A) a Type I error.

B) measurement error.

C) a sampling bias.

D) a sampling error.

Ans: D Feedback: Statistics are rarely exactly the same values as population parameters; the fluctuations in sample values result in sampling error. Sample bias concerns how well the sample reflects population characteristics, and measurement error concerns the reliability of measures used to collect data. A Type I error is one of two broad classes of errors in statistical decision making.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 03 Page and Header: 219, Sampling Distributions 33. The standard error of the mean (SEM) gets smaller as which occurs?

A) The mean gets smaller B) The sample size gets smaller C) The mean gets larger D) The sample size gets larger Ans: D Feedback: Larger samples increase the precision of estimates of the population mean, and so larger samples are associated with smaller standard errors of the mean (SEMs).

The value of the SEM is unrelated to the value of the means.

Format: Multiple Choice

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Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 219, Sampling Distributions 34. Which statement about standard errors of the mean (SEM) and sampling distributions is true?

A) One component in the formula for estimating SEMs is the standard deviation for the sample.

B) Researchers construct sampling distributions from their study data.

C) A sampling distribution of the mean is positively skewed.

D) The larger the SEM, the more accurate are sample means as estimation of population means.

Ans: A Feedback: The formula for estimating SEMs involves two pieces of information—the SD for the sample and sample size. Sampling distributions are theoretical and are not based on actual data. The accuracy of parameter estimates is enhanced when SEMs are smaller, not larger. Sampling distributions are unimodal and normal; they are not skewed.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 03 Page and Header: 219, Parameter Estimation 35. Confidence intervals (CIs) address a question relating to the appraisal of evidence. Which of the following questions do CIs address?

A) What is the quality of the evidence?

B) What is the magnitude of effects?

C) How precise is the estimate?

D) What is the cost of applying the evidence?

Ans: C Feedback:

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Confidence intervals provide an estimate of how precise estimates of effects are— they indicate the range of values within which the “true” effect probably lies, with a given probability. The smaller the interval, the more precise the estimates. CIs do not answer questions about the quality of evidence, the magnitude of effects, or costs of applying evidence.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 219, Parameter Estimation 36. Which of the following could not be a point estimate of a population parameter?

A) .05% B) 520 C) 18.0 to 22.0 D) .95 Ans: C Feedback: A point estimate is a single statistic that is used to estimate a population parameter—it is not a range of values. The values of 520 and .95 could be point estimates of population means, and .05% could be a point estimate of a population percentage.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 219, Parameter Estimation 37. A 95% confidence interval is associated with how many standard deviation (SD) units?

A) 0.95 B) 1.96 C) 2.58 D) Depends on the sample size

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Ans: B Feedback: In a normal distribution, 95% of the scores lie within about 2 SDs (more precisely, 1.96 SDs) from the mean. To calculate a 95% CI, the value of 1.96 is multiplied to the standard error of the mean, and that value is added to and subtracted from the sample mean to arrive at a range of scores within which the population value has a 95% probability of lying. For a 99% CI, the value is 2.58 SDs. The CI calculation does not depend on the sample size.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 220, Hypothesis Testing 38. Consider the following hypothesis: The amount of daily daylight is unrelated to levels of depression in older adults. What type of hypothesis is this?

A) Research hypothesis B) Alternative hypothesis C) Parametric hypothesis D) Null hypothesis Ans: D Feedback: A null hypothesis predicts the absence of a relationship between variables, as in this example (“unrelated”). The research (or alternative) hypothesis for this example might be as follows: The greater the amount of daily daylight, the lower the levels of depression among older adults. There is no such thing as a parametric hypothesis.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 04 Page and Header: 221, Type I and Type II Errors 39. Which statement about errors in statistical decision making is true?

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A) A Type I error occurs when a researcher concludes that there is no relationship between variables when there is one.

B) A Type II error occurs when a researcher concludes that there is no relationship between variables when there is none.

C) A Type II error occurs when a researcher concludes that there is no relationship between variables when there is one.

D) A Type I error occurs when a researcher concludes that there is a relationship between variables when there is one.

Ans: C Feedback: Researchers make a Type II error (not a Type I error) by accepting a null hypothesis that is, in fact, not true—i.e., concluding that there is no relationship when a relationship does exist between variables. Two of the response alternatives to this question are not errors at all—the researcher came to the correct conclusion.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 221, Level of Significance 40. For which level of significance is the probability of committing a Type I error lowest?

A) .10 B) .05 C) .01 D) .001 Ans: D Feedback: For hypothesis testing, researchers select a level of significance, which is the probability of making a Type I error. The smaller the probability, the lower the risk, and in this example, the smallest value is .001. With a .001 significance level, we would accept the risk that out of 1,000 samples from a population, a true null hypothesis would be wrongly rejected only 1 time.

Format: Multiple Choice Chapter: 13

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Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 221, Level of Significance 41. What is the least conservative alpha that is considered acceptable?

A) .10 B) .05 C) .01 D) .001 Ans: B Feedback: An alpha of .05 is considered a minimum threshold acceptable in most situations for declaring that a result is statistically significant. An alpha of .10 is not sufficiently stringent (a 1 in 10 chance of a Type I error) and both .01 and .001 are more conservative than .05.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 221, Level of Significance 42. A researcher controls the risk of a Type I error by: A) selecting a sufficiently large sample.

B) setting the level of significance.

C) computing confidence intervals rather than using hypothesis testing.

D) using the appropriate sampling distribution.

Ans: B Feedback:

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Setting the significance level (alpha) allows researchers to decide how much risk they are willing to accept that there will be a Type I error. Sample size affects the risk of Type II (not Type I) errors. Type I and Type II errors can occur with confidence intervals as well as with hypothesis tests. Researchers do not select sampling distributions; this is a function of which statistical test is used.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 221, Level of Significance 43. A 95% CI in parameter estimation corresponds to which alpha value in a hypothesis testing framework?

A) An alpha of .95 B) An alpha of .05 C) An alpha of .99 D) An alpha of .01 Ans: B Feedback: Levels of significance are analogous to the CI values—an alpha of .05 is analogous to the 95% CI, and an alpha of .01 is analogous to the 99% CI. By convention, the minimal acceptable alpha level is .05. An alpha of .01 is more stringent than an alpha of .05—just as a CI of .99 is more stringent than a CI of .95.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 04 Page and Header: 221, Level of Significance 44. If a power analysis indicated that for a given sample size, the power was .50, which would be true?

A) The risk of a Type II error would be 50%.

B) The results would be statistically significant 50% of the time.

C) The 95% CI would have a range of 50 points.

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D) The risk of a Type I error would be 50%.

Ans: A Feedback: The probability of committing a Type II error can be estimated through power analysis. When power equals .80 (the standard criterion), the risk for a Type II error is 20%. For a given sample size, if the power was estimated to be .50, there would be a 50% probability of a Type II (not a Type I) error—that is, wrongly concluding that the null hypothesis was correct. A power analysis is not related to particular CI values or to the probability that results would be significant a specified percentage of the time.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 222, Tests of Statistical Significance 45. When a researcher reports that a result is statistically significant, what does this mean?

A) The result is clinically meaningful.

B) The result does not contain a Type I or Type II error.

C) The result was consistent with the null hypothesis.

D) The obtained result likely was not the result of chance.

Ans: D Feedback: The term “statistically significant” means that results are not likely to have been due to chance at some specified level of probability. In this context, “significant” does not mean important or clinically meaningful. Any results could contain Type I or Type II errors—there is always some possibility of a statistical error. Statistically significant results indicate that the null hypothesis was rejected as probably being wrong.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 222, Overview of Hypothesis Testing Procedures

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46. Which of the following is not one of the steps involved in hypothesis testing?

A) Selecting the appropriate statistic to be used B) Specifying a level of significance C) Computing a test statistic D) Calculating the theoretical distribution for the test statistic Ans: D Feedback: Each statistical test can be used with specific kinds of data, but the overall hypothesis-testing process is similar for all tests: (1) selecting a test statistic, (2) specifying the level of significance, (3) computing a test statistic, (4) determining degrees of freedom, and (5) comparing the test statistic to a theoretical value.

Hypothesis testing does not involve calculating a theoretical distribution for the test statistic.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 04 Page and Header: 222, Overview of Hypothesis Testing Procedures 47. When a statistical test has been performed, the computed p value is compared to the: A) theoretical distribution for the test statistic.

B) values for the 95% CI. C) specified value of alpha.

D) specified value of the power criterion.

Ans: C Feedback: The value of alpha is the researcher’s criterion for statistical significance. The p value is the actual probability that the null hypothesis is false, and so the p value is compared to alpha. The p value is not compared to a theoretical distribution, CI values, or the power criterion.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Reduction of Risk Potential

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Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 05 Page and Header: 223, t-Tests 48. In a sample of 300 adults, a researcher tests the hypothesis that men and women differ in the amount of time (number of hours) they spend exercising weekly. Which of the following statistical tests would the researcher likely use?

A) An independent groups t-test B) A chi-squared test C) A dependent groups t-test D) A paired t-test Ans: A Feedback: In this example, the outcome variable is measured on a ratio scale; the mean number of weekly hours of exercise would be computed for men and women. The means of two separate groups of people are being compared, so an independent groups t-test would be appropriate. Paired (dependent groups) t-tests are used when the means for the same people are compared over time (e.g., before and after an exercise intervention). Chi-squared tests are not used with variables for which mean values would be computed.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 05 Page and Header: 224, t-Tests 49. A researcher compared an experimental and control group on scores on a quality-of-life scale. The value of the calculated t statistic was –2.50 and the theoretical t value (for df = 60 and α = .05) is 2.00. The researcher would: A) conclude that a Type II error had been made.

B) accept the null hypothesis.

C) reject the null hypothesis.

D) use a different level of significance.

Ans: C Feedback:

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The absolute value of the calculated t (–2.50) is larger than the theoretical value of t (2.00). Thus, the null hypothesis can be rejected—that is, the group means are significantly different at p < .05. The value of the test statistic indicates that the null hypothesis is “improbable.” A different level of significance does not need to be selected—nor would that be appropriate once the results are “in.” Given the significant results, a Type II error (false negative) was not made.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 05 Page and Header: 224, Analysis of Variance 50. A researcher compared the mean anxiety levels of patients who had been randomly assigned to a soothing music group, a massage group, or a control group.

Which of the following statistical tests was likely used to test group differences in anxiety scores?

A) t-Test B) ANOVA C) ANCOVA D) Chi-squared test Ans: B Feedback: Analysis of variance (ANOVA) is the statistical procedure used to test mean group differences for three or more groups. A t-test is used to compare means for two groups, not three. ANCOVA is used when a confounding variable is controlled, and no confounder is mentioned in this example. Chi-squared tests are not used with variables on an interval scale, as is the case in this example.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 05 Page and Header: 225, Analysis of Variance

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51. A researcher tested the effects of prenatal yoga on the mean stress levels of 100 pregnant women at three points in time—at baseline and at two points of follow-up. Which statistical procedure did the researcher likely use?

A) Paired t-test B) Chi-squared test C) Analysis of variance (ANOVA) D) Repeated measures ANOVA Ans: D Feedback: Repeated measures ANOVA compares means for one or more groups at three or more different points in time. A paired t-test can be used to test mean differences for a group at two different points of data collection. ANOVA is used to test the means of three or more independent groups—that is, different groups of people, which is not the case in this example. A chi-squared test is used to test differences in proportions, not mean differences.

Format: Multiple Choice Chapter: 13 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 05 Page and Header: 224, Analysis of Variance 52. In an analysis of variance (ANOVA), what is the test statistic?

A) F ratio B) t C) d D) r Ans: A Feedback: In ANOVA, the F ratio statistic contrasts the variation between three or more groups to the variation within the groups. The t statistic is used in t-tests, r is the statistic used as a correlation coefficient, and d is an effect size statistic.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process

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Objective: 05 Page and Header: 225, Chi-Squared Test 53. A researcher tested the hypothesis that patients in the ICU who were administered a silicone border foam dressing would be less likely than those without the dressing to experience incontinence-associated dermatitis. Which statistical test would the researcher likely use?

A) A chi-squared test B) A paired t-test C) ANOVA D) An independent groups t-test Ans: A Feedback: The chi-square ( 2) test is used to test hypotheses about group differences in proportions or percentages. In this example, there are two groups (those with and without the dressing), and the dependent variable (dermatitis vs. no dermatitis) is a nominal-level variable for which percentages would be computed. Neither ANOVA nor t-tests could not be used in this situation because the outcome variable is not on an interval or ratio scale (i.e., the researcher is not comparing group means).

Format: Multiple Choice Chapter: 13 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 05 Page and Header: 226, Correlation Coefficients 54. A researcher tested the hypothesis that weight gain during pregnancy was associated with infant birth weight. Which statistical test would be appropriate?

A) A paired t-test B) ANOVA C) Chi-squared test D) Pearson’s r Ans: D Feedback:

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Pearson’s r, the most widely used correlation coefficient, is used to test whether there is a relationship between the two variables that are measured on an interval or ratio scale, as is the case in this example (here, both ratio-level variables). The chi-squared test and ANOVA involve comparisons of groups (proportions and means, respectively), and there are no groups in this example. A paired t-test involves comparing means for a group under two circumstances or at two points in time.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 05 Page and Header: 226, Effect Size Indexes 55. Which of the following is an effect size index?

A) t B) F C) d D) 2 Ans: C Feedback: The d statistic is an effect size index that summarizes the strength of the difference in two means. The other answers are statistics used in statistical tests to compare groups and are not effect size indexes.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 05 Page and Header: 226, Effect Size Indexes 56. A researcher tested the hypothesis that a person’s decision to have a colonoscopy was related to his or her perceived risk for colorectal cancer. With α = .05, the hypothesis was not supported. What might be a cause of this result?

A) There were too many degrees of freedom.

B) The alpha level was too conservative.

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C) The test had inadequate power.

D) A researcher did not use an appropriate conceptual framework.

Ans: C Feedback: When a researcher uses too small a sample, statistical tests are underpowered, and there is a risk of a Type II error (falsely concluding there is no relationship when there is one), as is likely to be the case in this example. There can never be too many degrees of freedom, as it is a function of sample size and a large sample improves statistical power. The α level of .05 is the least conservative level considered appropriate. A conceptual framework is unlikely to affect the results of a statistical test.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 06 Page and Header: 228, Multiple Regression 57. What is the range of the multiple correlation coefficient (R)?

A) −0.10 to 0.00 B) −1.00 to +1.00 C) 0.00 to −1.00 D) 0.00 to +1.00 Ans: D Feedback: Unlike Pearson’s r, R does not have negative values. R varies from .00 to +1.00, showing the strength of the relationship between several independent variables and a dependent variable, but not the direction.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 06 Page and Header: 228, Multiple Regression

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58. A researcher found a multiple correlation of .40 (R = .40) between candy intake, age, and income on the one hand and dental caries on the other. How much variability in dental caries, the dependent variable, can be accounted by the three predictor variables?

A) 4% B) 16% C) 40% D) Cannot be determined Ans: B Feedback: R, when squared, can be interpreted as the proportion of the variability in the outcome variable that is explained by the predictors. In predicting dental caries by candy intake, age, and income, an R of .40 results in an R2 = .16. Thus, the predictors accounted for 16% (not 4% or 40%) of the variation in dental caries.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 06 Page and Header: 228, Multiple Regression 59. In terms of measurement levels for variables in a multiple regression analysis, which of the following is true?

A) Nominal-level variables cannot be used as predictors in multiple regression analysis.

B) Infant birth weight is measured at an acceptable level for use as either a predictor or a dependent variable in multiple regression.

C) Smoking status (smoker vs. nonsmoker) is measured at an acceptable level for use as either a predictor or a dependent variable in multiple regression.

D) The dependent variable in multiple regression can be measured at any measurement level.

Ans: B Feedback: Infant birth weight is on a ratio scale and could be used as either a predictor or a dependent variable in multiple regression. Dependent variables in multiple regression analysis should be measured on an interval or ratio scale, not on a nominal scale (e.g., smoking status). Predictor variables can be either continuous or nominal-level variables.

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Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 06 Page and Header: 228, Analysis of Covariance 60. A researcher wants to compare male and female oncology patients in terms of scores on a depression scale, controlling for age and severity of illness. The analysis would likely involve which test?

A) Multiple regression B) ANCOVA C) Logistic regression D) Repeated measures ANOVA Ans: B Feedback: Analysis of covariance (ANCOVA) is used to compare group means (here, mean scores on a depression scale for male and female patients) while statistically controlling confounding variables (age and illness severity) to “equalize” groups being compared. Multiple regression and logistic regression are used to predict a dependent variable using two or more predictor (independent) variables, which did not occur in this example. Repeated measures ANOVA is used to test mean differences over time, and there is no suggestion that depression was measured more than once.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 06 Page and Header: 228, Analysis of Covariance 61. Analysis of covariance (ANCOVA) removes the effect of which type of variable before testing whether mean group differences on the outcome are statistically significant?

A) Confounding variable B) Mediating variable C) Independent variable D) Dependent variable

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Ans: A Feedback: Analysis of covariance (ANCOVA) removes the effect of one or more confounding variables (covariates) before testing whether mean group differences (the independent variable) on the dependent variable are statistically significant. There are no mediating variables in ANCOVA. Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 06 Page and Header: 229, Logistic Regression 62. A researcher wanted to predict whether nursing home residents would or would not experience a fall within 6 months of admission based on four predictors (e.g., age, vision acuity, cognitive functioning, and having had a prior fall). The analysis would involve which of the following?

A) Multiple regression B) ANCOVA C) Logistic regression D) MANOVA Ans: C Feedback: Logistic regression analyzes the relationships between multiple independent variables and a nominal-level dichotomous outcome—here, whether or not a resident experienced a fall within 6 months of admission. None of the other types of analyses is appropriate for situations in which the outcome variable is dichotomous.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 06 Page and Header: 229, Logistic Regression 63. Which of the following is a statistic associated with logistic regression?

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A) OR B) R2 C) t D) F Ans: A Feedback: In logistic regression, the analysis yields an odds ratio (OR) for each predictor variable. The OR is the factor by which the odds change for a unit change in the predictors after controlling other predictors. F tests are used in many multivariate analyses (e.g., ANCOVA, multiple regression) but not in logistic regression. Neither R2 nor the t statistic is associated with logistic regression.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 07 Page and Header: 229, Reliability Assessment 64. A researcher is doing a test–retest assessment of a 10-item scale to measure fear of hospitals. What would be the preferred reliability statistic for this situation?

A) The intraclass correlation coefficient B) Pearson’s r C) Coefficient alpha D) Cohen’s kappa Ans: A Feedback: In test–retest reliability assessments of continuous measures (such as composite scales), the preferred reliability statistic is the intraclass correlation coefficient; it is preferred over the widely used Pearson’s correlation coefficient. Coefficient alpha is not used in test–retest reliability assessments. Cohen’s kappa is used primarily in interrater reliability assessments.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate

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Integrated Process: Nursing Process Objective: 07 Page and Header: 229, Reliability Assessment 65. Which measurement property of a multi-item composite scale is estimated with coefficient alpha?

A) Stability/reproducibility B) Interrater reliability C) Internal consistency D) Construct validity Ans: C Feedback: Internal consistency is the extent to which the items on a multi-item scale are measuring the same attribute, and internal consistency is most often estimated with coefficient alpha (Cronbach’s alpha). Stability/reproducibility and interrater reliability are different types of reliability, neither of which involves coefficient alpha. Construct validity also does not involve the computation of coefficient alpha.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 07 Page and Header: 230, Content Validity 66. A nurse researcher develops a scale to measure preparedness for caregiving among family members of palliative care patients. A panel of experts is recruited to assess the relevance of the items, and the results indicated a CVI of .91. What type of validity is being assessed?

A) Content validity B) Internal validity C) Criterion validity D) Construct validity Ans: A Feedback:

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Content validity is the extent to which the content of the items on a multi-item scale adequately captures the construct. Content validity, unlike criterion or construct validity, can be assessed with feedback from a panel of experts, who rate the relevance of items; the ratings are used to compute a content validity index (CVI). Internal validity concerns the adequacy of the research design for making causal inferences and is unrelated to measurement validity.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process Objective: 07 Page and Header: 230, Validity Assessment 67. A nurse researcher developed a new scale to measure stress in adolescents and calculated a Pearson’s r between scale scores and a gold standard, wake-up salivary free cortisol levels. What type of validity is being assessed?

A) Content validity B) Internal validity C) Criterion validity D) Construct validity Ans: C Feedback: Criterion validity is the extent to which the scores on a measure are a good reflection of a “gold standard,” which in this example is a biophysiological indicator of stress, wake-up salivary free cortisol levels. When scores on both measures are continuous, as in this example, Pearson’s r is the statistic used to evaluate criterion validity. Content validity and construct validity do not rely on a “gold standard” criterion. Internal validity concerns the adequacy of the research design for making causal inferences and is unrelated to measurement validity.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 08 Page and Header: 230, Validity Assessment 68. An instrument’s ability to correctly identify a case is its:

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A) sensitivity.

B) specificity.

C) content validity.

D) ROC curve.

Ans: A Feedback: Sensitivity is a measure’s ability to identify a “case” correctly, that is, to screen in or diagnose a condition or trait correctly (the true positive rate). Specificity is the measure’s ability to identify non-cases correctly, that is, to screen out those without the condition (the true negative rate). ROC curves are sometimes used to plot sensitivity against specificity. Content validity is unrelated to an instrument’s ability to correctly identify a case.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 08 Page and Header: 231, Tips on Reading Text With Statistical Information 69. Which statistical test result would not be considered statistically significant?

A) r = .19, p = .05 B) 2 = 12.33, p < .001 C) t = 1.70, p = .09 D) F = 3.23, p < .05 Ans: C Feedback: The standard criterion for statistical significance is a probability value of less than .05. All of the results reported in the response alternatives are statistically significant except for the t-test, where the p value is .09—i.e., greater than .05.

Format: Multiple Choice Chapter: 13 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 08 Page and Header: 231, Tips on Reading Text With Statistical Information

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70. In reporting the results of a statistical test in a research article, which would not be reported?

A) The computed value of the test statistic B) The theoretical value of the test statistic C) Degrees of freedom D) The probability (p) value Ans: B Feedback: Research articles usually provide certain information about statistical tests, including (1) which test was used, (2) the value of the calculated statistic, (3) degrees of freedom, and (4) level of statistical significance. The theoretical value of the test statistic would not be reported.

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Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01 Page and Header: 240, Interpretation of Quantitative Results 1. The results section of a quantitative research article summarizes results of the: A) study conclusions.

B) statistical analyses.

C) measurement plan.

D) interpretation of study findings.

Ans: B Feedback: Study results from statistical analyses are summarized in the results section of research articles that report quantitative studies. Researchers present their interpretations of the results (and their conclusions) in the discussion section.

Measures used in quantitative studies are described in the method section of the report. Even if researchers computed reliability statistics for measures they used, this would not usually be considered a “result” and would most often be reported in the method section (unless the study was a methodological one).

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01 Page and Header: 240, Aspects of Interpretation 2. Interpreting results involves several types of considerations. Which consideration is at issue when researchers ask the question “Are the results correct?”

A) The magnitude of effects B) The generalizability of the results C) The precision of the estimate of effects D) The credibility and accuracy of the results Ans: D Feedback:

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One of the most important interpretive tasks is to assess whether the results are correct—that is whether the results are credible and accurate. If the results are not credible, the remaining interpretive issues (meaning, magnitude, and so on) are not likely to be relevant.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 242, Proxies and Interpretation 3. Which statement about interpretation is true?

A) In interpreting findings, researchers can assume that their inferences are accurate.

B) One aspect of the credibility of the results concerns their meaning.

C) Researchers use proxies to “stand in for” the constructs in which they are interested.

D) If results are deemed not to be credible, it is still important to understand their generalizability.

Ans: C Feedback: Constructs are linked to reality in a series of approximations, and each proxy affects the interpretation of the results. Researchers should not “assume” that their inferences are accurate—they must search for evidence in support of their inferences. Credibility and meaning are two separate interpretive issues. If results are not credible, there is little point in asking whether they are generalizable.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 02 Page and Header: 241, The Interpretive Mindset 4. Which adjective best captures a prudent reader’s attitude in scrutinizing the evidence in a research report?

A) Admiring

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B) Accepting C) Skeptical D) Deferential Ans:C Feedback: It is prudent to approach the interpretation of results with a skeptical mindset, which involves critically scrutinizing and challenging the results until a conclusion about whether the results are “real” can be reached with confidence. A careful reader should think critically in reading a research report and demand methodological evidence that the results reflect the truth. Readers might admire a skillfully done study, and they might come to accept that the research evidence is valid, but should first carefully scrutinize how the study was done. Deference is never needed—readers should not “defer” to the researchers without thinking critically about how they addressed their research questions.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 241, Credibility of Quantitative Results 5. Which of the following statements is true?

A) The results of statistical testing have direct meaning.

B) Evaluating the credibility of a study involves a careful assessment of methodological decisions.

C) Support of a researcher’s hypothesis through statistical testing offers proof of its veracity.

D) A correlation between two variables indicates that the independent variable caused the outcome.

Ans: B Feedback: A credibility assessment requires a careful analysis of the study’s methodological and conceptual limitations and strengths. Statistical results do not always have direct meaning but, rather, require interpretation. Empirical evidence supporting research hypotheses never constitutes proof of their veracity. Correlation between two variables does not prove causation.

Format: Multiple Choice

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Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03, 07 Page and Header: 243, Proxies and Interpretation 6. What is a central purpose of a diagram advocated in the Consolidated Standards of Reporting Trials (CONSORT)?

A) To document the flow of people into and out of a study sample B) To summarize results from statistical analyses C) To document the progression of research activities in a study D) To chart the flow of the researcher’s methodological decisions Ans: A Feedback: Publication guidelines called the Consolidated Standards of Reporting Trials (CONSORT) are used by major medical and nursing journals. CONSORT flow charts are used to help readers understand the results of researchers’ efforts to recruit, enroll, and retain study participants. CONSORT flow charts do not summarize study findings, the progression of research activities, or the flow of researchers’ methodological decisions.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 242, Proxies and Interpretation 7. A team of nurse researchers sent surveys to a sample of 300 students at the University of Connecticut by e-mail and received 154 completed surveys. Which of the following is most likely to have been the researchers’ population construct?

A) Public universities in the United States B) Nursing students in the United States C) College students in the United States D) Cooperative students at the University of Connecticut Ans: C Feedback:

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The population construct would be college students in the United States. The construct involves students, not universities. There is nothing to suggest that the population construct was nursing students. “Cooperative students at the University of Connecticut” is the actual sample, not the population construct.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 244, Credibility and Validity 8. Which statement about validity is true?

A) Construct validity focuses exclusively on inferences about measurements.

B) Inappropriate eligibility criteria could affect a study’s construct validity.

C) Attrition would have no effect on a study’s generalizability.

D) Attrition would have no effect on a study’s internal validity.

Ans: B Feedback: Construct validity is not simply about measurements; it is about making inferences about all types of constructs, and so researchers must make sure that the eligibility criteria are appropriate for the population construct—that is, the target population of interest. Attrition could have negative effects on both the internal validity and the external validity (generalizability) of a study.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 03 Page and Header: 244, Credibility and Bias 9. It is important that researchers adopt rigorous study methods in an effort to eliminate: A) inferences.

B) the need for a CONSORT flow chart.

C) the rejection of null hypothesis.

D) biases.

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Ans: D Feedback: An important job for researchers is to eliminate, reduce, or control biases through the use of rigorous study methods. Researchers do not adopt rigorous study methods to prevent inferences or eliminate the need for a CONSORT flow chart.

Strong methods are used in the hopes of rejecting the null hypothesis.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 245, Credibility and Corroboration 10. Which of the following is an important concept that links efforts at corroboration to the credibility of research results?

A) Replication B) Confidence intervals C) Nonresponse D) The null hypothesis Ans: A Feedback: Credibility is enhanced when results can be corroborated, and replication is a key concept. If results replicate earlier findings, that is an important form of corroboration. In multisite studies, the replication of results across different sites also offers corroboration. Confidence intervals, nonresponse, and the null hypothesis are unrelated to efforts to support credibility through corroboration.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 246, Precision of the Results 11. Which of the following is a useful tool for understanding the precision of results?

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A) Effect size estimates B) P values C) Type I error rates D) Confidence intervals Ans: D Confidence intervals communicate information about how precise (or imprecise) the study results are. P values indicate whether the results are probably real and replicable but do not communicate information about precision. Information about the rate at which Type I errors are committed is never available. Effect size indexes summarize the magnitude of effects, not the precision of results.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01 Page and Header: 246, Precision of the Results 12. For those interpreting statistical results, confidence intervals (CIs) provide what information?

A) The range of the measured values in the sample reported in the research report B) The probability that the results were obtained in error C) The range of values within which the population value probably lies D) The likelihood that the results will be useful in practice Ans: C Feedback: A p value offers information about whether the study results are “real” and replicable, but confidence intervals (CIs) communicate information about the range of values within which the population parameter probably lies. CIs provide no information about the range of measured values in the sample, nor about the practical utility of the results.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01

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Page and Header: 246, Magnitude of Effects and Importance 13. The statistical significance of a study finding indicates that: A) the results were unlikely to be due to chance.

B) the results are clinically important.

C) the research methods were valid.

D) biases were eliminated.

Ans: A Feedback: Statistical significance indicates that the results were unlikely to be due to chance— not that they are necessarily clinically important. Statistical significance does not demonstrate that the research methods were valid or that biases were eliminated.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 247, Interpreting Hypothesized Results 14. Which of the following is an important research precept?

A) Correlation does not prove causation.

B) Causation does not prove a correlation.

C) Study results can prove that hypotheses are correct.

D) Study results can prove that hypotheses are incorrect.

Ans: A Feedback: A critical research precept is that correlation does not prove causation. The finding that two variables are related offers no evidence regarding which of the two variables—if either—caused the other. Evidence from study results can neither prove nor disprove that hypotheses are correct or incorrect. Evidence can only indicate whether hypotheses are probably correct. There is always a possibility that observed relationships resulted from chance—that is, that a Type I error has occurred.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care

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Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 01 Page and Header: 252, Critical Appraisal of Interpretations 15. Which title for a journal article might be misleading?

A) The Relationship Between Infant Birth Weight and Subsequent Behavior Problems B) Factors Associated With Medication Adherence in Children C) The Impact of Parenting Style on Adolescents’ Sexual Risk-Taking Behavior D) The Association Between Spiritual Well-Being and Quality of Life in the Elderly Ans: C Feedback: The word impact is a “loaded” word that implies a causal relationship. In this example, it suggests that parenting style causes different risk-taking behavior in adolescents. There may be a causal relationship, but it would be difficult to mount a persuasive argument in this study, which is necessarily nonexperimental: Parenting style could not be randomized to different children to assess the impact on subsequent risk-taking behavior. All other titles correctly use such terms as “relationship” and “associated with.”

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 246, Interpreting Hypothesized Results 16. Which of the following statements represents a “positive result”?

A) The correlation between age and calorie intake was positive.

B) As hypothesized, the variables were negatively correlated (r = −.45, p < .01).

C) Contrary to expectations, the variables were positively correlated.

D) All of the correlations in the correlation matrix were positive.

Ans: B Feedback:

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A positive result is one in which a hypothesis was supported by the data, as in the case where the researcher predicted a negative relationship between two variables.

A positive correlation does not mean that the researcher hypothesized that the relationship would be positive. In some cases, a positive correlation could reflect a result opposite to what the researcher hypothesized.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 01 Page and Header: 247, Interpreting Nonsignificant Results 17. Which of the following statements about nonsignificant results is true?

A) A nonsignificant result indicates that the sample size was too small.

B) A nonsignificant result indicates that the null hypothesis was correct.

C) A nonsignificant result means that a Type II error occurred.

D) A nonsignificant result is inconclusive.

Ans: D Feedback: Failure to reject a null hypothesis can occur for many reasons, and the real reason is usually impossible to discern—thus, a nonsignificant result is inconclusive. One possibility is that the sample was too small; another is that the null hypothesis was correct—but this cannot be known with certainty. If the null hypothesis was correct, then a Type II error would not have been committed.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 248, Interpreting Unhypothesized Significant Results 18. Which of the following statements is true?

A) Researchers should ignore results that are the opposite of what they hypothesized.

B) Researchers whose results are the opposite of what was hypothesized should scrutinize alternative theories, their methods, and findings from earlier research.

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C) Statistically significant results that are the opposite of what was hypothesized are likely the result of a Type II error.

D) Statistically significant results that are the opposite of what was hypothesized are likely wrong.

Ans: B Feedback: When significant findings are opposite to what was hypothesized, researchers need to carefully consider their own methods, findings from earlier studies, and alternative theoretical perspectives. The findings should not be ignored—they need to be carefully interpreted. The results are not especially likely to be “wrong,” and they cannot reflect a Type II error, which only occurs when the results are not significant.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 04 Page and Header: 249, Clinical Significance 19. A nurse researcher tested the effectiveness of a foot massage on geriatric patients’ pain levels. One study participant, Mr. Evans, had a pain score of 80 (on a scale from 0 to 100) before the massage and a pain score of 65 at follow-up. What would a score of 15 for Mr. Evans be called?

A) His targeted score B) His score at the next follow-up C) His baseline score D) His change score Ans: D Feedback: A change score is the difference between a baseline score (here, 80) and a followup score (here, 65), and so Mr. Evan’s change score is 15, indicating some improvement in his pain level. There is no way to know what Mr. Evan’s next follow-up score would be. A pain score of 15 is very low and is perhaps lower than could be considered realistic for a targeted score if the patient’s baseline pain score was 80.

Format: Multiple Choice Chapter: 14

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Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 05 Page and Header: 250, Clinical Significance at the Group Level 20. Which of the following is widely used as an index of clinical significance at the group level?

A) P values B) Effect size indexes C) Alpha levels D) Minimal important change Ans: B Feedback: Effect size indexes (such as the d statistic) summarize the magnitude of a change or a relationship and thus provide insights into how a group, on average, might benefit from a treatment (or be spared a harm). Alpha levels and p values do not communicate information about clinical significance. The minimal important change is sometimes used as an index of clinical significance at the individual level, not at the group level.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 05 Page and Header: 250, Clinical Significance at the Individual Level 21. Many strategies for operationalizing clinical significance at the individual level have been developed. What feature do they share in common?

A) They all involve establishing a benchmark value that would be considered clinically meaningful.

B) They all are linked to whether a change score is statistically reliable.

C) They all involve the use of an effect size index.

D) They all involve using characteristics of the distribution of scores.

Ans: A Feedback:

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Dozens of approaches to operationalizing clinical significance at the individual level exist, but they all involve establishing a benchmark (a threshold) that designates a value that would be considered clinically important. Some approaches involve scores based on distributional characteristics of a measure and yet others involve assessments of change score reliability, but these are not true of all approaches to operationalizing clinical significance at the individual level. Effect size indexes are used primarily for group-level clinical significance.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 05, 07 Page and Header: 251, Operationalizing Clinical Significance: Establishing the Minimal Important Change Benchmark 22. Which of the following is often used to create a threshold in evaluating clinical significance at the individual level?

A) Confidence intervals (CIs) B) Number needed to treat (NNT) C) d values D) Minimal important change (MIC) Ans: D Feedback: The minimal important change (MIC) is a benchmark for the smallest amount of change in a person’s score on an outcome that would be considered clinically important. Values of d, confidence intervals (CIs), and number needed to treat (NNT) are often used to interpret clinical significance at the group level.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 05 Page and Header: 251, Operationalizing Clinical Significance: Establishing the Minimal Important Change Benchmark 23. Which of the following statements about the minimal important change (MIC) is true?

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A) The traditional approach to establishing the MIC is to use the recommendation of a consensus panel of experts.

B) The value of the MIC usually is 3 points on a change score.

C) The distributional approach to establishing the MIC uses a threshold of p values in a distribution of change scores.

D) The MIC can be useful in interpreting clinical significance at the group level.

Ans: A Feedback: Consensus panels are the traditional approach to establishing the MIC, although other methods have become more popular in recent years. Another approach is based on distributional characteristics, but this approach does not use p values for a distribution of change scores to establish a threshold. The actual value of the MIC varies from outcome to outcome and is not a fixed value of 3.0 (or anything else).

MICs are useful for interpreting individuals’ change scores, not for interpreting average change scores of a group.

Format: Multiple Choice Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 05 Page and Header: 251, Operationalizing Clinical Significance: Establishing the Minimal Important Change Benchmark 24. A nurse researcher is using a distributional approach to define the minimal important change (MIC) threshold for a new measure. What is the most commonly used value for the MIC threshold using this approach?

A) SD = 1.0 B) SD = 0.5 C) d = 1.0 D) d = 0.5 Ans: B Feedback: Most often, the MIC using a distribution approach is set to a threshold of 0.5 SD based on the distribution of baseline scores. Values of d are not used as thresholds for the MIC. Format: Multiple Choice

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Chapter: 14 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 05, 07 Page and Header: 251, Operationalizing Clinical Significance: Establishing the Minimal Important Change Benchmark 25. For outcomes that have an established MIC threshold, what type of analysis is possible for detecting group differences in clinically significant change for individuals in the group?

A) A power analysis B) A distributional analysis C) A responder analysis D) An effect size analysis Ans: C Feedback: Study participants can be classified as responders or nonresponders to an intervention or an influence based on their change scores relative to an established MIC threshold. Researchers can then undertake a responder analysis that compares the percentage of responders in study groups (e.g., those in the intervention and those in the control group). Power analyses, effect size analyses, and distributional analyses do not examine differences in patterns of clinically meaningful individual change.

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Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01 Page and Header: 257, Introduction to Qualitative Analysis 1. Which of the following is a significant challenge in qualitative analysis?

A) Mastering the standard procedures for analyzing qualitative data B) Dealing with the shortage of narrative materials to analyze C) Reducing extensive amounts of data for reporting purposes D) Deducing particulars from general concepts Ans: C Feedback: Qualitative data analysis is challenging, for several reasons. One challenge concerns the fact that qualitative analysts must organize and make sense of hundreds or even thousands of pages of narrative materials (there is usually no shortage of data)—and the information must be reduced to essentials for reporting purposes.

There are no standard procedures for qualitative analysis. Qualitative analysis is an inductive (not deductive) process that involves inducing general concepts and theories from the particular details in the data.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01 Page and Header: 257, Introduction to Qualitative Analysis 2. Which statement about qualitative analysis is true?

A) Qualitative analysis is less time-consuming than quantitative analysis.

B) There are no universal rules for analyzing qualitative data.

C) Qualitative results can be summarized in tables.

D) Results from qualitative analyses are more difficult to understand than those from quantitative studies.

Ans: B Feedback:

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Qualitative analysis is arduous and time-consuming, and there are no standard “rules” for how to do it. Results from qualitative analyses rarely can be effectively summarized in tables. The results from qualitative analyses typically are easier for readers to understand than from quantitative analyses because the “stories” are usually told in everyday language.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01 Page and Header: 258, Developing a Coding Scheme 3. What is the first major step that a nurse researcher typically undertakes in a qualitative analysis?

A) Searching for major themes B) Coding the data C) Giving themes a label D) Developing a system for organizing and indexing the data Ans: D Feedback: The first major step in analyzing qualitative data typically is to develop a coding scheme so that the vast narrative material can be organized and accessed.

Researchers then use the coding scheme to code the data and eventually to search for major categories and themes, which are given labels that highlight what is emerging in the data.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 258, Developing a Coding Scheme 4. Which of the following is a type of coding identified by Saldaña?

A) Holistic B) Componential C) Taxonomic

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D) Deductive Ans: A Feedback: Saldaña identified 27 different types of coding approaches, including holistic, descriptive, process, concept, and in vivo coding. The other response options are not types of coding in Saldaña’s classification system.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01, 04 Page and Header: 260, Methods of Organizing Qualitative Data 5. Before the advent of computer software to facilitate qualitative analysis, the main procedure for managing qualitative data relied on the creation of: A) conceptual files.

B) core categories.

C) memos.

D) themes.

Ans: A Feedback: Traditionally, researchers organized their data by developing conceptual files, which are physical file folders in which coded excerpts of data for specific codes are placed. Computer software is now widely used to perform basic indexing functions and to facilitate data analysis. Memos, core categories, and themes are not tools for managing qualitative data.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 01, 04 Page and Header: 260, Methods of Organizing Qualitative Data 6. Which of the following statements is true?

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A) Narrative materials tend to be linear, which simplifies the coding process.

B) Qualitative researchers typically develop a coding scheme before they collect their data.

C) CAQDAS is used to organize and retrieve qualitative data.

D) CAQDAS is preferred by virtually all qualitative researchers because it allows analysts to get closer to their data.

Ans: C Feedback: Computer-assisted qualitative data analysis software (CAQDAS) removes the work of cutting and pasting pages of narrative material and is used to organize and retrieve coded data; the software cannot actually do the coding. Some qualitative researchers avoid CAQDAS, believing that manual methods allow them to get closer to their data. Narrative materials usually are not linear, a fact that complicates coding. A preliminary coding system is sometimes drafted before data collection, but typically qualitative analysts develop coding schemes based on a scrutiny of actual data.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01 Page and Header: 260, Methods of Organizing Qualitative Data 7. Which of the following describes a capability of qualitative data analysis software?

A) Coding of segments of transcribed interviews B) Detecting when there is a transcription error C) Guiding the researcher on how best to analyze the data D) Retrieving portions of text corresponding to specified codes Ans: D Feedback: Computer-assisted qualitative data analysis software (CAQDAS) permits an entire data set to be entered onto the computer and coded; portions of the text corresponding to specified codes can then be retrieved for analysis. Software cannot, however, do the coding, it cannot detect transcription errors, and it cannot tell the researcher how to analyze the data.

Format: Multiple Choice

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Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 260, A General Analytic Overview 8. Which of the following statements about qualitative analysis is true?

A) Qualitative data analysis is reductionist in nature.

B) To be valid, a theme identified in the data must be universal across participants.

C) Qualitative analysts search for commonalities across participants but also look for variation and patterns.

D) The underlying process of qualitative data analysis is deduction.

Ans: C Feedback: Themes are identified by finding commonalities across participants, but themes are seldom universal; it is important to search for any patterns of variation in the data.

Qualitative data management is reductionist, but analysis is constructivist (putting segments together into meaningful patterns). Induction (not deduction) is the logical thought process used in qualitative analysis.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 02 Page and Header: 260, A General Analytic Overview 9. In qualitative data analysis, which analytic device involves a symbolic comparison?

A) CAQDAS B) Metaphors C) Coding schemes D) Themes Ans: B Feedback:

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Some qualitative researchers use metaphors as an analytic strategy. A metaphor is a symbolic comparison, using figurative language to evoke a visual analogy.

CAQDAS, coding schemes, and themes all play a role in qualitative analysis, but they are not an analytic device involving symbolic comparisons.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 02 Page and Header: 260, A General Analytic Overview 10. Which of the following can facilitate researchers’ search for themes relating to dynamic processes?

A) Flow charts B) Coding scheme C) Conceptual files D) CAQDAS Ans: A Feedback: Researchers’ search for themes, regularities, and patterns in the data can sometimes be facilitated by charting devices, such as flow charts and timelines, that enable them to visualize dynamic processes. Conceptual files, computer software (CAQDAS), and coding schemes are devices related to data management and organization, not to the search for dynamic themes.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 261, Quality Content Analysis and Thematic Analysis 11. Which is not an activity involved in qualitative content analysis?

A) Breaking down data into smaller units B) Coding and naming units according to the content they represent C) Devising metaphors D) Grouping coded material based on shared concepts

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Ans: C Feedback: Devising metaphors is not associated with qualitative content analysis. Qualitative content analysis involves breaking down data into smaller units, coding and naming the units according to the content they represent, and grouping coded material based on shared concepts.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 261, Qualitative Content Analysis and Thematic Analysis 12. Which statement about qualitative content analysis is true?

A) Content analysis is used by grounded theory researchers.

B) In purely descriptive qualitative studies, the focus is typically on the latent content of the text.

C) In a qualitative content analysis, the data do not have to be coded.

D) In a content analysis, a meaning unit is the smallest segment of a text that contains usable information.

Ans: D Feedback: A meaning unit consists of the words, sentences, or paragraphs that have meaningful and recognizable information. To manage and gain access to qualitative data, content analysts, like other qualitative analysts, usually code their data. In descriptive qualitative studies, researchers typically focus on manifest content (what the text actually says), although they may also be interested in the latent content (what the text talks about, which requires interpretation). Content analysis is not associated with grounded theory.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 262, Qualitative Content Analysis and Thematic Analysis

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13. A theoretically flexible approach to qualitative analysis developed by the psychologists Braun and Clarke is called: A) content analysis.

B) thematic analysis.

C) metaphorical analysis.

D) exemplar analysis.

Ans: B Feedback: The psychologists Braun and Clarke developed thematic analysis as a foundational method for qualitative analysis and developed a six-phase step-by-step guide, They did not develop content analysis or any of the other response options.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 02, 04 Page and Header: 262, Ethnographic Analysis 14. Which of the following is not one of the levels of data analysis in Spradley’s ethnographic method?

A) Domain analysis B) Taxonomic analysis C) Componential analysis D) Content analysis Ans: D Feedback: Content analysis is used by researchers doing a qualitative descriptive study, not an ethnographic study. Spradley’s ethnographic approach involves four levels of data analysis: domain analysis (identifying domains, or units of cultural knowledge), taxonomic analysis (selecting key domains and constructing taxonomies), componential analysis (comparing and contrasting terms in a domain), and theme analysis (to uncover cultural themes).

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand

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Difficulty: Moderate Integrated Process: Nursing Process Objective: 02, 04 Page and Header: 262, Ethnographic Analysis 15. In an ethnographic analysis, what term is used for units of cultural knowledge?

A) Domains B) Components C) Taxonomies D) Themes Ans: A Feedback: Domains are units of cultural knowledge, and in Spradley’s analytic sequence, domain analysis is the first level of analysis. The second level is a taxonomic analysis (developing a classification system), followed by a componential analysis.

The final level is theme analysis, during which cultural themes are uncovered.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 263, Ethnographic Analysis 16. Who developed an alternative to Spradley’s approach to ethnographic analysis?

A) Van Manen B) Leininger C) Colaizzi D) Giorgi Ans: B Feedback: Approaches to ethnographic analysis other than Spradley’s have been developed.

For example, in her ethnonursing research method, Leininger described a fourphase ethnonursing data analysis process. Van Manen, Colaizzi, and Giorgi are all phenomenologists.

Format: Multiple Choice Chapter: 15

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Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 02 Page and Header: 263, Ethnographic Analysis 17. Which is the final phase of the data analysis process in the ethnonursing approach?

A) Abstracting major themes and presenting findings B) Identifying and categorizing descriptors C) Analyzing data to discover repetitive patterns in their context D) Collecting and recording data Ans: A Feedback: Leininger and colleagues developed a four-phase ethnonursing data analysis guide.

In the first phase, ethnographers collect, describe, and record data. The second phase involves identifying and categorizing descriptors. In phase 3, data are analyzed to discover repetitive patterns in their context. The fourth and final phase involves abstracting major themes and then presenting and disseminating the findings.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 263, Phenomenological Analysis 18. Descriptive phenomenology most fundamentally involves a search for: A) a core category from open coding.

B) intersubjective agreement among judges.

C) thematic descriptions from artistic sources.

D) the essential nature of an experience.

Ans: D Feedback:

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The basic outcome of the various approaches to descriptive phenomenology is the description of the essential nature of an experience, often through the identification of essential themes. The use of artistic sources for inspiration is sometimes a feature of interpretive, but not descriptive, phenomenology. Identifying core categories occurs in grounded theory, not phenomenological, data analysis.

Intersubjective agreement among judges is advocated by one phenomenologist (van Kaam), but it is not the fundamental feature in descriptive phenomenology.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 263, Phenomenological Analysis 19. According to the viewpoint of one leading phenomenologist, it is inappropriate to go back to study participants to validate a preliminary thematic analysis. Which phenomenologist had this view?

A) Colaizzi B) Giorgi C) Glaser D) Strauss Ans: B Feedback: Phenomenologists differ in their views on validating themes by asking study participants to provide feedback about preliminary results. Giorgi’s view is that it is inappropriate either to return to participants to validate findings or to use external judges to review the analysis. Colaizzi’s method calls for a validation of results by querying study participants. Glaser and Strauss are not phenomenologists.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 263, Phenomenological Analysis 20. Which of the following are leading scholars within the Duquesne School of Phenomenology?

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A) Colaizzi and van Kaam B) Spradley and Leininger C) Benner and van Manen D) Corbin and Charmaz Ans: A Feedback: Two frequently used methods for descriptive phenomenology are the methods of Colaizzi and van Kaam, who are from the Duquesne School of phenomenology, based on Husserl’s philosophy. Spradley and Leininger are ethnographic researchers. Benner is a hermeneutic researcher and van Manen is a phenomenologist from the Utrecht School of Phenomenology. Corbin and Charmaz are grounded theory researchers.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 264, Phenomenological Analysis 21. A leading phenomenologist held the view that qualitative researchers should glean experiential information about a phenomenon from artistic sources (e.g., poetry, paintings). Which phenomenologist had this view?

A) Colaizzi B) Van Kaam C) Giorgi D) Van Manen Ans: D Feedback: In addition to identifying themes from participants’ words, van Manen called for gleaning information from artistic sources. He believed that literature, music, painting, and other art forms offer a wealth of experiential information that can increase researchers’ insights. Colaizzi, van Kaam, and Giorgi were descriptive phenomenologists who did not explicitly promote the use of artistic sources to supplement text from interviews.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care

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Cognitive Level: Apply Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 02, 04 Page and Header: 264, Phenomenological Analysis 22. A researcher conducted a phenomenological study about the experience of losing one’s eyesight to macular degeneration, using one of van Manen’s analytic approaches. The researcher pulled out significant statements from interview transcripts that seemed essential to the participants’ experience. Which of van Manen’s methods did the researcher use?

A) Holistic B) Selective C) Detailed D) Interpretive Ans: B Feedback: Van Manen’s analytic method included three approaches. In the selective approach, researchers highlight or pull out statements or phrases that seem essential to the experience under study, as in this example. In the holistic approach, researchers view the text as a whole and try to capture its meanings. In the detailed approach, researchers analyze every sentence. Van Manen’s method does not include an “interpretive” approach.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 02, 04 Page and Header: 264, Phenomenological Analysis 23. In interpretive schools of phenomenology, some researchers believe that an analytic process that is essential to understanding phenomena is a continual movement between the parts and the whole of the text being analyzed. What is the term used to signify this process?

A) A hermeneutic circle B) A detailed approach C) A paradigm case D) An exemplar Ans: A

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Feedback: A hermeneutic circle is an interpretive process that involves continual movement between parts of the text and the whole of the text. The other terms—detailed approach, paradigm case, and exemplars—are used by various interpretive phenomenologists, but they are not processes.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 02, 04 Page and Header: 264, Phenomenological Analysis 24. Benner’s approach, which is sometimes used in hermeneutic analysis, involves a search for “strong instances of concerns or ways of being in the world.” Which term is associated with these “strong instances”?

A) A hermeneutic circle B) A holistic approach C) A paradigm case D) An exemplar Ans: C Feedback: Benner’s approach for hermeneutic analysis involves three interrelated processes: the search for paradigm cases, thematic analysis, and analysis of exemplars. As defined by Benner, paradigm cases are “strong instances of concerns or ways of being in the world;” these cases are used early in the analytic process to gain understanding. Van Manen’s analytic method (not Benner’s) included a holistic approach. A hermeneutic circle is a term used in hermeneutics regarding a broad process used to reach understanding.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 02, 04 Page and Header: 265, Glaser’s Grounded Theory Method 25. What does the process of constant comparison involve?

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A) Comparing two researchers’ interpretation of the data B) Comparing the researchers’ interpretation of the data against study participants’ interpretation C) Comparing elements present in one data source with those in another for similarity D) Comparing data from the study with data and categories from other similar studies Ans: C Feedback: Grounded theory researchers use the process of constant comparison during data analysis, a method that involves comparing elements present in one data source (e.g., in one interview) with those in another in an ongoing fashion to assess commonalities. Constant comparison does not involve comparing two researchers’ interpretation of the data, researchers’ interpretation of the data against study participants’ interpretation, or data from the study with data and categories from other similar studies.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 02, 04 Page and Header: 265, Glaser’s Grounded Theory Method 26. In Glaserian grounded theory, substantive coding involves open and selective coding. What are open codes?

A) Codes that capture a basic social process B) Codes that capture what is going on in the data C) Codes that encapsulate relationships among the substantive codes D) Codes that focus on a core category Ans: B Feedback: Substantive coding includes open coding, which is designed to capture what is going on in the data. Open coding is used in the first stage of constant comparison and may be the actual words used by the study participants. Open codes do not focus on a core category, nor do they encapsulate relationships among substantive codes. A basic social process is one type of core category and is not captured in preliminary open coding.

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Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 02, 04 Page and Header: 266, Glaser’s Grounded Theory Method 27. In Glaserian grounded theory, researchers seek to identify a pattern of behavior that is relevant or problematic for participants. This pattern is referred to as a: A) core category.

B) Level I code.

C) theoretical code.

D) BSP. Ans: A Feedback: In Glaserian grounded theory, the core category is a pattern of behavior that is relevant and/or problematic for participants. One type of core category is a basic social process (BSP) that evolves over time in two or more phases. All BSPs are core variables, but not all core variables are BSPs. Level I codes and theoretical codes are not core categories.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 266, Glaser’s Grounded Theory Method 28. In Glaserian grounded theory, theoretical codes help to weave pieces of data back together. Glaser devised “families” of theoretical codes. Which is not one of these families?

A) Process: phases, passages, transitions B) Themes: holistic, selective, detailed C) Strategy: tactics, techniques, maneuverings D) Cutting point: boundaries, critical junctures, turning points Ans: B Feedback:

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In Glaserian grounded theory, there are 18 families of theoretical codes, three of which are process, strategy, and cutting point. “Themes” is not a family of theoretical codes in grounded theory; the terms holistic, selective, and detailed are associated with approaches to data analysis by the interpretive phenomenologist van Manen.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 266, Glaser’s Grounded Theory Method 29. In the Glaserian approach to grounded theory analysis, selective coding begins when which occurs?

A) Constant comparison has begun.

B) Data saturation has occurred.

C) Memos have been prepared.

D) The core category has been identified.

Ans: D Feedback: Open coding ends when the core category is discovered, and then selective coding begins, not when data saturation has occurred or when memos have been prepared. Open coding is used in the first stage of constant comparison.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02, 04 Page and Header: 266, Glaser’s Grounded Theory Method 30. In the Glaserian approach to grounded theory analysis, constant comparison involves, in part, a scrutiny of other work on similar topics. Which term refers to the evolution of substantive theories involving other work?

A) Theoretical families B) Emergent fit C) Memoing

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D) Basic social processes Ans: B Feedback: Generating grounded theory does not necessarily require discovering all new categories: through constant comparison, researchers can compare concepts emerging from the data with similar concepts from existing theory or research to evaluate which parts have emergent fit with the theory being generated. Memoing, basic social processes, and theoretical families are grounded theory terms but are unrelated to the process of linking emerging categories to ones that are found in the literature.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 267, Strauss and Corbin’s Approach 31. Which of the following statements about grounded theory is true?

A) Corbin and Strauss stressed that the basic problem must emerge from the data.

B) Charmaz developed a list of “coding families” to facilitate theoretical coding.

C) In constructivist grounded theory, the types of coding are open, selective, and theoretical.

D) The outcome of the Corbin and Strauss approach to grounded theory is a full conceptual description.

Ans: D Feedback: The outcome of Glaserian grounded theory is an emergent theory, but in the Corbin and Strauss approach, the outcome has been described as full conceptual description. Corbin and Strauss believe that there are several possible sources for a problem (e.g., the literature), but Glaser insisted that the problem must emerge from the data. In constructivist grounded theory, Charmaz distinguished initial and focused coding. Glaser, not Charmaz, developed a list of theoretical coding families.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate

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Integrated Process: Communication and Documentation Objective: 02, 04 Page and Header: 268, Strauss and Corbin’s Approach 32. What are the two types of coding in the Corbin and Strauss approach to grounded theory?

A) Open and axial coding B) Level I and level II coding C) Substantive and theoretical coding D) Open and selective coding Ans: A Feedback: The Corbin and Strauss method involves two types of coding: open and axial coding. The term axial is uniquely associated with the Strauss and Corbin method, whereas the terms open and selective coding and are used in Glaserian grounded theory. Substantive and theoretical codes and level I and level II codes are part of the Glaserian approach to grounded theory analysis.

Format: Multiple Choice Chapter: 15 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 02 Page and Header: 268, Constructivist Grounded Theory Approach 33. Who developed the constructivist grounded theory approach?

A) Strauss B) Glaser C) Charmaz D) Corbin Ans: C Feedback: Charmaz is the researcher who originated the constructivist approach to grounded theory. In this approach, the theory is constructed from shared experiences and relationships between the researcher and the study participants, and interpretive aspects are emphasized. Strauss, Glaser, and Corbin are grounded theory researchers, but they are not associated with the constructivist approach.

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Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 01 Page and Header: 276, Debates About Rigor and Validity 1. In qualitative research, which term is most likely to be used to refer to issues focused on methodological and interpretive quality?

A) Validity B) Trustworthiness C) Credibility D) Rigor Ans: B Feedback: The most widely used term used to refer to methodological and interpretive quality in qualitative research is “trustworthiness.” “Validity” and “rigor” are avoided by some (but not all) qualitative researchers because these terms are used by quantitative researchers. Credibility is one aspect of trustworthiness.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 275, Debates About Rigor and Validity 2. Which term relating to quality is controversial among qualitative researchers?

A) Dependability B) Validity C) Transferability D) Credibility Ans: B Feedback:

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One of several controversies regarding quality in qualitative studies involves terminology. Some argue that rigor and validity are quantitative terms that are not suitable as quality criteria in qualitative inquiry, but others believe these terms are appropriate. Dependability, credibility, and transferability are aspects of trustworthiness and are terms that are widely used by qualitative researchers as criteria for study quality.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 01 Page and Header: 276, Generic Versus Specific Standards 3. Which of the following statements about quality issues in qualitative research is true?

A) One debate among qualitative researchers is whether there should be a generic set of quality standards or different standards for different traditions.

B) Quality standards for the conduct of qualitative research are the same as those for the conduct of quantitative studies.

C) The debate about using the term “validity” among qualitative researchers has been resolved.

D) There is a broad consensus among qualitative researchers regarding what the quality criteria for evaluating qualitative research should be.

Ans: A Feedback: There are many debates about quality nomenclature and criteria for qualitative research, one of which is whether generic standards or tradition-specific standards should be adopted. No consensus on quality criteria has been achieved. The views about “validity” have not been resolved; differences of opinion remain and are likely to persist. Quality standards for conducting qualitative research are not identical to standards for conducting quantitative research.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 01 Page and Header: 276, Terminology Proliferation and Confusion

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4. Which of the following statements about quality criteria in qualitative research is true?

A) Compared to quantitative researchers, qualitative researchers are less focused on assessing quality in their research designs and methods.

B) No criterion in qualitative research is comparable to the positivists’ criterion of internal validity.

C) With regard to qualitative research criteria, nothing is considered the “gold standard.”

D) There is no common vocabulary for quality criteria in qualitative inquiry.

Ans: D Feedback: Debates about quality criteria for qualitative research abound, and one result is that there is no common, universally accepted vocabulary about what criteria to use, or how to define those criteria. Lincoln and Guba established criteria that are considered the “gold standard” for qualitative research, but not all qualitative researchers agree with their recommendations. Nevertheless, qualitative researchers are as eager as quantitative researchers to produce high-quality research. One of Lincoln and Guba’s criteria (credibility) is a parallel to internal validity.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 276, Lincoln and Guba’s Quality Criteria 5. Which is not a quality criterion in Lincoln and Guba’s framework?

A) Credibility B) Dependability C) Objectivity D) Transferability Ans: C Feedback: Objectivity is not one of the criteria in the Lincoln and Guba’s framework.

Objectivity is more valued in quantitative research, but its qualitative counterpart is confirmability. Credibility, dependability, and transferability are all aspects of trustworthiness in Lincoln and Guba’s framework.

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Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 05 Page and Header: 276, Lincoln and Guba’s Quality Criteria 6. Which criterion is considered analogous to internal validity in Lincoln and Guba’s framework?

A) Credibility B) Transferability C) Dependability D) Confirmability Ans: A Feedback: Credibility, which refers to confidence in the truth value of the findings, has been viewed as the qualitative equivalent of internal validity. Dependability, the stability of data over time and over conditions, is somewhat analogous to reliability in quantitative studies. Confirmability is the qualitative equivalent of objectivity.

Transferability, the analog of external validity, is the extent to which findings can be transferred to other settings or groups.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02, 05 Page and Header: 276, Lincoln and Guba’s Quality Criteria 7. The quality criterion of credibility in the Lincoln and Guba’s framework for qualitative research refers to: A) the reliability of data over time.

B) objectivity of the interpretation of the data.

C) applicability of the data to other groups.

D) confidence in the truth value of the data.

Ans: D Feedback:

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Credibility refers to confidence in the truth value of the data and data interpretations. Dependability is the reliability (stability) of data over time.

Confirmability refers to establishing that the data objectively represent the participants’ information and viewpoint and not that of the researcher.

Transferability is the extent to which qualitative findings have relevance in other settings or groups.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 05 Page and Header: 277, Dependability 8. Dependability in Lincoln and Guba’s framework for qualitative research is considered the analog of which criterion in quantitative research?

A) Internal validity B) Construct validity C) Reliability D) Specificity Ans: C Feedback: Dependability refers to the stability of data over time and conditions and is somewhat analogous to reliability in quantitative studies. Credibility, which refers to confidence in the truth value of the findings, has been viewed as the qualitative equivalent of internal validity. Construct validity and specificity, which are criteria associated with quantitative research, do not have analogs in qualitative research.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 05 Page and Header: 277, Confirmability 9. Which is the criterion in Lincoln and Guba’s framework that refers to neutrality or objectivity in qualitative inquiry?

A) Credibility

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B) Transferability C) Authenticity D) Confirmability Ans: D Feedback: Confirmability refers to the objectivity of the data—the potential for congruence between two or more independent people about the data’s accuracy, relevance, or meaning. Credibility, transferability, and authenticity represent different aspects of trustworthiness in Lincoln and Guba’s framework.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 02, 05 Page and Header: 277, Transferability 10. Which term in Lincoln and Guba’s framework is the analog of external validity in quantitative studies?

A) Credibility B) Transferability C) Confirmability D) Dependability Ans: B Feedback: Transferability, the extent to which findings from the data can be transferred to other settings or groups, is the qualitative analog of external validity (i.e., generalizability). Credibility, dependability, and confirmability represent different aspects of trustworthiness in Lincoln and Guba’s framework.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 02, 05 Page and Header: 277, Authenticity

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11. What is authenticity in Lincoln and Guba’s framework of quality criteria?

A) A researcher’s confidence in the truth value of the findings B) Stability of data over time and conditions C) Objectivity or neutrality of the data D) The extent to which researchers faithfully depict the feeling tone of participants’ lives as they are lived Ans: D Feedback: Authenticity is a quality criterion that refers to the extent to which researchers fairly and faithfully show a range of different realities and convey the feeling tone of lives as they are lived. The criterion of credibility refers to confidence in the truth value of the findings. Dependability refers to the stability of data over time and conditions. Confirmability refers to the objectivity or neutrality of the data.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03, 05 Page and Header: 279, Prolonged Engagement and Persistent Observation 12. A nurse researcher is studying how members of an immigrant community manage chronic health problems. The researcher spends 15 months in the field conducting interviews and making observations in the community. Which qualityenhancement strategy is described in this study?

A) Reflexivity B) Prolonged engagement C) Audit trail maintenance D) Member checking Ans: B Feedback: Prolonged engagement is the investment of sufficient time collecting data to have an in-depth understanding of the people under study—in this case, 15 months of interviewing and observing community members. The researcher may also have used other strategies, such as reflexivity, the maintenance of an audit trail, and member checking, but these strategies were not described in the example.

Format: Multiple Choice

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Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03, 05 Page and Header: 279, Prolonged Engagement and Persistent Observation 13. One quality enhancement strategy concerns the salience of the data being gathered. With respect to this strategy, Lincoln and Guba said that if prolonged engagement provides scope, then this other strategy provides depth. What is that strategy?

A) Persistent observation B) Reflexivity C) Audit trail development D) Data triangulation Ans: A Feedback: Persistent observation refers to the researcher’s focus on the characteristics or aspects of a situation or conversation that are relevant to the phenomenon under study. Reflexivity, data triangulation, and audit trail development are also quality enhancement strategies used in the data collection stage of a study but are not the strategy described in the example.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 279, Reflexivity Strategies 14. A nurse researcher is planning to conduct a study about the experience of having a family member diagnosed with early onset Alzheimer’s disease. She asks an expert in Alzheimer’s disease to interview her about her prior assumptions and her own experiences with family members with this disease. Which qualityenhancement strategy did the researcher use?

A) Persistent observation B) Triangulation C) Reflexivity D) Member checking

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Ans: C Feedback: Researchers sometimes ask a colleague or expert to conduct a “bracketing interview.” In such an interview, a person knowledgeable about the study phenomenon queries the researcher about his or her a priori assumptions, perspectives, and experiences. The researcher may also have used other strategies, such as persistent observation, triangulation, and member checking, but these strategies were not described in the example.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03, 05 Page and Header: 280, Data and Method Triangulation 15. A nurse researcher studied women’s experiences during the transition to menopause. Data were collected by interviewing 20 women in their 50s. The participants were also asked to maintain a daily diary for a month. Which form of triangulation was used in this study?

A) Method triangulation B) Investigator triangulation C) Theory triangulation D) Data triangulation Ans: A Feedback: Triangulation is the process of using multiple referents to draw conclusions about what constitutes the truth. Method triangulation involves using multiple methods of data collection about the same phenomenon—here, the use of both interviews and diaries as data sources. This example does not illustrate investigator, data, or theory triangulation.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 280, Data and Method Triangulation

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16. A nurse researcher studied family response to adolescent suicide and interviewed parents and siblings independently. Which type of triangulation was used in this study?

A) Method triangulation B) Investigator triangulation C) Theory triangulation D) Data triangulation Ans: D Feedback: Triangulation is the process of using multiple referents to draw conclusions about what constitutes the truth. Data triangulation involves using multiple sources to validate conclusions—in this example, data from both parents and siblings. This example does not illustrate investigator, method, or theory triangulation.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 280, Data and Method Triangulation 17. A nurse researcher conducted a qualitative study on contraceptive decision making among youth. She interviewed youth in adolescent health clinics in four different communities. Which quality-enhancement strategy is described in this example?

A) Persistent observation B) Prolonged engagement C) Data triangulation D) Reflexivity Ans: C Feedback: Data triangulation refers to the use of multiple data sources for the purpose of validating conclusions. In this example, the nurse researcher used a type of data triangulation called space triangulation, which involves collecting data on the same phenomenon in multiple sites to assess cross-site consistency. This example does not illustrate reflexivity, persistent observation, or prolonged engagement— although these strategies may also have been used in the study.

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Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 280, Comprehensive and Vivid Recording of Information 18. A nurse researcher conducted an in-depth study of therapeutic relationships in day-surgery settings. The researcher systematically collected, documented, and maintained information about the progress of the study, including the raw data, reflexive and methodological notes, coding decisions, and data analysis products.

Which quality-enhancement strategy was the researcher using?

A) Maintaining an audit trail B) Undertaking a member check C) Enhancing persistent observation D) Ensuring adequate triangulation Ans: A Feedback: In this example, the researcher was developing an audit trail—a systematic collection of materials and documentation that would allow an independent auditor to come to conclusions about the data. The researcher may also have used other quality-enhancement strategies, such as persistent observation, triangulation, and member checking, but these strategies were not described in the example.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 281, Member Checking 19. Which quality-enhancement strategy—used primarily during data collection—is somewhat controversial among qualitative researchers?

A) Reflexivity B) Member checking C) Audit trails D) Person triangulation Ans: B

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Feedback: Member checking—getting feedback about preliminary study results from participants—is controversial, with some experts strongly advocating for its use and others refuting its utility. No other quality-enhancement strategy—including reflexivity, audit trails, and person triangulation—has been the topic of more debate.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 281, Member Checking 20. A nurse researcher did an in-depth study of physical aggression among residents in nursing home settings. After interviewing 14 residents, the researcher analyzed the data for important themes. Six study participants were asked to review the emergent themes. Which quality-enhancement strategy was the researcher using?

A) Member checking B) Persistent observation C) Data triangulation D) Method triangulation Ans: A Feedback: In this example, the researcher used member checking to obtain participants’ feedback about emerging interpretations of the interview data. The researcher may also have used other quality-enhancement strategies, such as persistent observation and data and method triangulation, but these strategies were not described in the example.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 281, Investigator Triangulation

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21. A nurse researcher conducted an in-depth study of anxiety in patients undergoing chemotherapy. The researcher coded data from interviews with 20 patients, and a coinvestigator independently coded 8 of the 20 interviews. The coding of the two researchers was then compared. Which quality-enhancement strategy was the researcher using?

A) Data triangulation B) Person triangulation C) Space triangulation D) Investigator triangulation Ans: D Feedback: Investigator triangulation refers to the use of two or more researchers to make coding, analysis, and interpretation decisions. Other forms of triangulation may have been used in this study, but such strategies were not described in the example.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03, 05 Page and Header: 282, Investigator Triangulation 22. In qualitative research, investigator triangulation is comparable to which quantitative research concept?

A) Content validity B) Construct validity C) Interrater reliability D) Internal consistency Ans: C Feedback:

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Investigator triangulation is conceptually analogous to interrater (or intercoder/interobserver) reliability in quantitative studies; in both cases, two independent people draw conclusions about the data, which are then compared.

Content validity refers to the degree to which items in an instrument actually measure the intended concept. Construct validity is the extent to which evidence about study particulars supports inferences about higher order constructs. Internal consistency in quantitative research refers to the degree to which subparts of a scale or instrument (the items) measure the same attribute. Investigator triangulation is unrelated to content validity, construct validity, or internal consistency.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 282, Searching for Disconfirming Evidence and Competing Explanations 23. Why do researchers search for and incorporate disconfirming evidence in a qualitative analysis?

A) To eliminate negative cases from data analysis B) To refine a conceptualization or theory C) To confirm saturation of the data D) To formulate a conclusion based on multiple sources of data Ans: B Feedback: Searching for disconfirming evidence is a verification procedure that involves challenging an explanation or category that has emerged early in data analysis. It occurs concurrently with data collection and analysis and its goal to continuously refine a conceptualization, hypothesis, or theory. Eliminating negative cases is the opposite of incorporating disconfirming evidence. Saturation of data occurs when data collection yields redundant information. Triangulation is the process of using multiple referents to draw conclusions about what constitutes the truth.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation

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Objective: 03 Page and Header: 282, Peer Review and Debriefing 24. Which question would researchers most likely ask peers to address in a peer debriefing?

A) Are there coding errors?

B) Are there possible errors of interpreting the data?

C) Is the description sufficiently thick?

D) Were interviews accurately transcribed?

Ans: B Feedback: In peer debriefing sessions, researchers are exposed to the searching questions of other experts. A major issue in peer debriefings is whether the researchers have developed a powerful and compelling interpretation of their data. Peer debriefings do not focus on coding or the accuracy of transcriptions, and “thick description” is not yet an issue because a report on the findings has typically not yet been written.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 283, Inquiry Audits 25. The maintenance of good, thorough documentation and a decision trail is especially critical for: A) member checks.

B) thick description.

C) negative case analyses.

D) inquiry audits.

Ans: D Feedback: An inquiry audit involves a formal scrutiny of actual data and relevant supporting documents by an independent auditor. Thick description, member checks, and negative case analyses are all strategies for enhancing the quality of qualitative inquiries, but they are not a component in inquiry audits, and they do not involve the maintenance of an audit trail.

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Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 03, 05 Page and Header: 283, Thick and Contextualized Description 26. Several strategies can be used to enhance transferability in qualitative studies.

Which is one of those strategies?

A) Inquiry audits B) Member checking C) Thick description D) Method triangulation Ans: C Feedback: Thick description refers to a rich, thorough, and vivid description of the research context and the people who participated in the study. Transferability cannot occur unless investigators provide detailed information to permit judgments about contextual similarity. Member checking, inquiry audits, and method triangulation are all strategies for enhancing the quality of qualitative inquiries, but they are not strategies that specifically address transferability.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03, 05 Page and Header: 283, Researcher Credibility 27. A nurse researcher studied lapses in medication compliance among schizophrenic patients living in the community. In his journal article, the researcher reported that he had worked in psychiatric nursing for 15 years and had a nephew who was schizophrenic. On which quality-enhancing strategy is the researcher focusing?

A) Researcher credibility B) Search for disconfirming evidence C) Inquiry audit D) Thick description

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Ans: A Feedback: A researcher’s qualifications and personal experiences are relevant in establishing confidence in qualitative findings—providing such information supports researcher credibility. The researcher may have used other quality-enhancing strategies (such as using thick description, conducting an inquiry audit, or searching for disconfirming evidence), but they were not described in this example.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 284, Interpretation of Qualitative Findings 28. Which of the following is not an interpretive dimension for qualitative studies?

A) The meaning of qualitative results B) The precision of qualitative results C) The importance of qualitative results D) The implications of qualitative results Ans: B Feedback: Precision is an important interpretive dimension in quantitative—but not qualitative—research. Interpretation in qualitative studies encompass such dimensions as the meaning of the results, their importance, and their implications.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 04 Page and Header: 284, Interpretation of Qualitative Findings 29. Which statement about qualitative research analysis is true?

A) Investigator triangulation in qualitative research provides proof that interpretations are correct.

B) Qualitative analyses test hypotheses generated from quantitative research.

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C) Interpretation and analysis of qualitative data typically occur simultaneously.

D) Qualitative researchers should resist the temptation of being creative in analyzing their data.

Ans: C Feedback: Interpretation and analysis of qualitative data typically occur virtually simultaneously, in an iterative and reciprocal process. Interpretation in qualitative studies sometimes yields hypotheses that can be tested in more controlled quantitative studies—not the other way around. Creativity can play an important role in uncovering meaning in the analysis of qualitative data. Investigator triangulation strengthens credibility, but it does not provide “proof” that interpretations are correct.

Format: Multiple Choice Chapter: 16 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 04 Page and Header: 285, Critical Appraisal of Quality and Integrity in Qualitative Studies 30. Which barrier do qualitative researchers face in demonstrating the trustworthiness of their studies to readers?

A) Page restrictions in journals B) Readers’ lack of skills in understanding trustworthiness C) Peer reviewers’ focus on study findings rather than methods D) Absence of disconfirming evidence Ans: A Feedback: Adhering to page limitations imposed by journals inevitably reduces the amount of thick description and verbatim accounts that can be reported in qualitative research reports, and so both authenticity and transferability can be affected. Failure to find disconfirming evidence enhances, rather than diminishes, trustworthiness. Readers’ skills do not constitute a barrier to demonstrating trustworthiness, and peer reviewers are typically very focused on critically appraising methodological decisions, including decisions affecting trustworthiness.

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Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 290, Research Integration and Synthesis 1. Which statement about systematic reviews is true?

A) “Systematic review” is another name for a literature review.

B) Systematic reviews follow many of the same “rules” as those for primary studies.

C) All systematic reviews of quantitative studies involve a meta-analysis.

D) All systematic reviews of quantitative studies involve a metasynthesis.

Ans: B Feedback: What distinguishes a systematic review from a literature review is that systematic reviews follow orderly sampling, data collection, and data analysis procedures, much as is true in a primary study (an original research investigation). Not all quantitative systematic reviews involve a meta-analysis, and none of them would involve a metasynthesis.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 01 Page and Header: 290, Research Integration and Synthesis 2. Systematic reviews are considered a cornerstone of: A) evidence-based practice.

B) evidence hierarchies.

C) meta-analyses.

D) primary studies.

Ans: A Feedback:

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Systematic reviews are a cornerstone of evidence-based practice (EBP), which relies on rigorous integration of research evidence on a topic. Meta-analyses (a particular method of analyzing data from a systematic review) of randomized controlled trials (RCTs) are at the pinnacle of traditional evidence hierarchies but are not a “cornerstone.” Primary studies play a role in EBP, but when several similar studies are integrated, the evidence is typically stronger.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 291, Basics of Meta-Analysis 3. In a meta-analysis, the “unit of analysis” is: A) individual study participants.

B) results from primary qualitative studies.

C) results from primary quantitative studies.

D) prior systematic reviews.

Ans: C Feedback: The unit of analysis in a meta-analysis is a result from a primary quantitative study (not a primary qualitative study). The unit of analysis in a primary study is an individual study participant. Prior systematic reviews are not the unit of analysis in a meta-analysis.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 01 Page and Header: 291, Advantages of Meta-Analysis 4. Which of the following is an advantage of meta-analysis, compared to narrative integration in a systematic review?

A) Meta-analysis is less work than a narrative systematic review.

B) Meta-analysis is feasible with a wider range of research questions than a narrative systematic review.

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C) Meta-analysis integrates information in a more objective manner than in a narrative integration.

D) Meta-analysis requires a smaller sample of primary studies than a narrative systematic review.

Ans: C Feedback: For systematic integration of quantitative evidence, meta-analysis offers the advantage of objectivity. Decision rules are made explicit, and the actual integration is statistical, not based on the researchers’ judgments. It is not true that meta-analyses are less work than a narrative systematic review or that they require smaller samples. Narrative reviews can be undertaken for any research question, but this is not the case for meta-analyses.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01, 04 Page and Header: 291, Research Integration and Synthesis 5. In the evolving field of evidence integration, special types of review are emerging. Which of the following is a type of review that integrates findings from two or more systematic reviews?

A) Scoping reviews B) Rapid reviews C) Mixed studies reviews D) Umbrella reviews Ans: D Feedback: When multiple systematic reviews on a topic have been conducted, an umbrella review that integrates studies from the previous systematic reviews can be conducted. A rapid review is a streamlined and less rigorous type of systematic review. A mixed studies review integrates findings from qualitative, quantitative, and mixed method studies. A scoping review is often undertaken to assess the feasibility of conducting a systematic review for a specific research question.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care

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Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 292, Criteria for Undertaking a Meta-Analysis 6. Which of the following is a criterion for undertaking a meta-analysis?

A) All of the primary studies must have statistically significant results.

B) All of the primary studies must have clinically significant results.

C) The results among the primary studies in a meta-analysis must all be consistent.

D) There needs to be a sufficiently large number of relevant primary studies.

Ans: D Feedback: One criterion for a meta-analysis concerns whether there is a sufficient base of knowledge for statistical integration. If there are only a few studies, it is not sensible to compute an “average” effect. The results from a primary study do not have to be statistically or clinically significant to be included in a meta-analysis. The results from primary studies do not have to be totally consistent—although highly conflicting results may suggest that a meta-analysis is inappropriate.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 292, Criteria for Undertaking a Meta-Analysis 7. Under which of the following conditions would a meta-analysis not be appropriate?

A) Results among studies are highly conflicting.

B) Research questions across studies are nearly identical.

C) There is a large pool of primary studies.

D) The independent variable is consistent across studies.

Ans: A Feedback: When the same hypothesis has been tested in multiple studies and the results are highly conflicting, meta-analysis is likely inappropriate. Another basic criterion is that the research question being addressed should be nearly identical across studies (including the independent and dependent variables). Finally, there must be

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a sufficient base of knowledge for statistical integration (i.e., a sufficiently large number of relevant primary studies).

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 02 Page and Header: 292, Formulation of the Review Question 8. Which research question is appropriately phrased for a quantitative systematic review, within the PICO framework?

A) “What is the effect of music, compared to no music, on agitation levels in patients with dementia?”

B) “What is the experience of caring for a patient with dementia?”

C) “What factors put people at risk for dementia?”

D) “What percentage of adults aged 60 years and older have dementia?”

Ans: A Feedback: Only one question among the four options specifies PICO components for a systematic review: What is the effect of music (the influence or intervention, I), compared to no music (the comparator or C) on agitation (the outcome, O), in patients with dementia (the population or P).

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 04 Page and Header: 292, Formulation of the Review Question 9. As a strategy for refining a research question for a systematic review, researchers may undertake: A) an effect size analysis.

B) a scoping review.

C) a mixed studies review.

D) a power analysis.

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Ans: B Feedback: A scoping review is a preliminary investigation that clarifies the range and nature of the evidence base. Scoping reviews can suggest strategies for a full systematic review and can also indicate whether statistical integration (a meta-analysis) is feasible. The other responses have no relevance to efforts to refine a research question for a systematic review.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 293, The Design of a Quantitative Systematic Review 10. Researchers must screen primary studies for eligibility in a quantitative systematic review. Which of the following is a plausible eligibility criterion?

A) The primary studies must have had funding.

B) The primary study reports must be written in English or Spanish.

C) The primary studies must have been based on pilot studies.

D) The primary studies must be within the grounded theory tradition.

Ans: B Feedback: Studies are often excluded from a systematic review if they are written in a language that the review team cannot read. There is no legitimate reason (in normal circumstances) to exclude unfunded studies or studies that are not based on a pilot study. Grounded theory studies are qualitative and would not be included in a quantitative systematic review.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 293, The Design of a Quantitative Systematic Review 11. Which statement about the design of a meta-analytic study is true?

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A) Statistical heterogeneity of results across primary studies is rare.

B) Only published research reports are included in meta-analyses.

C) Low-quality studies are excluded from meta-analyses.

D) If statistical heterogeneity is anticipated, subgroup analyses to explore variation in effects are often planned.

Ans: D Feedback: If it is expected that there will be variation in effects (statistical heterogeneity) associated with patient characteristics, site characteristics, or study methodology, subgroup analyses are often planned during the design phase of the project.

Statistical heterogeneity is almost inevitable—it is certainly not rare. Low-quality studies and unpublished studies are often (but not always) included in metaanalyses. The effects of study quality are, however, often explored in the analyses.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 04 Page and Header: 293, The Search for Evidence in the Literature 12. There is no consensus on whether systematic reviews should include the grey literature. What is the grey literature?

A) Research articles published in non–peer-reviewed journals B) Research articles published in peer-reviewed journals C) Unpublished research reports D) Research reports published in open-access journals.

Ans: C Feedback: There is no consensus on whether systematic reviews should include the grey literature—that is, unpublished reports with limited distribution such as theses, dissertations, and conference papers. Articles published in any type of journal (including open-access journals) are not grey literature.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate

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Integrated Process: Teaching/Learning Objective: 02 Page and Header: 293, The Search for Evidence in the Literature 13. When the grey literature is excluded from a meta-analysis, the risk is that: A) studies with nonsignificant results will be underrepresented.

B) studies not published in English will be underrepresented.

C) studies with weak effects will be overrepresented.

D) studies with biases will be overrepresented.

Ans: A Feedback: The grey literature—studies that have not been published—is disproportionately composed of studies with nonsignificant findings. This publication bias means that when the grey literature is excluded, effect size estimates tend to be inflated. The risk is not that non-English reports will be underrepresented or that studies with biases or weak effects will be overrepresented.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 294, Evaluations of Study Quality 14. Which statement relating to the evaluation of primary study quality is true?

A) The best way to measure primary study quality is to rate each study on a scale from 0 to 10.

B) The Cochrane Handbook recommends coding primary studies for the presence/absence of key features relating to the risk of bias.

C) Researchers who are experts do not need to do an interrater reliability assessment for evaluations of primary study quality.

D) If two raters disagree in their evaluations of study quality, the best way to resolve the difference is to flip a coin (i.e., randomly select one reviewer’s rating).

Ans: B Feedback:

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The authors of the Cochrane Handbook recommend a domain approach, as opposed to a scale approach. Individual methodological features are given a separate rating or code for each study (e.g., whether or not blinding was used). There are dozens of different scales for assessing study quality, and no consensus about which is preferred. Interrater reliability is strongly recommended regardless of the metaanalysts’ expertise. If two raters disagree, there should be a discussion until consensus is achieved, or a third rater should help to resolve the disagreement.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02 Page and Header: 294, Extraction and Encoding of Data for Analysis 15. Which piece of information is not typically encoded for each primary study in a meta-analysis?

A) Participant characteristics (e.g., mean age) B) Sample size C) Effect sizes for outcomes D) Number of coders Ans: D Feedback: The number of people who completed the coding is not typically included as a piece of information about each primary study. It is crucial, however, to encode sample characteristics, sample size, and effect size estimates.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 295, Calculation of Effects in Meta-Analysis 16. Which of the following cannot be used as an effect size index for a metaanalysis?

A) Standardized mean difference or d B) Intensity effect size

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C) Pearson’s correlation coefficient (r) D) The odds ratio (OR) Ans: B Feedback: An intensity effect size can be developed in metasyntheses, not in meta-analyses.

Meta-analyses depend on the calculation of an effect size index that encapsulates the relationship between the independent variable and the outcome variable in each study. The most common effect size index is Cohen’s d; others include the odds ratio (OR), and (in nonexperimental studies) Pearson’s r.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 295, Calculation of Effects in Meta-Analysis 17. A meta-analyst sought to estimate the effectiveness of interventions designed to improve mental health outcomes for family members who have a relative in palliative care. The primary studies compared participants in an intervention group with those in a control group in terms of their level of depression, as measured on multi-item self-report scales. Which effect size index would be used?

A) Cohen’s d (standardized mean difference) B) The relative risk (RR) index C) Pearson’s r D) The odds ratio (OR) Ans: A Feedback: This is a two-group situation with a continuous outcome variable (level of depression), which calls for the calculation of Cohen’s d (sometimes called the standardized mean difference). The other indexes are used to estimate effect size in different situations. If the outcome is dichotomous rather than continuous, the OR or RR could be used; if the independent variable is continuous rather than nominal level, Pearson’s r might be appropriate.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply

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Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 02 Page and Header: 295, Analysis of Data in a Meta-Analysis 18. A meta-analyst addressed the question of whether mindfulness-based interventions were effective in reducing anxiety in patients with cancer and found high levels of statistical heterogeneity (i.e., significant variation of effects across studies). What should the meta-analyst do?

A) Abandon efforts to undertake a meta-analysis.

B) Use a fixed effects analytic model.

C) Use a random effects analytic model.

D) Ignore the heterogeneity.

Ans: C Feedback: Statistical heterogeneity (diversity in effects across studies) is a major issue in meta-analysis. When results are varied, meta-analysts should use a random effects statistical model rather than a fixed-effects model. Heterogeneity should not be ignored, but it does not necessarily lead to an abandonment of the meta-analysis unless heterogeneity is extreme.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 04 Page and Header: 296, Analysis of Data in a Meta-Analysis 19. Which of the following is a visual method of identifying heterogeneity among primary studies in a meta-analysis?

A) A scatterplot B) A conceptual map C) A forest plot D) A frequency distribution Ans: C Feedback:

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Visual inspection of heterogeneity can most readily be accomplished by constructing a forest plot, which graphs the estimated effect size for each study. Other types of graphic devices—such as scatterplots, frequency distributions, and conceptual maps—are not useful to examining statistical heterogeneity in meta-analyses.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 296, Analysis of Data in a Meta-Analysis 20. For each primary study in a meta-analysis, a forest plot portrays information about: A) 95% CIs around an effect size.

B) number of study participants.

C) quality assessment scores.

D) sample size and standard errors.

Ans: A Feedback: A forest plot graphs the effect size estimate for each primary study, together with the 95% CI around each estimate. Forest plots do not graph the number of study participants, quality assessment scores, or sample size and standard errors for each study.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 297, Analysis of Data in a Meta-Analysis 21. Which of the following is a viable approach to dealing with primary study quality in a meta-analysis?

A) Disregarding quality in analyses but reporting mean quality ratings in the report B) Doing sensitivity analyses to see if effects change when low-quality studies are excluded C) Using a random effects model rather than a fixed effects model

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D) Using a forest plot to plot study quality against the effect size index Ans: B Feedback: Quality assessments are sometimes used to exclude weak studies from systematic reviews, but they can also be used in sensitivity analyses to evaluate whether including or excluding weaker studies changes conclusions. Quality of the studies should not be ignored because primary study rigor affects the quality of the evidence. Use of a random effects versus fixed effects model concerns statistical heterogeneity, not study quality. Forest plots do not provide information about study quality.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 297, Assessment of Degree of Confidence: GRADE 22. Which of the following statements about GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) is true?

A) GRADE is used to summarize reviewers’ conclusions about how much confidence can be placed in results for some outcomes in a review.

B) GRADE ratings are done for all of the outcomes in a systematic review, taken cumulatively.

C) GRADE ratings are on a 10-point scale, from 1 = low confidence to 10 = high confidence.

D) Systematic reviewers using GRADE first rate their level of confidence and then make recommendations in clinical guidelines.

Ans: A Feedback: Systematic reviewers use GRADE to summarize how much confidence can be placed in the in results of the systematic review, for a select number of clinically important outcomes evaluated one at a time. Reviewers do not use GRADE to make clinical guideline recommendations—groups of clinicians do that. GRADE ratings are high, moderate, low, or very low and are not on a 10-point scale.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care

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Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 297, Aggregative and Interpretive Qualitative Reviews 23. Which statement about systematic reviews of qualitative studies is true?

A) Qualitative systematic reviews do not include studies from multiple qualitative traditions.

B) Aggregative qualitative reviews are usually referred to as metasyntheses.

C) Interpretive qualitative reviews are more likely to be called qualitative evidence syntheses than aggregative reviews.

D) Most systematic qualitative reviews have elements of both aggregation and interpretation.

Ans: D Feedback: Qualitative systematic reviews can often be considered either “interpretive” or “aggregative,” but most such reviews have elements of both aggregation and interpretation. Many qualitative systematic reviews combine findings from diverse qualitative traditions. Interpretive, not aggregative, reviews are usually referred to as metasyntheses, and aggregative, not interpretive, reviews are increasingly called qualitative evidence syntheses (QES).

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 01 Page and Header: 298, Metasynthesis 24. Which of the following statements about metasynthesis is true?

A) Metasyntheses are very akin to concept analyses.

B) In a metasynthesis, only a single reviewer is needed.

C) The research question for a metasynthesis may evolve during the course of the review.

D) It is advisable not to use dissertations as a data source in metasyntheses.

Ans: C Feedback:

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Most metasyntheses involve an evolving and transformational process, and so the specific research question might not be known at the outset. It is prudent to have at least two reviewers involved in a metasynthesis, to enhance the trustworthiness of the findings. Dissertations are an excellent source of data for a metasynthesis because they often have richer and more detailed information than a journal article.

Metasynthesis is not akin to concept analysis.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02 Page and Header: 298, Metasynthesis 25. Which activity is not normally undertaken as part of doing a metasynthesis?

A) Systematically extracting and recording data from the primary studies B) Searching for and selecting a sample of primary studies C) Obtaining the original data set from primary study researchers D) Evaluating the quality of the primary studies Ans: C Feedback: Metasynthesists do not typically obtain the original data set from the primary study researchers. The steps in doing a metasynthesis include searching for and selecting a sample of primary studies, evaluating the quality of the study and the data, and systematically extracting and encoding data for analysis.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01 Page and Header: 299, Evaluations of Study Quality 26. Which is true about researchers conducting metasyntheses?

A) They use only primary studies from peer-reviewed journals in the analysis.

B) They perform little advance planning, as it is not needed in qualitative research.

C) They sample primary studies at random.

D) They often evaluate study quality using a 10-question assessment tool from the Critical Appraisal Skills Programme (CASP) from the United Kingdom.

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Ans: D Feedback: Many metasynthesists use the CASP quality appraisal tool in evaluating primary study quality. Like a quantitative systematic review, a metasynthesis requires considerable advance planning. Metasynthesists include both published and unpublished primary studies—and sometimes prefer unpublished studies (e.g., dissertations) because they provide richer detail. Metasynthesists do not sample primary studies at random. They may sample exhaustively (all the studies they can find) or may sample purposively.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02 Page and Header: 300, The Noblit and Hare Approach 27. One approach to systematically integrating qualitative findings is called metaethnography. Which scholars are associated with this approach?

A) Sandelowski and Barroso B) Glaser and Strauss C) Thorne and Morse D) Noblit and Hare Ans: D Feedback: Noblit and Hare’s methods of qualitative integration, which they called metaethnography, have been influential among nurse researchers. Thorne and Morse, Glaser and Strauss, and Sandelowski and Barroso are all notable qualitative researchers, but they are not associated with meta-ethnography.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 02 Page and Header: 300, The Noblit and Hare Approach

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28. In the Noblit and Hare approach to integrating qualitative findings, one phase involves: A) computing an intensity effect size.

B) computing a frequency effect size.

C) doing a reciprocal translation analysis.

D) undertaking a meta-summary.

Ans: C Feedback: The fifth phase in the Noblit and Hare approach involves translating the qualitative studies into one another. Reciprocal translation analysis involves exploring and explaining similarities and contradictions between studies and is not unlike a constant comparative process. Noblit and Hare’s meta-ethnographic approach does not involve computing intensity or frequency effect sizes, nor does it involve doing a meta-summary.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Remember Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02 Page and Header: 301, The Sandelowski and Barroso Approach 29. One approach to systematically integrating qualitative findings distinguished qualitative reports that are “summaries” and ones that are “syntheses;” the researchers argued for including only “syntheses” as the primary studies in a metasynthesis. Which scholars are associated with this approach?

A) Sandelowski and Barroso B) Glaser and Strauss C) Thorne and Morse D) Noblit and Hare Ans: A Feedback: Sandelowski and Barroso describe qualitative reports as summaries if the findings are descriptive synopses of the qualitative data, without conceptual reframing.

Syntheses are findings that are more interpretive and explanatory and that involve conceptual or metaphorical reframing. Sandelowski and Barroso have argued that only syntheses should be used in a metasynthesis. Thorne and Morse, Glaser and Strauss, and Noblit and Hare are all notable qualitative researchers, but they are not associated with the distinction between summaries and syntheses.

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Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 02, 04 Page and Header: 301, The Sandelowski and Barroso Approach 30. A metasynthesist calculated manifest effect sizes in a meta-summary of qualitative studies on adolescent mothers’ experience of being homeless. The researcher divided the number of unduplicated reports that contained the theme of “enduring abuse” by all unduplicated reports in the analysis. What type of effect size is this?

A) An intensity effect size B) A frequency effect size C) A reciprocal effect size D) A refutational effect size Ans: B Feedback: A frequency effect size, which indicates the magnitude of the findings, is the number of reports with unduplicated information that contain a given finding, divided by all unduplicated reports. Another type of manifest effect size is the intensity effect size, which indicates the concentration of findings within each report. There are no effect sizes called “reciprocal” or “refutational.”

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 02 Page and Header: 301, The Sandelowski and Barroso Approach 31. What is the unit of analysis in computing a manifest effect size, using the Sandelowski-Barroso approach to integrating qualitative studies?

A) An individual primary study B) A study participant C) A study summary D) A qualitative finding or theme

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Ans: D Feedback: An intensity effect size indicates the concentration of findings within each primary study; it is calculated by dividing the number of different findings in a given report, by the total number of findings in all reports. The unit of analysis is not an individual study, a study participant, or a study summary.

Format: Multiple Choice Chapter: 17 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 02 Page and Header: 301, Meta-Aggregation 32. In the Johanna Briggs Institute’s (JBI’s) approach to meta-aggregation, which of the following is a step in the data analysis process?

A) Rating confidence in the findings using ConQual B) Integrating findings using reciprocal translation analysis C) Collapsing two or more categories into synthesized findings D) Collapsing findings to compute frequency effect sizes Ans: C Feedback: The JBI approach to data analysis is a three-step process, the third of which is to develop synthesized findings that encompass two or more categories. Frequency effect sizes are not computed in meta-aggregation, nor is reciprocal translation analysis used to integrate findings. ConQual is used after the data analysis and synthesis stage is completed to assess confidence in the findings.

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Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 01 Page and Header: 310, Evidence-Based Practice and Related Concepts 1. Most definitions of evidence-based practice (EBP) call for the integration of best research evidence with clinical expertise and: A) patient preferences and values.

B) well-worded clinical questions.

C) systematic reviews.

D) rankings on evidence hierarchies.

Ans: A Feedback: Evidence-based practice, according to most definitions, call for integrating best evidence from research with clinical expertise and patient preferences and values.

The evidence itself is often derived from systematic reviews, which can be retrieved by asking well-worded clinical questions. The rigor of evidence is sometimes graded according to a ranking system on evidence hierarchies.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 01, 08 Page and Header: 310, Evidence-Based Practice and Related Concepts 2.Research utilization is a process that begins with which of the following?

A) A clinical problem that needs to be solved B) A problem-focused trigger C) A finding from existing research D) A well-worded clinical question Ans: C Feedback:

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Research utilization (RU) is the use of an existing finding from research in a practical application that is unrelated to the original research. Evidence-based practice (EBP) is a broader concept than RU, and EBP efforts can begin with an existing finding (also called a knowledge-focused trigger in some EBP models), or with a problem to be solved (a problem-focused trigger). Asking a well-worded clinical question is often the first step in the EBP process.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 311, Evidence-Based Practice and Related Concepts 3. Which of the following statements is true?

A) The learning strategy called evidence-based medicine was initiated in the United States by an epidemiologist.

B) The Cochrane Collaboration, with centers around the world, plays a major role in preparing and disseminating systematic reviews.

C) Research utilization (RU) currently is a more prominent concept than evidencebased practice (EBP).

D) EBP activities in nursing are always undertaken by teams of nurses.

Ans: B Feedback: The international Cochrane Collaboration was founded in the United Kingdom based on the work of epidemiologist Archie Cochrane. The collaboration aims to support health care providers by disseminating systematic reviews of the effects of health care interventions. The learning strategy called evidence-based medicine was developed at the McMaster Medical School in Canada by Dr. David Sackett.

Research utilization efforts have largely been superseded by EBP. Individual nurses as well as teams of nurses (and interdisciplinary teams) can engage in EBP activities.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 311, Evidence-Based Practice and Related Concepts 4. Which argument is used by advocates of EBP? Page 2

A) EBP provides an excellent basis for lobbying for health research funding.

B) EBP offers a good framework for self-directed lifelong learning.

C) EBP activity helps to build professional credentials.

D) EBP promotes the elimination of health disparities.

Ans: B Feedback: EBP encourages ongoing learning to discover “best evidence”—and new evidence is constantly emerging through expanded research efforts. Thus, EBP promotes the idea that knowledge is not fixed. High-quality clinical work requires ongoing inquiry about best evidence throughout clinicians’ careers. EBP is not usually linked to efforts to lobby for funding. EBP activity might be professionally advantageous, but it is not an argument for undertaking it. Although evidence about health disparities may lead to innovative strategies to combat health disparities, EBP per se does not promote their elimination.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 01, 08 Page and Header: 311, Evidence-Based Practice and Related Concepts 5.Knowledge translation is a term most often associated with: A) international efforts to translate evidence into other languages.

B) the use of evidence by individual clinicians in their practice.

C) the adaptation of innovations for diverse cultural groups.

D) system-wide efforts to apply new evidence in practice settings.

Ans: D Feedback: The term knowledge translation (KT), a term coined by the Canadian Institutes of Health Research, generally refers to institutional, system-wide projects to make changes based on emerging evidence. KT is not specifically aimed at international efforts to translate evidence into diverse languages or at adapting innovations for diverse cultural groups. EBP, and not KT, is focused on the use of evidence by individual clinicians.

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Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 312, Preprocessed and Pre-Appraised Evidence 6. The “6S” hierarchy ranks evidence sources in terms of ease of applying the evidence to clinical practice. What is at the lowest rung on this hierarchy?

A) Systematic reviews B) Synopses of systematic reviews C) Primary studies D) Synopses of primary studies Ans: C Feedback: Evidence found in primary studies is the most difficult for clinicians to apply directly to their practice; primary studies are at the bottom rung of the “6S” hierarchy, followed by evidence that has been preprocessed or pre-appraised, including synopses of individual studies, systematic reviews, and synopses of systematic reviews.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 312, Preprocessed and Pre-Appraised Evidence 7. Which statement best describes clinical practice guidelines?

A) They offer recommendations for a specific clinical practice area based on an integration of available evidence.

B) They provide general recommendations for evidence-based decision making.

C) They are universally useful, regardless of context or country of adoption.

D) They are designed to offer suggestions for areas in which more research is needed.

Ans: A Feedback:

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Clinical practice guidelines give specific recommendations for evidence-based decision making, often based on experts’ analysis of systematic reviews. Their intent is to influence what clinicians do in specific situations, not in the general use of EBP. Guidelines are often context-specific, and so different guidelines may be used in different countries or for different populations. The purpose of the guidelines is to guide clinicians, not to guide researchers regarding what areas are in need of further study.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 02, 08 Page and Header: 312, Preprocessed and Pre-Appraised Evidence 8. Which of the following can be used to critically appraise clinical practice guidelines?

A) The PRECIS-2 instrument B) The Iowa model C) The AGREE II instrument D) GRADE Ans: C Feedback: Evidence-based clinical practice guidelines distill a body of evidence into a usable form. Several appraisal instruments are available to evaluate clinical practice guidelines, but one with broad support is the Appraisal of Guidelines Research and Evaluation (AGREE II) Instrument. The Iowa model is used as a framework for an evidence-based project. The PRECIS-2 instrument is used to assess the degree to which a trial design is pragmatic or explanatory. GRADE is used to evaluate degree of confidence in the results of systematic reviews, and these evaluations are sometimes taken into account in developing clinical practice guidelines.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 03 Page and Header: 313, Models of the Evidence-Based Practice Process

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9. Which model was explicitly developed with the idea that individual nurses could engage in research utilization?

A) Iowa Model of EBP B) Johns Hopkins Nursing EBP Model C) Cochrane Model D) Stetler Model Ans: D Feedback: Some models focus on the use of research from the perspective of individual clinicians such as the Stetler Model, one of the oldest models that originated as a research utilization (RU) model. Most models, however, focus on institutional or team-based EBP efforts, such as the John Hopkins Nursing EBP Model and the Iowa Model of EBP. There is no Cochrane Model; the Cochrane Collaboration is an organization that prepares and disseminates systematic reviews.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 313, Models of the Evidence-Based Practice Process 10. Several models of EBP, including the Iowa Model, distinguish problem-focused and knowledge-focused triggers. Which of the following is a problem-focused trigger?

A) A paper published about a patient fall intervention in a nursing journal B) A new clinical guideline on strategies to reduce patient falls C) An observed increase in patient falls among patients on a neurological unit D) A journal club discussion of a paper on patient falls Ans: C Feedback: Several models of EBP, such as the Iowa Model, have distinguished two types of stimulus (“triggers”) for an EBP endeavor: (1) problem-focused triggers—the identification of a clinical practice problem in need of solution, or (2) knowledgefocused triggers—findings discovered in the research literature. The observance of an increase in patient falls in a neurologic unit could be the problem “trigger” for an EBP project on that unit. All other alternatives would be knowledge-focused triggers, coming from outside the organization.

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Format: Multiple Choice Chapter: 18 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 313, Models of the Evidence-Based Practice Process 11. Several models of EBP, including the Iowa Model, distinguish problem-focused and knowledge-focused triggers. Which of the following is a knowledge-focused trigger?

A) A report in Journal of Advanced Nursing regarding predictors of pressure injuries among hospitalized older adults B) Increases in the readmission rate of heart failure patients C) Poor patient satisfaction survey results D) Increase in medication errors Ans: A Feedback: Several models of EBP have distinguished two types “triggers” for an EBP endeavor: (1) problem-focused triggers—the identification of a clinical practice problem in need of solution, or (2) knowledge-focused triggers—information from the research literature. A report in a nursing journal regarding factors that affect pressure injuries in hospitalized older adults is an example of a knowledge-focused trigger.

The other answers are examples of problem-focused triggers.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 04 Page and Header: 315, Major Steps in Evidence-Based Practice 12. For EBP efforts, nurses often follow five major steps. What is the first step in the process?

A) Searching for and acquiring relevant research evidence B) Appraising and synthesizing research evidence C) Posing a clinical question that can be answered with research evidence D) Integrating evidence with other factors, such as patient preferences, and applying it to clinical practice Ans: C Page 7

Feedback: Individual nurses can put research into practice using five basic steps, in this order: (1) asking a clinical question for which research evidence is relevant, (2) searching for and acquiring relevant research evidence, (3) appraising and synthesizing the evidence, (4) integrating evidence with other factors and applying it to clinical practice, and (5) assessing effectiveness.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 315, Major Steps in Evidence-Based Practice 13. Which of the following is a question that would be asked in appraising research evidence in an individual EBP effort?

A) What are the P, I, C, and O components?

B) How valid and unbiased is the evidence?

C) With what other information should I integrate the evidence?

D) Is a relevant systematic review available?

Ans: B Feedback: In appraising the quality of research evidence, which is the third step in many EBP endeavors, a key question is, “To what extent is the evidence valid? How serious is the risk of biases?” The first step is asking well-worded questions, guided by the PICO question format. The second step is locating and acquiring evidence, which might involve asking whether a relevant systematic review is available. The fourth step is to apply the evidence in making evidence-based decisions or providing evidence-based advice.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 316, Magnitude of Effects 14. During an appraisal of the evidence, researchers often use such indexes as the effect size index to come to conclusions about: Page 8

A) the precision of evidence estimates.

B) the quality and rigor of the evidence.

C) the magnitude of effects of an intervention.

D) the consistency of the evidence.

Ans: C Feedback: Clinicians assessing relevant evidence in an EBP effort need to understand not only whether the evidence is valid (the quality of the evidence) but also how powerful any effects are—that is, their magnitude. Indexes such as effect size indexes quantify the magnitude of effects of an intervention on outcomes. Such indexes do not provide information about precision or consistency.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 05 Page and Header: 318, Evidence-Based Practice and Practice-Based Evidence 15. Which statement about practice-based evidence is true?

A) Practice-based evidence is an alternative name for evidence-based practice.

B) Practice-based evidence is the kind of evidence most often used in evidencebased practice.

C) Practice-based evidence is evidence developed in real-world contexts, responsive to the needs of clients with varying health challenges.

D) Intervention studies using a randomized design do not yield practice-based evidence.

Ans: C Feedback: Practice-based evidence—which is not an alternative name for evidence-based practice (EBP)—is evidence that has been developed in real-world settings with the aim of being responsive to the needs and circumstances of specific patients. EBP has not traditionally relied on practice-based evidence. Intervention studies using a randomized design can be designed to yield evidence that is more practice-based than has traditionally been the case.

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Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 05 Page and Header: 318, Evidence-Based Practice and Population Models of Evidence 16. Traditionally, evidence-based practice (EBP) has relied on evidence about: A) patients’ contexts.

B) populations.

C) subgroups of patients.

D) individual patients.

Ans: B Feedback: Traditionally, EBP has been based on evidence about populations of people, not about individual clients, subgroups of clients, or client contexts. EBP relies heavily on evidence from randomized controlled trials about the “average” effects of an intervention on a population of people—the population implied by the eligibility criteria for the trial.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 06 Page and Header: 318, Evidence-Based Practice and Population Models of Evidence 17. Which of the following statements is true?

A) Randomized controlled trials yield information about average treatment effects for a specified population.

B) Heterogeneity of treatment effects (HTE) is synonymous with average treatment effects.

C) Average treatment effects are avoided in traditional models of evidence-based practice.

D) Individual patients can always benefit from knowledge of average treatment effects from a rigorous randomized trial.

Ans: A Feedback: Page 10

Findings from randomized controlled trials (RCTs) are in the form of treatment effects for “average” clients in a specified population. Average treatment effects are usually the evidence used as the basis for EBP. Heterogeneity of treatment effects results when “average” effects do not capture the full range of effects of an intervention. No matter how rigorous the trial, individual patients may not benefit from knowledge of “average” treatment effects because they may not be an “average” member of the specified population.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 05 Page and Header: 318, Evidence-Based Practice and Population Models of Evidence 18. In a randomized controlled trial of a stress-reducing intervention for family caregivers, the mean effect was an improvement of 3 points on a depression scale.

Some participants improved by 6 or more points and others deteriorated by 3 or more points. This situation reflects: A) universal effects.

B) average treatment effects.

C) subgroup effects.

D) heterogeneity of treatment effects.

Ans: D Feedback: In this situation, the average treatment effect of a 3-point improvement for the population masked considerable diversity in effects, which is referred to as heterogeneity of treatment effects (HTE). The treatment effects were not universal, and no subgroups of trial participants were identified in this example.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 06 Page and Header: 319, Evidence-Based Practice and External Validity 19. Traditional evidence hierarchies rank evidence sources primarily on the basis of which type of validity?

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A) External validity B) Internal validity C) Construct validity D) Statistical conclusion validity Ans: B Feedback: Traditional evidence hierarchies rank evidence almost exclusively on the basis of a study’s internal validity. Other types of validity are not taken into account in the ranking of evidence sources.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 06 Page and Header: 319, Evidence-Based Practice and External Validity 20. Which of the following is often a constraint on generalizability in traditional (explanatory) randomized controlled trials (RCTs)?

A) Sample sizes in RCTs are usually too small to safely generalize.

B) High rates of participation in the RCT are atypical of what occurs in clinical settings.

C) RCTs are often undertaken in atypical, tightly controlled settings.

D) The follow-up period in the RCTs is too long.

Ans: C Feedback: Traditional explanatory RCTs impose tight controls over many aspects of RCTs— they are often undertaken in tightly controlled and resource-rich settings with highly skilled health care staff that are not “typical.” RCTs typically have shorter follow-up periods than is offered in clinical care, and rates of participation tend to be low. Rigorous RCTs are adequately powered (have a sufficiently large sample size); sample size per se seldom factors into the generalizability of RCT results.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 06 Page 12

Page and Header: 319, Evidence-Based Practice and External Validity 21. With regard to the people who participate in randomized controlled trials (RCTs), which of the following statements is true?

A) Eligibility criteria for RCTs often exclude patients with comorbidities.

B) RCTs are held in such high esteem that rates of participation are typically high.

C) Clinical patients are generally very similar to ones included in traditional RCTs. D) RCTs often select as participants older patients, who might especially benefit from innovative treatments.

Ans: A Feedback: Trialists typically exclude clients with potentially confounding characteristics, such as comorbidities and older age. As a result, study participants may be very different from those in average clinical caseloads. Rates of participation in RCTs tend to be low.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 06, 08 Page and Header: 319, Generalizability, Applicability, and Relevance 22. Applicability, in a research context, can be defined as the degree to which: A) study evidence can be generalized to the target population.

B) a clinical research team can apply study results to their own patients.

C) the study participants can apply the study findings to their own health care needs.

D) study evidence can be applied to individuals, small groups of individuals, or local contexts.

Ans: D Feedback: Applicability, as defined in the chapter, refers to the degree to which research evidence can be applied to individual clients, small subgroups of people, or local contexts. Applicability is not the same as generalizability, and it does not refer to the use of study findings by the participants themselves or by a research team conducting a study.

Format: Multiple Choice Page 13

Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 07 Page and Header: 320, Comparative Effectiveness Research 23. Which of the following is not a defining characteristic of comparative effectiveness research (CER)?

A) CER involves comparisons of two or more alternative treatments.

B) CER studies always involve the use of an experimental design.

C) CER is undertaken in real-world settings.

D) CER strives to develop evidence that goes beyond “average effects.”

Ans: B Feedback: Many comparative effectiveness studies use an experimental design, but CER uses a diverse array of designs and methods, including nonexperimental (observational) approaches. CER involves direct comparisons of alternative treatments, each of which has potential to be “best practice.” CER is undertaken in real-world clinical settings and strives to produce evidence that goes beyond “average effects.”

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 07 Page and Header: 320, Comparative Effectiveness Research 24. Three foundational questions for the conduct of comparative effectiveness research are: A) What works? For whom? In whose hands?

B) What should be compared? Is it effective? At what cost?

C) Which stakeholders should be involved? When should an intervention be initiated? Who will conduct the research?

D) Which outcomes should be assessed? What design should be used? Who should study participants be?

Ans: A

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Feedback: The evolving comparative effectiveness research (CER) model calls for innovations that address three fundamental questions: What works? For whom? and In whose hands? These questions focus squarely on the issue of the applicability of research evidence to individuals, groups of individuals, and to local contexts. All of the other questions are likely to be addressed during the design of a CER study, but they are not fundamental questions about its goals.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 07 Page and Header: 320, Comparative Effectiveness Research 25. Comparative effectiveness research (CER) gives special weight to which type of outcomes?

A) Nursing sensitive outcomes B) Short-term outcomes C) Patient-reported outcomes D) Administrative outcomes Ans: C Feedback: CER prioritizes outcomes that are important to patients and gives weight to patientreported outcomes (e.g., pain, anxiety). CER is interested in long-term (not shortterm) outcomes of health care interventions. CER projects may involve nursingsensitive outcomes (as well as administrative outcomes such as efficiency), but these are not outcomes that are specifically prioritized.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 07, 08 Page and Header: 321, Pragmatic Clinical Trials 26.Concern about the disproportionate focus on internal validity in traditional randomized controlled trial designs has led to interest in designs called:

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A) efficacy trials.

B) superiority trials.

C) explanatory trials.

D) pragmatic clinical trials.

Ans: D Feedback: Concerns about the applicability and generalizability of evidence from traditional (explanatory) trials has led to interest in pragmatic clinical trials (PCTs), which have features designed to enhance external validity. Traditional explanatory trials are usually superiority trials (the hypothesis is that an intervention is better than a comparator), and the term “efficacy trial” is often used for “Phase III” trials that focus on internal validity using traditional designs.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 07, 08 Page and Header: 321, Pragmatic Clinical Trials 27. Which statement about the PRECIS-2 tool is true?

A) The PRECIS-2 tool is used to critically appraise pragmatic clinical trials.

B) The PRECIS-2 tool encompasses three domains.

C) The lower the score on PRECIS-2, the more pragmatic the trial design is.

D) One of the domains that is scored on the PRECIS-2 tool is participant eligibility.

Ans: D Feedback: The PRECIS-2 tool scores from 1 to 5 on the nine domains in the instrument. One domain is for participant eligibility—i.e., how similar study participants are to clients in usual care. Higher (not lower) scores on PRECIS-2 indicate a more pragmatic design. The instrument is not used to critically appraise pragmatic clinical trials.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 07 Page and Header: 321, Pragmatic Clinical Trials Page 16

28. Which research design has been found to be especially useful for pragmatic clinical trials?

A) A cluster randomized design B) A time series design C) A crossover design D) A case-control design Ans: A Feedback: One of the most widely used designs in pragmatic clinical trials is cluster randomized designs that involves randomization of groups of participants (e.g., hospital units) rather than individuals. Such a design protects against contamination of treatments. A crossover design is not especially “pragmatic” and the other two designs are either quasi-experimental (time series) or observational (case-control) that expose them to threats to internal validity and are less useful in pragmatic trials than randomized designs.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 07 Page and Header: 321, Pragmatic Clinical Trials 29. Researchers conducting a randomized controlled trial can take several steps with regard to their sampling plan to enhance patient-centered evidence. One of these steps is to: A) exclude patients who have characteristics that could confound the results.

B) make efforts to ensure that research samples reflect the full range of people who could benefit from (or be harmed by) the intervention.

C) sample patients from a single site so that confounding contextual factors will be controlled.

D) make efforts to sample in a manner that avoids heterogeneity of effects.

Ans: B Feedback: For developing practice-based evidence, it is important to sample the full range of people who could benefit from (or be harmed by) the intervention—including people with comorbidities who are often excluded. The other options—excluding clients with potentially confounding characteristics, sampling from a single site, and taking steps to avoid heterogeneity of effects—would undermine practice-based evidence.

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Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 07 Page and Header: 322, Subgroup Analyses 30. Epidemiologist Alvan Feinstein described the challenges of subgroup analysis as a “clinicostatistical tragedy.” The challenge to which he was referring was the high risk of: A) making both Type I and Type II errors.

B) focusing on the wrong subgroups.

C) using an inappropriate statistical analysis.

D) having low replicability across studies.

Ans: A Feedback: Feinstein recognized that subgroup analyses are fraught with a high risk of both Type II errors (because of small sample sizes) as well as a high risk of Type I errors (because often too many subgroup analyses are undertaken). It is true that statistical analyses are often performed incorrectly, but this is not the statistical issue to which Feinstein was referring. There is not necessarily a high risk of low replicability (true subgroup effects are replicable) nor a high risk of focusing on the wrong subgroups.

Format: Multiple Choice Chapter: 18 Client Needs: Safe and Effective Care Environment: Management of Care Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 07 Page and Header: 322, Subgroup Analyses 31. Experts have provided considerable advice about subgroup analysis. Which statement about the appropriate conduct of subgroup analyses is true?

A) For the sake of efficiency, it is prudent to test subgroup treatment effects for 5 to 10 subgroups.

B) If power for the analysis of overall treatment effects is 80%, then the power for each subgroup analysis would also be 80%.

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C) Subgroup analyses should be undertaken based on well-grounded hypotheses specified in advance.

D) The subgroups in a subgroup analysis should be defined on the basis of variables measured at follow-up.

Ans: C Feedback: Subgroup analyses should be a hypothesis-testing effort based on hypotheses articulated in advance. Statistical experts advise that only one or two primary subgroup analyses should be conducted. If the power for the overall study is 80%, power for the subgroup analyses would be lower because the sample size for subgroups is necessarily lower than that for the entire sample. Subgroup analyses should be based on variables defined at baseline, not at follow-up.

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