Evidence Based Practice
What is evidence-based practice?
A. Following hospital rules without questioning them
B. Using the best current research, clinical expertise, and patient preferences to guide nursing care
C. Only using information from nursing textbooks
D. Providing care based only on a nurse’s personal experience
B. Using the best current research, clinical expertise, and patient preferences to guide nursing care.
A nurse is preparing to call the provider about a client whose blood pressure has dropped from 124/78 to 86/54 mmHg in the past hour. Which statement represents the Situation portion of SBAR?
A. “The client’s BP was stable this morning.”
B. “I am calling about Mr. Jones in room 412 who has hypotension.”
C. “He has a history of hypertension and heart failure.”
D. “I recommend starting IV fluids.”
B. “I am calling about Mr. Jones in room 412 who has hypotension.”
The SBAR method organizes communication into Situation, Background, Assessment, and Recommendation.
Situation: What is happening right now and why the nurse is calling.
Background: Relevant medical history or context.
Assessment: The nurse’s evaluation of the problem.
Recommendation: What the nurse suggests or requests.
Option B clearly states who the patient is and the current problem (hypotension), which correctly represents the Situation portion of SBAR.
A nurse is reviewing a patient’s electronic chart at the nurses’ station. A visitor asks the nurse about the patient’s diagnosis. What is the nurse’s best response?
A. Tell the visitor the diagnosis if they seem concerned.
B. Ask the visitor if they are a family member before answering.
C. Tell the visitor to ask the patient directly.
D. Do not disclose any information and explain privacy rules.
Correct answer: D. Do not disclose any information and explain privacy rules.
Rationale:
Patient health information is protected under Health Insurance Portability and Accountability Act. Nurses must maintain patient confidentiality and cannot share medical information with visitors or others unless the patient has given permission. The appropriate response is to politely refuse to disclose information and explain privacy regulations that protect the patient’s health information.
A client newly diagnosed with diabetes says, “I don’t think I can give myself insulin shots.” What is the nurse’s best response?
A. “You’ll get used to it over time.”
B. “Why do you feel that way?”
C. “Tell me what concerns you most about giving insulin.”
D. “Your provider says this is necessary.”
Correct Answer: C
Rationale: Open-ended statements encourage expression of feelings and support therapeutic communication. “Why” questions can sound accusatory, and reassurance or authority statements block communication.
A nurse develops the following goal for a patient:
"The patient will feel better soon."
What should the nurse do next?
A. Implement the care plan
B. Revise the goal to make it measurable
C. Document the goal in the chart
D. Notify the physician
B. Revise the goal to make it measurable
Rationale: Expected outcomes should be specific and measurable so the nurse can evaluate whether the goal was achieved.
What does "T" stand for in PICOT?
A. Treatment
B. Test
C. Time
D. Therapy
C. Time
The “T” in the PICOT framework stands for Time. This part of the question identifies the time frame in which the outcome is expected to occur. It helps specify how long the intervention will be applied or when the outcome will be measured.
For example, a PICOT question might ask whether a certain nursing intervention improves patient outcomes within 6 months or during a hospital stay. Including Time makes the clinical question clearer and helps guide research and evidence-based decision-making.
Which of the following statements belong in the Background portion of SBAR?
(Select all that apply.)
A. “The client was admitted with pneumonia.”
B. “The oxygen saturation is 88% on 2 L nasal cannula.”
C. “The client has a history of COPD.”
D. “The respiratory rate is 32.”
E. “The client received IV morphine 1 hour ago.”
A. “The client was admitted with pneumonia.”
C. “The client has a history of COPD.”
E. “The client received IV morphine 1 hour ago.”
Rationale:
The SBAR method organizes information into four parts:
Situation: What is happening right now.
Background: Relevant medical history, diagnosis, or recent treatments/medications.
Assessment: Current vital signs or clinical findings.
Recommendation: What the nurse thinks should happen next.
A: Admission diagnosis (pneumonia) → Background
C: Past medical history (COPD) → Background
E: Recent medication given → Background
B and D: These describe current patient status, which belong in the Assessment portion.
Which statement best explains why documentation is important in nursing care?
A. It helps nurses finish their work faster.
B. It allows nurses to avoid communicating with other staff.
C. It serves as a legal record of care.
D. It replaces verbal communication between healthcare providers.
Correct answer: C. It serves as a legal record of care.
Rationale:
Accurate documentation creates a permanent, legal record of the care provided to a patient. In healthcare, the medical record can be used to verify treatments, track patient progress, support communication among providers, and provide legal protection if questions arise about the care given. Proper documentation is also important for meeting standards required by organizations such as The Joint Commission.
A hospitalized client is crying quietly after receiving bad news. Which action by the nurse is most therapeutic?
A. Offer advice on coping strategies
B. Sit quietly with the client
C. Tell the client everything will be okay
D. Change the subject to distract the client
Correct Answer: B
Rationale: Presence and silence allow emotional processing and demonstrate support. Premature advice, false reassurance, or distraction are non-therapeutic.
The nurse is using the nursing process to provide care.
Place the five steps in the correct order:
________ → ________ → ________ → ________ → ________
Evaluate.Assess.Diagnose.Implement.Plan.
Assess.Diagnose.Plan.Implement.Evaluate.
A way to identify knowledge, improve professional education and practice, and use resources effectively refers to which concept?
A. Patient advocacy
B. Evidence-based practice
C. Quality assurance
D. Nursing diagnosis
Correct answer: B. Evidence-based practice
Rationale:
Evidence-Based Practice is the process of using the best current research evidence, clinical expertise, and patient preferences to make decisions about patient care. It helps nurses identify knowledge gaps, improve professional education and practice, and use healthcare resources more effectively to provide high-quality care.
Which documentation entry is correctly written in SOAP format?
A. S: Client states pain is 8/10. O: Grimacing and guarding abdomen. A: Acute abdominal pain. P: Administer morphine as prescribed.
B. Client appears uncomfortable and may be exaggerating pain.
C. Patient is probably having appendicitis.
D. Gave pain medication. Will continue to monitor.
A. S: Client states pain is 8/10. O: Grimacing and guarding abdomen. A: Acute abdominal pain. P: Administer morphine as prescribed.
Rationale:
SOAP note is a structured method for charting patient information:
S – Subjective: What the patient reports (e.g., pain level).
O – Objective: Observable or measurable data (e.g., grimacing, guarding).
A – Assessment: The nurse’s clinical interpretation of the problem.
P – Plan: The action or intervention to address the problem.
Option A correctly includes all four SOAP components and uses objective, professional documentation, while the other options are incomplete or contain subjective assumptions.
Which charting entry by a nurse is most appropriate?
A. Patient seems comfortable and doing well.
B. Patient is fine and resting normally.
C. Patient appears to have less pain today.
D. Patient states pain is 2/10, respirations 16, unlabored.
Correct answer: D. Patient states pain is 2/10, respirations 16, unlabored.
Rationale:
Nursing documentation should be objective, specific, and measurable. The entry “Patient states pain is 2/10, respirations 16, unlabored” includes direct patient statements and observable data, which makes the documentation clear and accurate. Objective charting helps ensure proper communication among healthcare providers and supports safe patient care.
The nurse is teaching a client about a new antihypertensive medication. Which statement by the client indicates effective learning?
A. “I’ll take this medicine only when my blood pressure is high.”
B. “I should stop the medication if I feel better.”
C. “I will take this medication at the same time every day.”
D. “I can double the dose if I miss a pill.”
Correct Answer: C
Rationale: Consistent timing improves therapeutic levels. Antihypertensives are usually taken daily, not PRN, and doses should never be doubled.
The nurse notes a patient’s blood pressure is 88/54, heart rate 118, and the patient appears pale. Is this subjective data, objective data, or both?
Objective data
Scientific peer-reviewed journals are an example of what type of evidence?
A. Expert opinion
B. Clinical experience
C. Research-based evidence
D. Patient preference
Correct answer: C. Research-based evidence
Rationale:
Research-Based Evidence refers to information that comes from scientific studies and research findings. Articles published in peer-reviewed journals are reviewed by other experts in the field before publication, which helps ensure the quality, accuracy, and reliability of the research. These sources are commonly used in Evidence-Based Practice to guide nursing care and clinical decision-making.
The nurse documents the following note:
“S: Patient is noncompliant and difficult.
O: Refuses medication.
A: Manipulative behavior.
P: Will notify provider.”
Which action is most appropriate?
A. Leave documentation as written.
B. Add more descriptive language about personality.
C. Revise documentation to remove judgmental language.
D. Delete the note entirely
C. Revise documentation to remove judgmental language.
The nurse is calling the provider about a patient’s low blood pressure. Which communication method should the nurse use?
A. SOAP
B. PIE
C. SBAR
D. ADPIE
Correct answer: C. SBAR
Rationale:
SBAR stands for Situation, Background, Assessment, and Recommendation. It is a structured communication method used in healthcare to clearly and quickly share important patient information, especially when contacting a provider about a patient concern such as low blood pressure. Using SBAR helps ensure accurate communication, patient safety, and efficient decision-making.
The RN is delegating tasks to an AP. Which task is appropriate to delegate?
A. Teaching a client how to use an incentive spirometer
B. Assessing pain after medication administration
C. Ambulating a stable post-op client
D. Evaluating effectiveness of a care plan
Correct Answer: C
Rationale: UAPs can perform routine, non-assessment tasks on stable clients. Teaching, assessment, and evaluation must be done by licensed nurses.
Administering medications is what phase of the nursing process?
A. Implementation
B. Assessment
C. Planning
D.Evaluation
A. Implementation
Rationale: Implementation is when the nurse performs interventions to achieve client outcomes.
What are patient preferences (or patient values)?
A. The doctor’s opinion about the best treatment
B. Hospital policies for patient care
C. Research findings from scientific studies
D. The patient’s values, beliefs, and preferences that must be considered when applying evidence to care
Correct answer: D. The patient’s values, beliefs, and preferences that must be considered when applying evidence to care
Rationale:
In Evidence-Based Practice, patient preferences (or patient values) refer to the individual patient’s beliefs, cultural values, personal choices, and expectations about their care. When nurses apply research evidence to clinical practice, they must also consider what the patient wants or believes is important to ensure care is respectful, individualized, and patient-centered.
A client with diabetes has a blood glucose of 42 mg/dL and is diaphoretic and confused. Which statement represents the Recommendation portion of SBAR?
A. “The client is confused and diaphoretic.”
B. “The blood glucose is 42.”
C. “The client has Type 1 diabetes.”
D. “I recommend administering IV dextrose.”
D. “I recommend administering IV dextrose.”
When should an incident report be completed?
A. When a patient is discharged from the hospital
B. When routine care is provided to a patient
C. When an event is inconsistent with routine patient care
D. When a patient requests a copy of their medical record
Correct answer: C. When an event is inconsistent with routine patient care
Rationale:
An Incident Report is completed when an unusual event or error occurs that is not part of routine patient care, such as patient falls, medication errors, or equipment malfunctions. Incident reports help healthcare facilities identify safety issues, improve procedures, and prevent future incidents. They are not part of the patient’s medical record but are used for quality improvement and risk management.
The nurse is teaching a client with asthma how to use a metered-dose inhaler. Which statement indicates the client needs further teaching?
A. “I will shake the inhaler before use.”
B. “I will inhale slowly while pressing the canister.”
C. “I will rinse my mouth after using the inhaler.”
D. “I will use the rescue inhaler every day even if I feel fine.”
Correct Answer: D
Rationale: Rescue inhalers are used PRN for symptoms, not daily. The other statements reflect correct technique.
Which nursing intervention is considered direct patient care?
A. Documenting care in the chart
B. Adjusting the patient’s environment
C. Administering IV medication
D. Participating in interdisciplinary rounds
B. Administering IV medication
Rationale Direct care involves hands-on interactions with the patient, such as medication administration or teaching.