10 original SNLE questions on research and evidence based practice, each with an explanation for all four options. Part of Nursing Management and Leadership, worth 10% of the Saudi Nursing Licensure Examination.
Q01 / 10medium0 correct
Nursing Management and Leadershipmediumq050
A nurse manager on a medical-surgical unit is reviewing current evidence to update the unit's protocol for preventing catheter-associated urinary tract infections (CAUTI). The manager wants to base the new protocol on the strongest available evidence. Which type of research evidence should the manager prioritize?
All 10 questions
Every question below, with the reasoning for all four options. Try to answer before you open one.
Research and Evidence Based Practice · medium
A nurse manager on a medical-surgical unit is reviewing current evidence to update the unit's protocol for preventing catheter-associated urinary tract infections (CAUTI). The manager wants to base the new protocol on the strongest available evidence. Which type of research evidence should the manager prioritize?
AA quasi-experimental study with a control group
BA single randomized controlled trial with a large sample size
CA systematic review of multiple randomized controlled trials
DA qualitative study exploring nurses' perceptions of CAUTI prevention
Show the answer and why the others fail
Answer: C. A systematic review of multiple randomized controlled trials
A
Quasi-experimental studies lack randomization, which increases the risk of selection bias. They provide a lower level of evidence than RCTs or systematic reviews.
B
While a well-designed RCT provides strong evidence, a single study is not as robust as a synthesis of multiple RCTs. Individual studies may have limitations or conflicting results.
C — correct
Systematic reviews of RCTs are considered the highest level of evidence because they critically appraise and synthesize results from multiple studies, reducing bias and increasing generalizability.
D
Qualitative research provides valuable insights into experiences and barriers but does not establish cause-and-effect relationships or measure intervention effectiveness, making it a lower level of evidence for practice change.
TakeawayIn evidence-based practice, systematic reviews of randomized controlled trials (RCTs) represent the highest level of evidence for evaluating intervention effectiveness, as they synthesize findings from multiple studies to provide more reliable conclusions than single studies.
Research and Evidence Based Practice · medium
A nurse on a medical-surgical unit is concerned about the high rate of catheter-associated urinary tract infections (CAUTIs). The nurse decides to search for evidence and formulates the following clinical question: "In adult hospitalized patients with indwelling urinary catheters, does the use of a silver alloy-coated catheter compared to a standard latex catheter reduce the incidence of CAUTIs within 30 days?" Which component of the PICOT format does "silver alloy-coated catheter" represent?
AOutcome
BPopulation
CIntervention
DComparison
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Answer: C. Intervention
A
The outcome (O) is the reduction in CAUTI rates, which is the effect being measured.
B
The population (P) is "adult hospitalized patients with indwelling urinary catheters," not the intervention.
C — correct
The intervention (I) is the new treatment or approach being tested, which in this question is the silver alloy-coated catheter.
D
The comparison (C) is the standard latex catheter, which serves as the control or usual care.
TakeawayIn a PICOT question, the 'I' stands for Intervention, which is the new treatment or approach being evaluated for its effectiveness.
Research and Evidence Based Practice · medium
A nurse researcher is evaluating a study that examined the effect of a new patient education program on medication adherence. The study assigned participants to the intervention or control group based on the day of the week they attended the clinic. Which type of research design does this study use?
AQuasi-experimental design
BDescriptive design
CCorrelational design
DRandomized controlled trial
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Answer: A. Quasi-experimental design
A — correct
The study uses a non-random method (day of the week) to assign participants to groups, which is characteristic of a quasi-experimental design.
B
A descriptive design aims to describe characteristics of a population or phenomenon without comparing groups or testing an intervention.
C
A correlational design examines relationships between variables without manipulating an intervention, whereas this study implemented an intervention.
D
A randomized controlled trial requires random assignment of participants to groups, which was not done in this study.
TakeawayQuasi-experimental designs lack random assignment, making them less rigorous than RCTs but still useful for evaluating interventions when randomization is not feasible.
Research and Evidence Based Practice · easy
A nurse on a medical-surgical unit wants to implement an evidence-based practice change to reduce hospital-acquired pressure injuries. The nurse formulates the following clinical question: "In bedridden adult patients, does the use of a prophylactic silicone foam dressing in addition to standard repositioning compared to standard repositioning alone reduce the incidence of sacral pressure injuries over a 4-week period?" Which part of the PICOT question represents the "Outcome"?
AStandard repositioning alone
BBedridden adult patients
CIncidence of sacral pressure injuries
DProphylactic silicone foam dressing plus standard repositioning
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Answer: C. Incidence of sacral pressure injuries
A
This is the Comparison (C) – the usual care against which the intervention is measured.
B
This is the Population (P) – the specific group of patients to whom the clinical question applies.
C — correct
This is the Outcome (O) – the measurable result that the nurse aims to evaluate.
D
This is the Intervention (I) – the treatment being tested, which includes the dressing as an adjunct to standard care.
TakeawayIn a PICOT question, the 'O' stands for Outcome, which is the measurable result of interest (e.g., incidence of pressure injuries).
Research and Evidence Based Practice · medium
A nurse on a medical-surgical unit wants to reduce the incidence of catheter-associated urinary tract infections (CAUTI). She formulates the PICOT question: 'In adult hospitalized patients with indwelling urinary catheters (P), how does a nurse-driven removal protocol (I) compared to standard care (C) affect CAUTI rates (O) over a 6-month period (T)?' After formulating this question, what should the nurse do next?
ASearch databases for the best available evidence related to the question.
BEvaluate patient outcomes to determine if CAUTI rates have decreased.
CImplement the nurse-driven removal protocol on the unit.
DCritically appraise the retrieved studies for validity and applicability.
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Answer: A. Search databases for the best available evidence related to the question.
A — correct
The evidence-based practice process follows the 5 A's: Ask, Acquire, Appraise, Apply, and Assess. After asking the clinical question (PICOT), the next step is to acquire the evidence by conducting a systematic literature search.
B
Evaluating outcomes is the final step (Assess) in the EBP process, performed after the intervention has been implemented. It cannot occur before evidence is gathered and applied.
C
Implementation occurs after the evidence has been acquired, appraised, and determined to be sufficient to support a practice change. This is the 'Apply' step, not the immediate next step.
D
Critical appraisal is the third step (Appraise) and can only be done after the evidence has been acquired. It is not the immediate next step after formulating the question.
TakeawayThe evidence-based practice process follows the 5 A's: Ask, Acquire, Appraise, Apply, and Assess. After formulating a PICOT question, the next step is to acquire the best available evidence.
Research and Evidence Based Practice · medium
A nurse researcher is conducting a study on pain management in postoperative patients. A potential participant asks, "What will happen if I decide to withdraw from the study after I start?" Which response by the nurse best reflects the ethical principle of respect for persons?
A"You are free to withdraw at any time, and your care will not be affected in any way."
B"Once you sign the consent form, you are expected to complete the study to ensure valid results."
C"You may withdraw at any time without penalty, but we would appreciate if you could complete the study."
D"You can withdraw, but we will need to use the data already collected up to that point."
Show the answer and why the others fail
Answer: A. "You are free to withdraw at any time, and your care will not be affected in any way."
A — correct
This response correctly upholds the ethical principle of respect for persons by clearly stating the right to withdraw without penalty and explicitly assuring that the participant's care will not be compromised, which is essential for truly voluntary informed consent.
B
This statement is incorrect and unethical because it implies that withdrawal is not permitted after enrollment, violating the fundamental right of participants to discontinue participation at any time.
C
This response includes a subtle coercive element by expressing appreciation for completion, which may pressure the participant to continue. Respect for persons requires an unqualified assurance of voluntary withdrawal.
D
While it is often true that data collected prior to withdrawal may be used (as per consent), this response fails to address the participant's primary concern about consequences to their care and does not fully reassure them of the voluntary nature of participation.
TakeawayIn research ethics, respect for persons demands that participants have the right to withdraw at any time without penalty or loss of entitled benefits, and this must be clearly communicated during the informed consent process.
Research and Evidence Based Practice · easy
A nurse researcher is planning a study to evaluate a new pain management protocol for postoperative patients. Before beginning data collection, the researcher submits the study proposal to the Institutional Review Board (IRB). What is the primary purpose of this review?
ATo ensure the study has adequate funding and resources.
BTo approve the publication of the study findings in a journal.
CTo protect the rights and welfare of human subjects.
DTo determine the statistical significance of the study results.
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Answer: C. To protect the rights and welfare of human subjects.
A
While funding and resources are important for study feasibility, the IRB's primary focus is not financial oversight but ethical protection of participants.
B
Publication approval is handled by journal editors and peer reviewers, not the IRB. The IRB's role is pre-study ethical review, not post-study dissemination.
C — correct
The IRB's main responsibility is to review research protocols to ensure that the rights, safety, and well-being of human participants are protected, in accordance with ethical principles and regulations.
D
Statistical analysis is conducted after data collection, not by the IRB. The IRB reviews the study design but does not calculate or determine significance.
TakeawayThe Institutional Review Board (IRB) exists to safeguard the rights, dignity, and safety of human research participants, and all research involving human subjects must receive IRB approval before commencing.
Research and Evidence Based Practice · medium
A nurse researcher is recruiting participants for a study on non-pharmacological pain management techniques. Which action best demonstrates the process of obtaining informed consent?
AExplaining the study purpose, procedures, risks, and benefits in simple language.
BOffering a monetary incentive for participation in the study.
CProviding a written consent form for the participant to sign.
DAssuring the participant that all data will be kept confidential.
Show the answer and why the others fail
Answer: A. Explaining the study purpose, procedures, risks, and benefits in simple language.
A — correct
Informed consent is a communication process; the researcher must provide all relevant information in an understandable manner and verify comprehension to enable a voluntary decision.
B
Incentives may be offered but must not be coercive; they are not a component of the informed consent process itself, which focuses on information and comprehension.
C
Signing a form is documentation of consent, but the process of informed consent requires ensuring the participant understands the study, not merely obtaining a signature.
D
Confidentiality is an important ethical safeguard, but it is a separate principle from informed consent, which centers on disclosure, understanding, and voluntariness.
TakeawayInformed consent is an ongoing process of communication that ensures the participant understands the study and voluntarily agrees, not just signing a form.
Research and Evidence Based Practice · medium
A nurse is appraising a qualitative study that explored the lived experiences of patients with chronic pain. Which action by the researchers would best ensure the credibility of the study findings?
ACalculating the inter-rater reliability of the coding process
BReturning the analyzed data to participants to verify accuracy
CUsing a control group to compare outcomes between groups
DRecruiting a large, randomly selected sample of participants
Show the answer and why the others fail
Answer: B. Returning the analyzed data to participants to verify accuracy
A
Inter-rater reliability is a measure of consistency in quantitative research when multiple coders are used. While some qualitative approaches may use multiple coders, the primary trustworthiness criterion is credibility, often achieved through member checking.
B — correct
This describes member checking, a key strategy in qualitative research to establish credibility (the qualitative equivalent of internal validity). It ensures the findings accurately reflect participants' experiences.
C
Control groups are used in experimental quantitative designs (e.g., RCTs) to test interventions, not in qualitative studies that aim to explore experiences and meanings.
D
Large sample sizes and random selection are hallmarks of quantitative research to ensure generalizability, not qualitative credibility. Qualitative studies typically use purposive sampling and smaller samples to gain in-depth understanding.
TakeawayMember checking is a technique used in qualitative research to enhance credibility by verifying findings with participants.
Research and Evidence Based Practice · medium
A nurse manager on a medical-surgical unit notices an increase in catheter-associated urinary tract infections (CAUTIs) over the past quarter. The manager wants to use an evidence-based practice approach to reduce these infections. Which of the following actions should the manager take first?
ACollect baseline data on current catheter insertion and maintenance practices.
BSearch the literature for systematic reviews on CAUTI prevention.
CFormulate a clinical question using the PICOT format.
DImplement a new catheter care protocol based on expert opinion.
Show the answer and why the others fail
Answer: C. Formulate a clinical question using the PICOT format.
A
Collecting baseline data on current practices is an important step, but it occurs later in the EBP process—typically after evidence has been reviewed—to compare current practice with evidence-based recommendations.
B
Searching the literature is the 'Acquire' step, which should be guided by a clearly formulated clinical question; it is not the first step in the evidence-based practice process.
C — correct
The first step in the evidence-based practice process after recognizing a problem is to 'Ask' a focused, answerable clinical question, often structured using PICOT, to direct the search for evidence.
D
Implementing a protocol without first searching for and appraising the best available evidence bypasses the core steps of evidence-based practice and may not lead to improved outcomes.
TakeawayThe evidence-based practice process follows five sequential steps: Ask a focused clinical question, Acquire the best evidence, Appraise the evidence, Apply the evidence in practice, and Assess the outcomes.