1. What are the connections between evidence-based practice and nursing research? (Select all that apply.)

   1. Evidence-based care cannot be provided to patients without the nurse understanding something of research.

   2. A synthesis of current research within an area of nursing is used to improve care in that area.

   3. All patients with a given diagnosis should be cared for based solely on research knowledge.

   4. Nursing diagnosis and management depend on a practitioner’s exploration of best research evidence.

   5. Nursing research provides evidence that allows us each to practice with the same style and capability.

      ANS: A, B, D

      Evidence-based practice in nursing requires a strong body of research knowledge that nurses must synthesize and use to promote quality care for their patients, families, and communities. In order to synthesize and use research appropriately, a nurse must understand it. A nurse must explore the best research evidence about a practice problem before using his or her clinical expertise to diagnose and manage an individual patient’s health problem. Not all patients are treated in the same way, however. Because reality can vary with perception, and because the facts can be relative, nurses do not impose their views on patients. Rather, nurses help patients seek health from within the patients’ worldviews. This is a critical component of evidence- based practice.

      DIF: Cognitive Level: Analysis REF: Page 11

2. What is the hospitalized patient’s place in evidence-based practice? (Select all that apply.)

   1. The patient is the recipient of the total of formal research evidence and the nurse’s practice wisdom, and these represent the patient’s care plan.

   2. The patient brings values to the clinical encounter, which the nurse considers in providing evidence-based care.

   3. The patient provides a valuable source of knowledge, since each patient cared for contributes to the nurse’s total practice wisdom.

   4. The patient is the focus of research. The patient serves both as a recipient of evidence-based research and the subject of future evidence, based on data collected now from the patient.

   5. The patient may always refuse to participate—in evidence-based care, in therapies, in research participation—and this refusal must be honored.

      ANS: B, C, E

      Because reality can vary with perception, and because the facts can be relative, nurses do not impose their views on patients. Rather, nurses help patients seek health from within the patients’ worldviews. This is a critical component of evidence-based practice. The nurse’s individual wisdom is based upon the nurse’s actual practice, over time.

      DIF: Cognitive Level: Analysis REF: Page 11

3. In nursing mentorship, as opposed to authority, the novice nurse fills which of the following roles? (Select all that apply.)

   1. Counselor

   2. Student

   3. Sponsor

   4. Disciplinarian

   5. Teacher

   6. Questioner

   7. Apprentice

      ANS: B, F, G

      An intense form of role-modeling is mentorship. In a mentorship, the expert nurse—or mentor

      —serves as a teacher, sponsor, guide, exemplar, and counselor for the novice nurse. Over time, the relationship morphs into a colleague relationship in which both mentor and mentee share information and exchange ideas in a cooperative spirit.

      DIF: Cognitive Level: Analysis REF: Page 10

4. How are dialectic reasoning and holistic practice similar? (Select all that apply.)

   1. They are both based on intuition, not facts.

   2. They both consider the whole, rather than one part of the picture.

   3. Dialectic reasoning emphasizes truth and holistic practice accepts untruth.

   4. They both ignore the main idea or diagnosis and concentrate on different entities.

   5. They both honor context and the interactions among ideas and people.

   6. They both break down concepts into understandable parts.

   7. Dialectic reasoning can be used to validate a study design, whereas holistic practice does not contribute to research.

      ANS: B, E, F

      Dialectic reasoning involves looking at situations in a holistic way. A dialectic thinker believes that the whole is greater than the sum of the parts and that the whole organizes the parts.

      DIF: Cognitive Level: Synthesis REF: Page 6

5. Which of the following statements synopsize the relationship between research and practice? (Select all that apply.)

   1. Practice limits nursing research to issues that are client-centered.

   2. Research participation helps nurses to meet re-licensure requirements for evidence- based practice.

   3. Research knowledge, combined with experiential wisdom, constitutes the base for practice.

   4. Research emphasizes what can be done in practice, rather than what has been done in practice.

   5. Practice does not affect research: research affects practice.

   6. Practice provides inspiration for meaningful nursing research.

   7. Practice helps a nurse differentiate between rigorous, well-designed research and useless research.

      ANS: C, F

      Evidence-based practice in nursing requires a strong body of research knowledge that nurses must synthesize and use to promote quality care for their patients. Research is a way to test reality and generate the best evidence to guide nursing practice. Practice problems inspire meaningful clinical research. Evidence-based practice evolves from the integration of the best research evidence with clinical expertise and patient needs and values.

      DIF: Cognitive Level: Evaluation REF: Page 3

6. Realistically, what might be done in a situation in which a nurse does not know the appropriate way to use a new ultrasonic bladder scanner (a non-invasive, painless procedure) but has an order to scan? (Select all that apply.)

   1. Refuse to carry out the order.

   2. Ask a co-worker who has used the equipment for help.

   3. Access the instructions on the company’s web site.

   4. Try to scan the bladder and see if the value obtained makes sense.

   5. Notify the manager that a formal inservice is needed.

   6. Read the instruction booklet.

      ANS: B, C, D, F

      Trial and error is an approach with unknown outcomes that is used in a situation of uncertainty, when other sources of knowledge are unavailable. The profession evolved through a great deal of trial and error before knowledge of effective practices was codified in textbooks and journals. The trial-and-error way of acquiring knowledge can be time- consuming, because multiple interventions might be implemented before one is found to be effective.

      DIF: Cognitive Level: Application REF: Page 9

7. Which of the following sources generates new knowledge for nurses? (Select all that apply.)

   1. Editorials in nursing journals

   2. Qualitative research

   3. Adhering to hospital policies

   4. Research that tests a new sling scale for safety of patients and nurses

   5. Quantitative research

   6. Comparison of two different insulin dosing protocols

      ANS: B, D, E

      Nursing research is defined as a scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences the delivery of evidence-based nursing. Nurses use a variety of research methods to test their reality and generate nursing knowledge, including quantitative research, qualitative research, outcomes research, and intervention research.

      DIF: Cognitive Level: Application REF: Page 2

8. Which of these are suitable focuses for a nursing research study? (Select all that apply.)

   1. How clinical nurse specialists contribute to patient outcomes

   2. Which elements of a nursing school curriculum remain useful for current practice after students graduate

   3. Whether requiring nurse managers to supervise more than four units is cost- effective

   4. What styles of physician teaching produce better diabetic compliance

   5. Whether patients with exacerbation of CHF are best managed with inpatient treatment or with outpatient treatment

   6. What the personality characteristics are of nurses in various inpatient areas

      ANS: A, B, C, F

      Many nurses hold the view that nursing research should focus on acquiring knowledge that can be directly implemented in clinical practice, which is sometimes referred to as applied research or practical research. However, another view is that nursing research should include studies of nursing education, nursing administration, health services, and nurses’ characteristics and roles, as well as clinical situations, education, practice, and service.

      Research is needed to identify teaching-learning strategies to promote nurses’ management of practice. Thus, nurse researchers are involved in building a science for nursing education so that the teaching-learning strategies used are evidence-based. Nurse administrators are involved in research to enhance nursing leadership and the delivery of quality, cost-effective patient care.

      DIF: Cognitive Level: Application REF: Page 1

9. What might a nursing research study address? (Select all that apply.)

   1. Whether having a nurse practitioner manage care is effective in decreasing length- of-stay

   2. Whether students learn better in an online course format or by actual lecture attendance

   3. Comparing four types of leadership used by nurse managers and comparing their employees’ job satisfaction, absenteeism rates, and error rates

   4. Different common surgical procedures and the mortality rate of each

   5. Learning specific things about the liver failure patient that can be applied to nursing practice

ANS: A, B, C, E

Many nurses hold the view that nursing research should focus on acquiring knowledge that can be directly implemented in clinical practice, which is sometimes referred to as applied research or practical research. However, another view is that nursing research should include studies of nursing education, nursing administration, health services, and nurses’ characteristics and roles, as well as clinical situations, education, practice, and service.

Research is needed to identify teaching-learning strategies to promote nurses’ management of practice. Thus, nurse researchers are involved in building a science for nursing education so that the teaching-learning strategies used are evidence-based. Nurse administrators are involved in research to enhance nursing leadership and the delivery of quality, cost-effective patient care.

DIF: Cognitive Level: Application REF: Page 1

Chapter 2: Evolution of Research in Building Evidence-Based Nursing Practice Test Bank

MULTIPLE CHOICE

1. In which way did Florence Nightingale contribute to evidence-based practice?

   1. She conducted research on outcomes and the power of nursing for change.

   2. She was the first woman elected to the Royal Statistical Society.

   3. She gathered data that changed the care of hospitalized soldiers.

   4. She calculated mortality rates under varying conditions.

      ANS: C

      Nightingale gathered data on soldier morbidity and mortality rates and the factors influencing them and presented her results in tables and pie charts, a sophisticated type of data presentation for the period. Nightingale’s research enabled her to instigate attitudinal, organizational, and social changes. She changed the attitudes of the military and society toward the care of the sick. The military began to view the sick as having the right to adequate food, suitable quarters, and appropriate medical treatment, which greatly reduced the mortality rate.

      DIF: Cognitive Level: Application REF: Page 17

2. If a nurse manager wants to study how well last year’s policies governing implementation of a “bundle” of interventions to prevent cross-contamination of MRSA have been working in her units, which of the following strategies would she use?

   1. Outcomes research

   2. Intervention research

   3. Ethnographic research

   4. Experimental research

      ANS: A

      Outcomes research emerged as an important methodology for documenting the effectiveness of health care services in the 1980s and 1990s. This type of research evolved from the quality assessment and quality assurance functions that originated with the professional standards review organizations (PSROs) in 1972. During the 1980s, William Roper, the director of the Health Care Finance Administration (HCFA), promoted outcomes research for determining the quality and cost-effectiveness of patient care. Intervention research investigates the effectiveness of a nursing intervention in achieving the desired outcome or outcomes in a natural setting. Through the use of ethnographic research, different cultures are described, compared, and contrasted to add to our understanding of the impact of culture on human behavior and health. Experimental studies have three main characteristics: (1) a controlled manipulation of at least one treatment variable (independent variable), (2) administration of the treatment to some of the subjects in the study (experimental group) and not to others (control group), and (3) random selection of subjects or random assignment of subjects to groups, or both. Experimental studies usually are conducted in highly controlled settings, such as laboratories or research units in clinical agencies.

      DIF: Cognitive Level: Analysis REF: Page 22

3. A researcher publishes a paper describing how faith, pain, adherence to therapy, and meditation interact during the rehabilitation process. The description of the process is based on many interviews the researcher conducted with persons during and following rehabilitation experiences. The methodology is

   1. Ethnography

   2. Phenomenology

   3. Historical research

   4. Grounded theory

      ANS: D

      Grounded theory methodology emphasizes observation and the development of practice-based intuitive relationships among variables. Throughout the study, the researcher formulates, tests, and redevelops propositions until a theory evolves. The theory developed is “grounded,” or has its roots in, the data from which it was derived.

      DIF: Cognitive Level: Synthesis REF: Page 27

4. A panel of researchers conducts several studies, all drawn from an existent hospital and clinic database. The studies focus on quality and effectiveness within that system. The specific studies address mortality rates in elders within a year after hip fracture, functional outcomes six months after admission to a neurosurgical ICU after traumatic brain injury, rate of nurse injuries in an emergency department, and number of patient falls on various floors of the hospital. What type of research is this?

   1. Experimental research

   2. Outcomes research

   3. Ethnographic research

   4. Grounded theory research

      ANS: B

      The spiraling cost of health care has generated many questions about the quality and effectiveness of health care services and the patient outcomes. Consumers want to know what services they are buying, and whether these services will improve their health. Health care policy makers want to know whether the care is cost-effective and of high quality. These concerns have promoted the development of outcomes research, which examines the results of care and measures the changes in health status of patients. It can also examine costs related to care delivery within a hospital system.

      DIF: Cognitive Level: Comprehension REF: Page 27

5. A researcher designs a study. It depends on questionnaires for data, it has a clear purpose statement, it provides its results as a narrative without statistical analysis, and it makes general suggestions for practice. What type of research is this?

   1. Qualitative research

   2. Outcomes research

   3. Intervention research

   4. Quantitative research

      ANS: D

      Quantitative research is a formal, objective, systematic process in which numerical data are used to obtain information about the world. Qualitative research is also systematic, but it is a holistic, interactive, and subjective approach to describe life experiences and identify their meaning. Both types of research have a purpose statement and can use a survey instrument; however, neither depends on surveys for data. Both can contain suggestions for practice.

      Qualitative research results are presented as a narrative, without statistical analysis. Outcomes research examines the results of care and measures the changes in health status of patients.

      Intervention research investigates the effectiveness of a nursing intervention in achieving the desired outcome or outcomes in a natural setting.

      DIF: Cognitive Level: Application REF: Page 23

6. A newly employed nurse administrator wants to know more about the employees on the units the administrator supervises. The manager accesses the managerial database and gathers data about all of the current employees on the unit, including work shift, number of years employed, age, gender, educational preparation, certifications, work history, and professional accomplishments. What type of research is this?

   1. Descriptive research

   2. Correlational research

   3. Quasi-experimental research

   4. Experimental research

      ANS: A

      The quantitative research methods are classified into four categories: (1) descriptive, which defines the magnitude of a concept and its characteristics, (2) correlational, which determines association between or among variables, (3) quasi-experimental, which tests an intervention and lacks control in at least one of three areas, and (4) experimental, which tests an intervention and includes both a control group and random assignment. This is a research study, even though it depends upon existent data, collected by another manager. Its purpose is to describe the employees.

      DIF: Cognitive Level: Analysis REF: Page 26

7. A human resources employee performs research focusing on the professional lifespan within the institution of nurses, and trying to discover whether their choice of work area is connected with the number of years they work in the institution. What type of research is this?

   1. Descriptive research

   2. Correlational research

   3. Quasi-experimental research

   4. Experimental research

      ANS: B

      The quantitative research methods are classified into four categories: (1) descriptive, which defines the magnitude of a concept and its characteristics, (2) correlational, which determines association between or among variables, (3) quasi-experimental, which tests an intervention and lacks control in at least one of three areas, and (4) experimental, which tests an intervention and includes both a control group and random assignment. This study investigates the connection or association between work area and length of time worked.

      DIF: Cognitive Level: Analysis REF: Page 26

8. In an attempt to assess whether selection of a same-gender psychiatrist leads to better mental health outcomes, clients newly referred for mental health services are told they may choose their mental health physicians. Later, measures of mental health are performed. What type of research is this?

   1. Descriptive research

   2. Correlational research

   3. Quasi-experimental research

   4. Experimental research

      ANS: C

      The quantitative research methods are classified into four categories: (1) descriptive, which defines the magnitude of a concept and its characteristics, (2) correlational, which determines association between or among variables, (3) quasi-experimental, which tests an intervention and lacks control in at least one of three areas, and (4) experimental, which tests an intervention and includes both a control group and random assignment. This research study is designed to test an intervention but does not include random assignment.

      DIF: Cognitive Level: Analysis REF: Page 26

9. In a rehabilitation unit, patients are randomly assigned to high fiber diets versus ordinary fiber diets, in order to measure the effect on constipation. What type of research is this?

   1. Descriptive research

   2. Correlational research

   3. Quasi-experimental research

   4. Experimental research

      ANS: D

      The quantitative research methods are classified into four categories: (1) descriptive, which defines the magnitude of a concept and its characteristics, (2) correlational, which determines association between or among variables, (3) quasi-experimental, which tests an intervention and lacks either a control group or random assignment, and (4) experimental, which tests an intervention and includes both a control group and random assignment. This research study tests an intervention and includes both a control group and random assignment.

      DIF: Cognitive Level: Analysis REF: Page 26

10. A researcher uses interviews with two or three open-ended questions to study women in the staging phase of breast cancer treatment, in order to understand their experiences and the meanings they attribute to those experiences. What type of research is this?

    1. Phenomenologic research

    2. Grounded theory research

    3. Ethnographic research

    4. Historicism

       ANS: A

       Phenomenologic research examines the lived experiences of participants and the meanings those experiences hold for them, drawing its results only from the participants’ views.

       Grounded theory research defines under-researched concepts and explains them within a social framework, building on both observation and the perceptions of the persons who are familiar with the concepts, and sometimes generating theory; it emphasizes interaction, observation, and development of relationships among concepts. Ethnography defines shared characteristics of members of a culture or participants who share in a common characteristic, and explains commonalities, often within a cultural framework, using observation, interview, and other data collection strategies; through the use of ethnographic research, different cultures are described, compared, and contrasted to add to our understanding of the impact of culture on the human experience. Historicism tells the story of past events, reconstructing these from other historical references, interviews, artifacts, art, and other sources that reflect the time of interest.

       DIF: Cognitive Level: Analysis REF: Page 27

11. A researcher uses interviews with eight open-ended questions to study women in a new staging phase of breast cancer treatment, which includes serial biopsies and necessitates weekly closed biopsy, in order to understand more about social factors that impinge upon their experience. What type of research is this?

    1. Phenomenologic research

    2. Grounded theory research

    3. Ethnographic research

    4. Historicism

       ANS: B

       Grounded theory research defines under-researched concepts and explains them within a social framework, building on both observation and the perceptions of the persons who are familiar with the concepts, and sometimes generating theory; it emphasizes interaction, observation, and development of relationships among concepts. Phenomenologic research examines the lived experiences of participants and the meanings those experiences hold for them, drawing its results only from the participants’ views. Ethnography defines shared characteristics of members of a culture or participants who share in a common characteristic, and explains commonalities, often within a cultural framework, using observation, interview, and other data collection strategies; through the use of ethnographic research, different cultures are described, compared, and contrasted to add to our understanding of the impact of culture on the human experience. Historicism tells the story of past events, reconstructing these from other historical references, interviews, artifacts, art, and other sources that reflect the time of interest.

       DIF: Cognitive Level: Analysis REF: Page 27

12. A researcher conducts many interviews, over a one-year period, with women in the treatment phase of breast cancer, all of whom are attending a breast cancer support group, in order to understand what happens in the support group, how the members are affected by membership, and how the members contribute to the group. The researcher herself is also in treatment for breast cancer and is a member of the group. What type of research is this?

    1. Phenomenologic research

    2. Grounded theory research

    3. Ethnographic research

    4. Historicism

       ANS: C

       Ethnography defines shared characteristics of members of a culture or participants who share in a common characteristic, and explains commonalities, often within a cultural framework, using observation, interview, and other data collection strategies; through the use of ethnographic research, different cultures are described, compared, and contrasted to add to our understanding of the impact of culture on the human experience. Phenomenologic research examines the lived experiences of participants and the meanings those experiences hold for them, drawing its results only from the participants’ views. Grounded theory research defines under-researched concepts and explains them within a social framework, building on both observation and the perceptions of the persons who are familiar with the concepts, and sometimes generating theory; it emphasizes interaction, observation, and development of relationships among concepts. Historicism tells the story of past events, reconstructing these from other historical references, interviews, artifacts, art, and other sources that reflect the time of interest.

       DIF: Cognitive Level: Analysis REF: Page 27

13. A researcher reviews the twenty years that a breast cancer clinic has been in operation in a small Midwestern city. The researcher interviews many of the women who have been treated in the clinic during this period and reviews the records of the clinic, along with its survival rates and the emergence of several of its innovative support programs for women and their families. The researcher ultimately writes a story of the clinic over those twenty years. What type of research is this?

    1. Phenomenologic research

    2. Grounded theory research

    3. Ethnographic research

    4. Historicism

ANS: D

Phenomenologic research examines the lived experiences of participants and the meanings those experiences hold for them, drawing its results only from the participants’ views.

Grounded theory research defines under-researched concepts and explains them within a social framework, building on both observation and the perceptions of the persons who are familiar with the concepts, and sometimes generating theory; it emphasizes interaction, observation, and development of relationships among concepts. Ethnography defines shared characteristics of members of a culture or participants who share in a common characteristic, and explains commonalities, often within a cultural framework, using observation, interview, and other data collection strategies; through the use of ethnographic research, different cultures are described, compared, and contrasted to add to our understanding of the impact of culture on the human experience. Historicism tells the story of past events, reconstructing these from other historical references, interviews, artifacts, art, and other sources that reflect the time of interest.

DIF: Cognitive Level: Analysis REF: Page 27

MULTIPLE RESPONSE

1. Florence Nightingale researched mortality and morbidity rates in soldiers during the Crimean War and investigated various factors that influenced both, presenting her results as pie charts and graphs. Consequently, it is known that she conducted which types of research? (Select all that apply.)

1. Phenomenologic research

2. Causational research

3. Descriptive research

4. Correlational research

5. Ethnographic research

   ANS: C, D

   Nightingale is noted for her data collection and statistical analyses during the Crimean War. She gathered data on soldier morbidity and mortality rates and the factors influencing them and presented her results in tables and pie charts, a sophisticated type of data presentation for the period. There is no evidence that she designed causational (experimental or quasi- experimental) research or any type of qualitative research.

   DIF: Cognitive Level: Analysis REF: Page 17

• Which of the following statements about quantitative research is accurate? (Select all that apply.)

  1. The results of quantitative research should be generalized back to the population from which the sample was drawn.

  2. Quantitative research is always easy and straightforward to read and understand.

  3. Quantitative research addresses quantities, connections, and causes.

  4. Quantitative research predominates in the nursing research literature.

  5. Quantitative research is always experimental.

  6. Quantitative research provides answers to “What?” and “Who?” questions.

     ANS: A, C, D, F

     The quantitative approach to scientific inquiry emerged from a branch of philosophy called logical positivism, which operates on strict rules of logic, truth, laws, axioms, and predictions. Quantitative research requires the use of structured interviews, questionnaires, or observations, scales, or physiological measures that generate numerical data. Statistical analyses are conducted to reduce and organize data, describe variables, examine relationships, and determine differences among groups. Control, instruments, and statistical analyses are used to ensure that the research findings accurately reflect reality so that the study findings can be generalized. Generalization involves the application of trends or general tendencies (which are identified by studying a sample) to the population from which the research sample was drawn. Researchers must be cautious in making generalizations, because a sound generalization requires the support of many studies with a variety of samples.

     DIF: Cognitive Level: Analysis REF: Page 24

• Which of the following statements about qualitative research is accurate? (Select all that apply.)

  1. Qualitative research deals exclusively with humans.

  2. Qualitative research’s principal purpose is to inform the reader.

  3. Qualitative research yields data that are not numbers-based, such as audiotapes, videotapes, and field notes.

  4. Qualitative research is not systematic.

  5. Qualitative research does not contain or imply a research question.

  6. Qualitative research is ill-defined and vague.

  7. Qualitative research has no practical use.

     ANS: B, C

     Qualitative researchers use observations, interviews, and focus groups to gather data. The interactions are guided but not controlled in the way that quantitative data collection is controlled. For example, the researcher may ask subjects to share their experiences of powerlessness in the health care system. Qualitative researchers would begin interpreting the subjective data during data collection, recognizing that their interpretation is influenced by their own perceptions and beliefs. Qualitative data take the form of words and are analyzed according to the qualitative approach that is being used. The intent of the analysis is to organize the data into a meaningful, individualized interpretation, framework, or theory that describes the phenomenon studied. The findings from a qualitative study are unique to that study, and it is not the researcher’s intent to generalize the findings to a larger population.

     Qualitative researchers are encouraged to question generalizations and to interpret meaning based on individual study participants’ perceptions and realities.

     DIF: Cognitive Level: Analysis REF: Page 25

• Which is true of quantitative research? (Select all that apply.)

  1. It addresses human responses by measuring or counting them.

  2. It presents information by clustering it or counting it.

  3. It yields a data set that can be analyzed by statistics.

  4. It operates systematically.

  5. It states or implies a research question.

  6. It operates in a concrete realm.

  7. It can always be generalized.

     ANS: A, B, C, D, E, F

     The quantitative approach to scientific inquiry emerged from a branch of philosophy called logical positivism, which operates on strict rules of logic, truth, laws, axioms, and predictions. Quantitative research requires the use of structured interviews, questionnaires, or observations, scales, or physiological measures that generate numerical data. Statistical analyses are conducted to reduce and organize data, describe variables, examine relationships, and determine differences among groups. Control, instruments, and statistical analyses are used to ensure that the research findings accurately reflect reality so that the study findings can be generalized. Generalization involves the application of trends or general tendencies (which are identified by studying a sample) to the population from which the research sample was drawn. Researchers must be cautious in making generalizations, because a sound generalization requires the support of many studies with a variety of samples.

     DIF: Cognitive Level: Analysis REF: Page 24

• Ethnographic research might focus upon which of the following topics? (Select all that apply.)

  1. Bacterial cultures

  2. Cultural beliefs of the ancient Romans

  3. How children in Alaska play during the winter

  4. Twenty-year abstinence members of Alcoholics Anonymous

  5. The mentoring process in a labor-delivery unit

  6. Conversational Spanish

     ANS: C, D, E

     Ethnographic research was developed by anthropologists to investigate cultures through an in- depth study of the members of the culture. The culture may be an actual culture, a loosely connected group of people who share a common characteristic, or a work or recreational group. The ethnographic research process is the systematic collection, description, and analysis of data to develop a description of cultural behavior. The researcher (ethnographer) actually lives in or becomes a part of the cultural setting to gather the data.

     DIF: Cognitive Level: Analysis REF: Page 24

• A researcher is operating from the point of view of logical positivism. Which of the following research methods would the logical positivist use? (Select all that apply.)

  1. Grounded theory research

  2. Correlational research

  3. Historical research

  4. Quasi-experimental research

  5. Quantitative descriptive research

  6. Exploratory descriptive qualitative research

     ANS: B, D, E

     The quantitative approach to scientific inquiry emerged from a branch of philosophy called logical positivism, which operates on strict rules of logic, truth, laws, axioms, and predictions. The quantitative research methods are classified into four categories: (1) descriptive, (2) correlational, (3) quasi-experimental, and (4) experimental. The qualitative research methods included in this textbook are (1) phenomenological research, (2) grounded theory research, (3) ethnographic research, (4) exploratory-descriptive qualitative research, and (5) historical research.

     DIF: Cognitive Level: Analysis REF: Page 27

• Which of the follow potential studies would fall within the Agency for Healthcare Research and Quality’s future research goals? (Select all that apply.)

  1. Performing a synthesis of research evidence regarding skin-to-skin contact of mothers and newborns

  2. Enacting a quantitative research project measuring bacterial count on nurses’ uniforms at the beginning and the end of 12-hour work shifts

  3. Performing a qualitative research project to explain sources of student nurses’ stress

  4. Enacting a public education Internet commercial encouraging smokers to read the statistics regarding sequelae of cigarette smoking

  5. Trialing clean-and-sober support groups that are based in community shopping centers

     ANS: A, D, E

     The Agency for Healthcare Research and Quality partners with public and private sectors to improve the quality and safety of patient care by promoting the use of the best research evidence available in practice. Its three future goals are focused on the following: “Safety and quality: Reduce the risk of harm by promoting delivery of the best possible health care; Effectiveness: Improve healthcare outcomes by encouraging the use of evidence to make informed healthcare decisions; and Efficiency: Transform research into practice to facilitate wider access to effective healthcare services and reduce unnecessary costs.”

     DIF: Cognitive Level: Analysis REF: Page 22

• Early nursing research by Nightingale focused on improving patient outcomes. What were the principal topics for the next wave of nursing research, in the first half of the 20th century? (Select all that apply.)

  1. Evidence-based practice

  2. Primary nursing’s advantages in hospitals

  3. Nursing education, as opposed to nurse training

  4. The nursing process and nursing diagnosis

  5. Staffing, patient assignments, and type of care

     ANS: C, E

     From 1900 to 1950, research activities in nursing were limited, but a few studies advanced nursing education. Based on recommendations of the Goldmark Report, more schools of nursing were established in university settings. A research trend that started in the 1940s and continued in the 1950s focused on the organization and delivery of nursing services. Studies were conducted on the numbers and kinds of nursing personnel, staffing patterns, patient classification systems, patient and nurse satisfaction, and unit arrangement. Types of care such as comprehensive care, home care, and progressive patient care were evaluated. In the 1970s, the nursing process became the focus of many studies, with the investigations of assessment techniques, nursing diagnoses classification, goal-setting methods, and specific nursing interventions. Primary nursing care, which involves the delivery of patient care predominantly by registered nurses (RNs), was the trend for the 1970s. The vision for nursing research in the twenty-first century includes conducting quality studies using a variety of methodologies, synthesizing the study findings into the best research evidence, and using this research evidence to guide practice. The focus on EBP has become stronger over the last decade.

     DIF: Cognitive Level: Synthesis REF: Page 19

• Which of the following is true of the Cochrane Center and Cochrane Collaboration, begun in the 1970s by Professor Archie Cochrane? (Select all that apply.)

  1. It was originally called the Walter Reed Army Institute of Research.

  2. It developed the original master’s degrees in nursing practice.

  3. It serves as a repository for evidence-based practice guidelines.

  4. It was the first association to publish a nursing research journal.

  5. It is the online library resource for research literature reviews.

     ANS: C, E

     Cochrane advocated the provision of health care based on research to improve the quality of care and patient outcomes. To facilitate the use of research evidence in practice, the Cochrane Center was established in 1992 and the Cochrane Collaboration in 1993. The Cochrane Collaboration and Library house numerous resources to promote EBP, such as systematic reviews of research and evidence-based guidelines for practice.

     DIF: Cognitive Level: Evaluation REF: Page 20

• How does quantitative research contribute to evidence-based practice? (Select all that apply.)

1. It provides facts that nurses can add to their knowledge base. This makes practice more objective and quantifiable.

2. It provides scientific support for policies already in place. More evidence makes an existent policy more defensible.

3. It provides evidence opposing policies already in place. Evidence in opposition to policies may result in new policies.

4. It allows the nurse to understand the personal experience of illness and the meaning the client attaches to it. This engenders compassion.

5. It contributes evidence that will make nursing practice almost completely evidence-based, eliminating different styles of nursing practice.

   ANS: B, C

   Quantitative research is a formal, objective, systematic process in which numerical data are used to obtain information about the world. This research method is used to describe variables, examine relationships among variables, and determine cause-and-effect interactions between variables. The qualitative research method of phenomenology allows understanding of the lived experience and the meaning it engenders. The aim of phenomenology is to explore an experience as it is lived by the study participants and interpreted by the researcher.

   Evidence-based practice is the conscientious integration of best research evidence with clinical expertise and patient values and needs in the delivery of quality, cost-effective health care. It provides the basis for policy decisions and for voluntary change in individual nursing practice. Nursing style is a matter of personal choice.

   DIF: Cognitive Level: Analysis REF: Page 23

• What does appropriate generalization require? (Select all that apply.)

  1. Any type of sample, whether or not it is representative

  2. Application of findings to the population from which the sample was drawn

  3. More than one research study using the same research questions and variables

  4. Statistically significant findings

  5. Non-significant findings that are supported by several related studies

     ANS: B, C, D

     Generalization involves the application of trends or general tendencies (which are identified by studying a sample) to the population from which the research sample was drawn.

     Researchers must be cautious in making generalizations, because a sound generalization requires the support of many studies with a variety of samples.

     DIF: Cognitive Level: Analysis REF: Page 23

• What best characterizes the contribution of qualitative nursing research to evidence-based practice? (Select all that apply.)

  1. It presents collective common evidence of health care clients’ experiences, which may provide inspirations for individual practice.

  2. It provides stories of how health care clients feel. This lets nurses know what people in similar circumstances can be expected to experience.

  3. It provides evidence that determines how nurses should interact with various

     cultures. This mandates action.

  4. It generates and tests theory.

  5. It reveals participants’ experiences and individual viewpoints, feelings, and interpretations. These can provide guidelines for client-centered care.

ANS: A, E

Qualitative research is a systematic, interactive, subjective approach used to describe life experiences from the research participants’ point of view. This type of research is conducted to explore, describe, and promote understanding of human experiences, events, and cultures over time. It is holistic and describes the human in context.

Chapter 3: Introduction to Quantitative Research Test Bank

MULTIPLE CHOICE

1. A researcher conducts a study to determine the effectiveness of a special program of sensitivity training for nurse managers upon several outcomes, all related to the staff’s ability to identify and intervene appropriately when medication errors occur. This is an example of what type of quantitative research?

   1. Applied research

   2. Basic research

   3. Descriptive research

   4. Qualitative research

      ANS: A

      Applied, or practical, research is a scientific investigation conducted to generate knowledge that will directly influence or improve clinical practice. The purpose of applied research is to solve problems, to make decisions, or to predict or control outcomes. Basic, or pure, research is a scientific investigation that involves the “pursuit of knowledge for knowledge’s sake,” or for the pleasure of learning and finding truth. The purpose of basic research is to generate and refine theory and build constructs; thus, the findings are frequently not directly useful in practice. However, because the findings are more theoretical in nature, they can be generalized to various settings. Descriptive quantitative research and qualitative research describe what exists but do not test specific interventions used in practice.

      DIF: Cognitive Level: Application REF: Page 35

2. A researcher randomly assigns a large group of subjects who are hospital patients either to receive magnesium at bedtime or not to receive magnesium at bedtime, and then measures sleep quality and duration. What type of research is this?

   1. Correlational research

   2. Experimental research

   3. Descriptive research

   4. Quasi-experimental research

      ANS: B

      Control occurs when the researcher imposes “rules” to decrease the possibility of error and thus increases the probability that the study’s findings are an accurate reflection of reality. Descriptive and correlational studies are usually conducted with minimal control of the study design, because subjects are examined as they exist. In experimental research, the independent and dependent variables are highly controlled, the researcher exerts high control over the planning and implementation of the study, and often these studies are conducted in a laboratory setting on animals or objects. If a research study randomly assigns subjects to two different groups, applies an intervention to one of the groups, and then measures both groups and compares them, it is experimental design.

      DIF: Cognitive Level: Analysis REF: Page 36

      Use the following information to answer Questions 3 through 7:

      A research study contains the following in its Introduction section: “This study was undertaken to explore the effect of massage on total hours of sleep per 24-hour day, in persons averaging fewer than 7 hours of sleep per night, attributable to insomnia Presumably by

      increasing endorphin levels, massage seems to provide an immediate relaxation and an ability to sleep immediately following the session, but it is unclear whether these benefits actually extend to total sleep, despite anecdotal support. The claim that massage increases total hours of sleep has been inadequately researched. Does massage increase the total number of

      hours of daily sleep? It was posited that provision of daily late-morning massage would

      affect total hours of sleep per 24-hour day. The study’s causational explanation was based on the physiologic matrix of McCarthy, which includes effects of endorphins on sleep, learning ability, pain, digestive function, and cardiac output It was taken as established fact that

      massage is pleasant, that research subjects getting fewer than 7 hours of sleep per night were sleep-deprived, and that endorphins mediated the changes observed.”

3. What is the research problem?

   1. This study was undertaken to explore the effect of massage on total hours of sleep per 24-hour day, in persons averaging fewer than 7 hours of sleep per night, attributable to insomnia.

   2. It was posited that provision of daily late-morning massage would affect total hours of sleep per 24-hour day.

   3. It was taken as established fact that massage is pleasant, that research subjects getting fewer than 7 hours of sleep per night were sleep-deprived, and that endorphins mediated the changes observed.

   4. Presumably by increasing endorphin levels, massage seems to provide an immediate relaxation and an ability to sleep immediately following the session, but it is unclear whether these benefits actually extend to total sleep, despite anecdotal support.

      ANS: D

      A research problem is an area of concern or phenomenon of interest about which there is a gap in the knowledge base needed for nursing practice. The problem identifies an area of concern or phenomenon of interest for a particular population and often indicates the concepts to be studied.

      DIF: Cognitive Level: Analysis REF: Page 39

4. What is the research framework?

   1. It was taken as established fact that massage is pleasant, that research subjects getting fewer than 7 hours of sleep per night were sleep-deprived, and that endorphins mediated the changes observed.

   2. Presumably by increasing endorphin levels, massage seems to provide an immediate relaxation and an ability to sleep immediately following the session, but it is unclear whether these benefits actually extend to total sleep, despite anecdotal support.

   3. It was posited that provision of daily late-morning massage would affect total hours of sleep per 24-hour day.

   4. The study’s causational explanation was based on the physiologic matrix of McCarthy, which includes effects of endorphins on sleep, learning ability, pain, digestive function, and cardiac output.

      ANS: D

      A framework is the abstract, logical structure of meaning that will guide the development of a study and enable the researcher to link the findings to the body of nursing knowledge. In quantitative research, the framework is often a testable midrange theory that has been developed in nursing or in another discipline, such as psychology, physiology, or sociology.

      DIF: Cognitive Level: Analysis REF: Page 41

5. What is the research assumption?

   1. This study was undertaken to explore the effect of massage on total hours of sleep per 24-hour day, in persons averaging fewer than 7 hours of sleep per night, attributable to insomnia.

   2. It was posited that provision of daily late-morning massage would affect total hours of sleep per 24-hour day.

   3. It was taken as established fact that massage is pleasant, that research subjects getting fewer than 7 hours of sleep per night were sleep-deprived, and that endorphins mediated the changes observed.

   4. Presumably by increasing endorphin levels, massage seems to provide an immediate relaxation and an ability to sleep immediately following the session, but it is unclear whether these benefits actually extend to total sleep, despite anecdotal support. The claim that massage increases total hours of sleep has been inadequately researched.

      ANS: C

      Assumptions are statements that are taken for granted or that are considered true, even though they have not been scientifically tested. Assumptions are often embedded (unrecognized) in thinking and behavior, and uncovering them requires introspection. Sources of assumptions include universally accepted truths, theories, previous research, and nursing practice.

      DIF: Cognitive Level: Analysis REF: Page 41

6. What is the research purpose?

   1. This study was undertaken to explore the effect of massage on total hours of sleep per 24-hour day, in persons averaging fewer than 7 hours of sleep per night, attributable to insomnia.

   2. It was posited that provision of daily late-morning massage would affect total hours of sleep per 24-hour day.

   3. Presumably by increasing endorphin levels, massage seems to provide an

      immediate relaxation and an ability to sleep immediately following the session, but it is unclear whether these benefits actually extend to total sleep, despite anecdotal support. The claim that massage increases total hours of sleep has been inadequately researched.

   4. The study’s causational explanation was based on the physiologic matrix of McCarthy, which includes effects of endorphins on sleep, learning ability, pain, digestive function, and cardiac output.

      ANS: A

      The research purpose is generated from the problem and identifies the specific focus or aim of the study. The focus of the study might be to identify, describe, explain, or predict a solution to a situation. The purpose often indicates the type of study to be conducted (descriptive, correlational, quasi-experimental, or experimental) and usually includes the variables, population, and setting for the study.

      DIF: Cognitive Level: Analysis REF: Page 41

7. What is the research question?

   1. This study was undertaken to explore the effect of massage on total hours of sleep per 24-hour day, in persons averaging fewer than 7 hours of sleep per night, attributable to insomnia.

   2. It was posited that provision of daily late-morning massage would affect total hours of sleep per 24-hour day.

   3. Does massage increase the total number of hours of daily sleep?

   4. Presumably by increasing endorphin levels, massage seems to provide an immediate relaxation and an ability to sleep immediately following the session, but it is unclear whether these benefits actually extend to total sleep, despite anecdotal support.

      ANS: C

      Research objectives, questions, and hypotheses bridge the gap between the more abstractly stated research problem and purpose and the study design and plan for data collection and analysis. Objectives, questions, and hypotheses are narrower in focus than the research purpose and often (1) specify only one or two research variables, (2) identify the relationship between the variables, and (3) indicate the population to be studied. A research question is a concise, interrogative statement that is worded in the present tense and includes one or more variables (or concepts).

      DIF: Cognitive Level: Analysis REF: Page 39

8. A researcher conducting a study to examine linkages among age, gender, driver’s license suspension, and zip code poverty, educational level, and income, sourced from the records of the State Department of Motor Vehicles, is using which of the following types of research?

   1. Descriptive research

   2. Correlational research

   3. Problem solving

   4. Triangulation

      ANS: B

      Through descriptive research, concepts are described and relationships are identified but not examined. A researcher conducting a study to examine linear relationships between two or more variables is using the quantitative research process for correlational research.

      In descriptive and correlational studies, no treatment is administered, so the study design centers on describing variables, examining relationships, and improving the precision of measurement. In descriptive research concepts are explored and phenomena are described in real-life situations. This approach is used to generate new knowledge about concepts or topics about which limited or no research has been conducted. In correlational research linear relationships between two or more variables are explored and the strength between variables is quantified.

      DIF: Cognitive Level: Application REF: Page 49

9. A student completes her master’s thesis on correlates of depression in retired airline pilots, and it is shelved in the library. Has this student communicated her research findings?

   1. Yes, because the thesis is in the library and can be accessed.

   2. No, because the findings have not been made available to persons who will utilize them.

   3. Yes, because the students in this particular master’s program often discuss their work in progress.

   4. No, because if the findings do not appear in print in a nursing journal, they have not been communicated.

      ANS: B

      Research is not considered complete until the findings have been communicated. Communicating research findings involves developing and disseminating a research report to appropriate audiences; the research report is disseminated through presentations and publications. Analyzing data, drawing conclusions, and writing a report of the findings are essential steps in conducting research—but they do not complete the process.

      DIF: Cognitive Level: Analysis REF: Page 49

10. Hospital nurses are observed in order to determine exactly how long nurses swab IV ports with alcohol. Because they are being observed, they “scrub the hub” longer than they ordinarily would have. This is an example of what concept relevant to quantitative research?

    1. Bias

    2. Control

    3. Inaccurate operationalization of variables

    4. Hawthorne effect

       ANS: D

       Subjects’ knowledge of a study could influence their behavior and possibly alter the research outcomes. This threatens the validity or accuracy of the study design. An example of this type of threat to design validity is the Hawthorne effect, which was identified during the classic experiment at the Hawthorne plant of the Western Electric Company during the 1920s and 1930s. The employees at this plant exhibited a particular psychological response when they became research participants: they changed their behavior simply because they were subjects in a study, not because of the research treatment.

       DIF: Cognitive Level: Analysis REF: Page 38

11. A researcher studies the effect upon dental caries formation of a year-long regimen of daily rinsing with a particularly noxious-flavored oral solution, only to discover than 285 of the 300 subjects in the study have withdrawn from it by the end of the first month. Which step in the research process was not properly undertaken?

    1. Defining the purpose

    2. Conducting the literature review

    3. Selecting study variables

    4. Performing a pilot study

       ANS: D

       A pilot study is commonly defined as a smaller version of a proposed study conducted to refine the methodology. It is developed much like the proposed study, using similar subjects, the same setting, the same treatment, and the same data collection and analysis techniques. Some of the reasons for conducting pilot studies are to determine feasibility, to develop a treatment or intervention, to develop an implementation protocol, to identify problems with the design, to evaluate the sampling method, to examine instrument reliability or validity, to refine instruments, to refine plans for data collection and analysis, to provide research experience, and to evaluate data analysis techniques.

       DIF: Cognitive Level: Application REF: Page 46

12. A researcher studies the effect of three one-hour counseling sessions on eliminating bullying behaviors in teenagers. For the dependent variable, the researcher selects the outcome of being reported to the principal’s office in the two weeks following the sessions. The results of the research are dismissed by reviewers as meaningless, severely limiting generalization. What is the problem here?

    1. Theoretical limitations

    2. Not enough independent variables

    3. Methodological limitations

    4. Insufficient sample size

       ANS: A

       Limitations are restrictions or problems in a study that may decrease the generalizability of the findings. Study limitations often include a combination of theoretical and methodological weaknesses. Theoretical weaknesses in a study might include poorly developed study framework and unclear conceptual definitions of variables. The limited conceptual definitions of the variables might decrease the operationalization or measurement of the study variables. This is the case here, since a two-week measuring period is sufficient only for purposes of suppressing a behavior, not changing it. Methodological limitations result from factors such as nonrepresentative samples, weak designs, single setting, limited control over treatment (intervention), instruments with limited reliability and validity, limited control over data collection, and improper use of statistical analyses. These study limitations can limit the credibility of the findings and conclusions and restrict the population to which the findings can be generalized.

       DIF: Cognitive Level: Analysis REF: Page 48

13. Which is the best statement that differentiates between the sizes of samples and populations?

    1. A sample has a maximum size; a population does not.

    2. A sample cannot be the same size as a population.

    3. If a person is a member of a population, he or she is a member of the sample

       chosen from that population.

    4. A population is usually larger than a sample.

       ANS: D

       The population is all the elements (individuals, objects, or substances) that meet certain criteria for inclusion in a given universe. The researcher must determine which population is accessible and can be best represented by the study sample. A sample is a subset of the population that is selected for a particular study. Being a subset, the sample is either smaller than the population or, very occasionally, equal in size to it; it cannot be larger.

       DIF: Cognitive Level: Analysis REF: Page 44

14. What does a quantitative research instrument measure?

    1. The level of measurement

    2. A statistical test

    3. Itself, for validity

    4. A study variable

       ANS: D

       When conducting a quantitative study, the researcher attempts to use the most precise instruments available to measure the study variables.

       DIF: Cognitive Level: Comprehension REF: Page 37

15. Which is the highest form of measurement?

    1. Interval

    2. Nominal

    3. Ordinal

    4. Ratio

       ANS: D

       An instrument is selected to measure a specific variable in a study. Data generated with an instrument are at the nominal, ordinal, interval, or ratio level of measurement. The level of measurement, with nominal being the lowest form of measurement and ratio being the highest, determines the type of statistical analyses that you can perform on the data.

       DIF: Cognitive Level: Comprehension REF: Page 45

16. The researcher believes that adults can remember details about the first time they were taken on a camping trip, as 7-year-olds, and that the experiences of a first camping trip are life- altering. What is a research term for these beliefs?

    1. Applications

    2. Assumptions

    3. Limitations

    4. Variables

       ANS: B

       Assumptions are statements that are taken for granted or are considered true, even though they have not been scientifically tested. Assumptions are often embedded (unrecognized) in thinking and behavior, and uncovering them requires introspection. Sources of assumptions include universally accepted truths (e.g., all humans are rational beings), theories, previous research, and nursing practice. In studies, assumptions are embedded in the philosophical base of the framework, study design, and interpretation of findings. Theories and instruments are developed on the basis of assumptions that the researcher may or may not recognize. These assumptions influence the development and implementation of the research process. Since researchers’ assumptions influence the logic of the study, their recognition leads to more rigorous study development.

       DIF: Cognitive Level: Application REF: Page 41

17. Which of the following items is different when comparing probability sampling and nonprobability sampling?

    1. The type of descriptive statistics applied to the sample

    2. The size of the sample

    3. The relative chance of being selected as a study participant

    4. Whether or not the findings can be generalized

       ANS: C

       Sampling is a process of selecting subjects, events, behaviors, or elements for participation in a study. Random sampling methods usually provide a sample that is representative of a population, because each member of the population has a probability greater than zero of being selected for a study. This is not true of nonrandom sampling methods, in which not every member of the population has an opportunity for selection to the sample. Descriptive statistics applied to the sample are identical. The size of the sample doesn’t vary depending on type of sample chosen. Generalization of the findings is possible under either condition.

       DIF: Cognitive Level: Analysis REF: Page 37

18. A correlational researcher reports that the strength of the relationship between X and Y is near 0 (r = 10.03). What does this mean, relative to prediction?

    1. If X is present, Y is only somewhat likely to be present.

    2. If Y is absent, X will also be absent.

    3. If X is present, there is no guarantee at all that Y will be present.

    4. If Y is absent, X will always be present.

ANS: C

Correlational research examines a linear relationship between two or more variables and determines the type (positive or negative) and degree (strength) of the relationship. The strength of a relationship varies from –1 (perfect negative correlation) to +1 (perfect positive correlation), with 0 indicating no relationship. The positive relationship indicates that the variables vary together—that is, the two variables either increase or decrease together. The negative or inverse relationship indicates that the variables vary in opposite directions; thus, as one variable increases, the other variable decreases.

DIF: Cognitive Level: Application REF: Page 49

MULTIPLE RESPONSE

1. How is a researcher who exemplifies rigor similar to the best technical nurse on her shift in a cardiovascular intensive care unit? (Select all that apply.)

   1. They are both rigid and inflexible in details such as timelines and doing things the way they want to do them.

   2. They are both aggressive in acquiring and recording data.

   3. They both strive for excellence.

   4. They both communicate well with others.

   5. They both are disciplined in the way they conduct their jobs.

   6. They both are passionate about accuracy and attending to details.

      ANS: C, E, F

      Rigor is striving for excellence in research and involves discipline, scrupulous adherence to detail, and strict accuracy. A rigorous quantitative researcher constantly strives for more precise measurement methods, structured treatment, representative samples, and tightly controlled study designs. Characteristics valued in these researchers include critical examination of reasoning and attention to precision.

      DIF: Cognitive Level: Synthesis REF: Page 49

2. A researcher undertakes a research study on the danger of bears in Yosemite Valley. What determines the researcher’s selection of a research design? (Select all that apply.)

   1. The mentor the researcher chooses to support the study

   2. Whether or not the researcher intends to generalize the findings

   3. The researcher’s expertise and comfort with the research process chosen

   4. Whether the National Park Systems are funding the research

   5. The study purpose and its anticipated outcomes

   6. The body of research already present on bear danger

      ANS: B, C, E, F

      A research design is a blueprint for maximizing control over factors that could interfere with a study’s desired outcome. The choice of research design depends on the researcher’s expertise, the problem and purpose for the study, and the desire to generalize the findings. This means that other research in the area must be taken into consideration as well.

      DIF: Cognitive Level: Application REF: Page 43

3. A researcher performs a study of how many nurses are assigned to a nursing floor on the basis of total square feet of the unit, correlating this with injury, fatigue, patient assignment, patient acuity, and length of employment. Which of the following are true regarding the type of quantitative data analysis used by the researcher? (Select all that apply.)

   1. The type of quantitative data analysis guides the study objectives and hypotheses.

   2. The type of quantitative data analysis is determined by the level of measurement of data.

   3. The type of quantitative data analysis determines the research design.

   4. The type of quantitative data analysis should include some sort of numerical analysis.

   5. The kind of data that will be collected is determined by the type of analysis chosen.

      ANS: B, D

      Planning data analysis is the final step before the study is implemented. The analysis plan is based on (1) the research objectives, questions, or hypotheses; (2) the data to be collected; (3) research design; (4) researchers’ expertise; and (5) availability of computer resources. Several statistical analysis techniques are available to describe the sample, examine relationships, or determine significant differences within studies. Most researchers consult a statistician for assistance in developing an analysis plan.

      DIF: Cognitive Level: Application REF: Page 45

4. A researcher conducts a pilot study before the main study is conducted. Why might the researcher choose to do this? (Select all that apply.)

   1. The researcher has no idea whether subjects will complete the various phases of the study.

   2. The researcher needs to know how much of a change will occur in the dependent variable, so that sample size can be determined.

   3. The researcher isn’t sure whether the fourth phase of the study is really necessary.

   4. The study site is a new one, and the researcher wants to find out whether it’s suitable for this kind of research.

   5. The researcher has insufficient funding for a large study.

   6. The researcher isn’t sure whether the tool he or she is using to measure the dependent variable will be practical.

      ANS: A, B, C, D, F

      A pilot study is commonly defined as a smaller version of a proposed study conducted to refine the methodology. It is developed much like the proposed study, using similar subjects, the same setting, the same treatment, and the same data collection and analysis techniques. Some of the reasons for conducting pilot studies are to determine feasibility, to develop a treatment or intervention, to develop an implementation protocol, to identify problems with the design, to evaluate the sampling method, to examine instrument reliability or validity, to refine instruments, to refine plans for data collection and analysis, to provide research experience, and to evaluate data analysis techniques.

      DIF: Cognitive Level: Synthesis REF: Page 46

5. What is applied research? (Select all that apply.)

   1. Research that has been applied in the past to practice

   2. Research directly useful in clinical practice

   3. Research usually conducted in the setting in which it will be applied

   4. Research that is conducted with paid volunteers

   5. Research conducted to generate knowledge that will directly and indirectly influence or improve clinical practice

      ANS: B, C, E

      Basic, or pure, research is a scientific investigation that involves the pursuit of “knowledge for knowledge’s sake,” or for the pleasure of learning and finding truth. The purpose of basic research is to generate and refine theory and build constructs; thus, the findings are frequently not directly useful in practice. Applied, or practical, research is a scientific investigation conducted to generate knowledge that will directly influence or improve clinical practice. The purpose of applied research is to solve problems, to make decisions, or to predict or control outcomes in real-life practice situations.

      DIF: Cognitive Level: Analysis REF: Page 53

6. A marketing researcher reviews the month’s sales slips for a convenience store and compares them with restocking orders, in order to determine which products are being stolen from the shelves. This study has little control. Why is this the case? (Select all that apply.)

   1. The researcher has no control over whether people choose to shoplift.

   2. There is no control for extraneous variables.

   3. No variables are manipulated.

   4. The design is descriptive or correlational; as compared with other types of research, control is low.

   5. The data collected were actually generated by other people and may be erroneous.

      ANS: B, C, D, E

      Control occurs when the researcher imposes “rules” to decrease the possibility of error and thus increase the probability that the study’s findings are an accurate reflection of reality. Through control, the researcher can reduce the influence or confounding effect of extraneous variables on the study variables. Quantitative research requires varying degrees of control, ranging from minimal control to high control of study design. Descriptive and correlational studies are usually conducted with minimal or partial control of the study design.

      Correlational research often has more control of its design than does descriptive research. Quasi-experimental studies are usually conducted with moderate control of study design. Experimental studies are highly controlled.

      DIF: Cognitive Level: Application REF: Page 36

7. In a given research study, the findings reveal that as A increases, B also increases, that the relationship is linear, and that the strength of the relationship is 0.78. What type of relationship is this? (Select all that apply.)

   1. Positive

   2. Negative

   3. Inverse

   4. None

   5. Causational

   6. Correlational

      ANS: A, F

      Correlational research examines a linear relationship between two or more variables and determines the type (positive or negative) and degree (strength) of the relationship. The strength of a relationship varies from –1 (perfect negative correlation) to +1 (perfect positive correlation), with 0 indicating no relationship. The positive relationship indicates that the variables vary together—that is, the two variables either increase or decrease together. The negative or inverse relationship indicates that the variables vary in opposite directions; thus, as one variable increases, the other variable decreases.

      DIF: Cognitive Level: Application REF: Page 49

8. A researcher selects a quantitative experimental research design. For what reasons does the researcher select this particular design? (Select all that apply.)

   1. To generate a theory

   2. To answer a research question

   3. To determine which of several causes is the true one

   4. To prove a theory

   5. To disprove a hypothesis

   6. To determine the strength of the relationship between the independent variable and the dependent variable

      ANS: B, F

      A research design is a blueprint for maximizing control over factors that could interfere with a study’s desired outcome. The choice of research design depends on the researcher’s expertise, the problem and purpose for the study, and the desire to generalize the findings. This means that other research in the area must be taken into consideration as well.

      DIF: Cognitive Level: Application REF: Page 43

9. The director of a major hospital complex conducts a study to discover the types of critical incidents that have occurred in this hospital and its sister hospital over the past five years. She makes a list of every critical incident that has occurred over this period. Choose the true statements about this list. (Select all that apply.)

   1. The list is the dependent variable.

   2. The list represents the hospital director’s assumptions.

   3. The list is an extraneous variable.

   4. The list represents the sample.

   5. If the two hospitals have been in operation only five years, the list represents the population.

ANS: A

The population is all the elements (individuals, objects, or substances) that meet certain criteria for inclusion in a given universe. The researcher must determine which population is accessible and can be best represented by the study sample. A sample is a subset of the population that is selected for a particular study. Being a subset, the sample is either smaller than the population or, very occasionally, equal in size to it; it cannot be larger.

DIF: Cognitive Level: Application REF: Page

Chapter 4: Introduction to Qualitative Research Test Bank

MULTIPLE CHOICE

1. What does the “grounded” in grounded theory mean?

   1. Small pieces of data are “ground up” in the analysis process.

   2. The theory that emerges is “grounded” in real-world data.

   3. No theory is groundless.

   4. All data must be “on the ground” and written out fully.

      ANS: B

      Grounded theory research is an inductive research technique developed by Glaser and Strauss through their study of the experience of dying. The method’s name means the findings are grounded in the concrete world as experienced by the participants and are interpreted at a more abstract theoretical level.

      DIF: Cognitive Level: Analysis REF: Page 62

2. An ethnographic researcher plans to study organizations and how they promote or suppress individual effort. What type of ethnography will the researcher select?

   1. Classical ethnography

   2. Systematic ethnography

   3. Interpretive ethnography

   4. Critical ethnography

      ANS: B

      Four schools of thought within ethnography have emerged from different philosophical perspectives and these include classical, systematic, interpretive, and critical ethnography. Classical ethnography seeks to provide a comprehensive holistic description of a culture. In contrast, systematic ethnography explores and describes the structures of the culture with an increased focus on groups, patterns of social interaction, organizations, and institutions.

      Interpretive ethnography has as its goal understanding the values and thinking that result in the behaviors and symbols of the people being studied. Critical ethnography has a political purpose of relieving oppression and empowering a group of people to take action on their own behalf. It is not ethnography’s focus to construct theories.

      DIF: Cognitive Level: Application REF: Page 64

3. Why is the Sunshine Model of ethnonursing more specific to health than other ethnography models?

   1. It was created by a nurse.

   2. It values the point of view of the individual.

   3. It focuses on factors that impact health.

   4. It explains how various levels of culture interact.

      ANS: C

      Madeline Leininger (1970) brought ethnography into nursing science by writing the first book linking nursing with anthropology. Leininger was first a nurse and then earned her doctoral degree in anthropology. In the 1950s, she began developing a framework for culture care that became the Sunshine Model (Clarke, McFarland, Andrews, & Leininger, 2009). The Sunshine Model identifies factors that affect health and illness, such as religion, income, kinship, education, values, and beliefs. Chapter 7 contains more information about the Theory of Culture Care developed by Leininger, so this section focuses on the qualitative method that she developed to be consistent with ethnonursing. Multiple levels of factors affect the culture and, consequently, the care expressions of the people. A person who is a member of the only Vietnamese family in a small rural community in Georgia may have different care practices than if he or she were living in New York City in a predominantly Vietnamese community.

      DIF: Cognitive Level: Analysis REF: Page 65

4. A researcher investigates the fact that women with chronic pain are more apt to be treated for depression than are men with chronic pain. Which qualitative strategy will most likely be used to study this topic?

   1. Grounded theory

   2. Exploratory-descriptive qualitative research

   3. Phenomenology

   4. Critical research

ANS: D

Critical ethnography has a political purpose of relieving oppression and empowering a group of people to take action on their own behalf.

DIF: Cognitive Level: Analysis REF: Page 64

MULTIPLE RESPONSE

1. A research study about holiday celebrations is based on a philosophy or philosophical perspective. In the analysis, the authors state that they reflected upon the data for several weeks, reading and re-reading interviews, in order to capture their meaning. Aside from descriptive statistics addressing the sample, the results are all presented in narrative form. Which of the following statements are true? (Select all that apply.)

   1. The philosophy for the study is logical positivism.

   2. The sample size was decided upon using power analysis.

   3. In this method, meaning emerges from the data.

   4. The data analysis process seems to be inductive.

   5. The method was shaped by the authors’ philosophical perspectives.

      ANS: C, D, E

      Quantitative studies are based primarily on the philosophy of logical positivism that values logic, empirical data, and tightly controlled methods. Power analysis is a quantitative method of setting the sample size. Inductive thinking involves perceptually putting insights and pieces of information together and identifying abstract themes or working from the bottom up. From this inductive process, meanings emerge. In qualitative research, the philosophy directs the research questions and the collection and interpretation of the data.

      DIF: Cognitive Level: Application REF: Page 57

2. Which statements best describes the differences between Heideggerian and Husserlian phenomenology? (Select all that apply.)

   1. Husserl proposed that the researcher could identify and set aside his or her own private attitudes and opinions before data analysis.

   2. Heidegger postulated that a person interacted with the world only through his or her physical body.

   3. Heideggerians believe that the past has no influence on present thought.

   4. Heideggerian phenomenologists posit that the person is situated in a specific context and time that shape his or her experiences, paradoxically freeing and constraining the person’s ability to establish meanings through language, culture, history, purposes, and values.

   5. Husserl developed his ideas as a method for understanding and avoiding conflict between psychology and the basic sciences.

      ANS: A, B, D, E

      Heideggerian phenomenologists believe that the person is a self within a body; the person is referred to as embodied. Husserlian phenomenologists believe that although self and world are mutually shaping, it is possible to separate oneself from one’s beliefs or set aside one’s beliefs to see the world firsthand in a naive way. Setting aside one’s beliefs during qualitative research is called bracketing. Heideggerian phenomenologists posit that the person is situated in a specific context and time that shape his or her experiences, paradoxically freeing and constraining the person’s ability to establish meanings through language, culture, history, purposes, and values. Husserl developed his ideas about phenomena in an effort to resolve the conflict in thought between human sciences (primarily psychology) and the basic sciences (such as physics).

      DIF: Cognitive Level: Analysis REF: Page 60

3. What is the major contribution of historical nursing research? (Select all that apply.)

   1. It explains how to avoid pitfalls of the past.

   2. It allows us to explain the world of today through the lens of yesterday.

   3. It identifies recurrent social patterns.

   4. It tells the story of where we have been as a profession.

   5. It provides the dates of important events.

      ANS: B, D

      Historical research examines events of the past. Historians describe events in the context of time, social structures, concurrent events, and key individuals. These descriptions can increase understanding and raise awareness of the forces shaping current events. Historical nursing research can do the same for the profession and its role in society. Nurse researchers using historical methods have examined the events and people that shaped health in different settings and countries as well as nursing as a profession.

      DIF: Cognitive Level: Application REF: Page 68

4. Which of the following might be the focus of historical nursing research? (Select all that apply.)

   1. The evolution of the role of the physician in the 20th century

   2. Diseases that resulted in significant mortality in the 18th century

   3. Patterns of nursing staffing in years of shortage prior to 1980

   4. A person or persons who have contributed to the profession of nursing

   5. Social patterns that have fostered or squelched nurses’ developing autonomy

      ANS: C, D, E

      Historical research examines events of the past. Historians describe events in the context of time, social structures, concurrent events, and key individuals. These descriptions can increase understanding and raise awareness of the forces shaping current events. Historical nursing research can do the same for the profession and its role in society. Nurse researchers using historical methods have examined the events and people that shaped health in different settings and countries as well as nursing as a profession.

      DIF: Cognitive Level: Application REF: Page 68

5. What is exploratory-descriptive qualitative research? (Select all that apply.)

   1. Research that is clearly qualitative but that does not espouse any distinct methodology

   2. Quantitative research that contains descriptions

   3. Research that contains elements of at least two other types of qualitative research

   4. Mixed methods research

   5. A non-method

      ANS: A, E

      Qualitative nurse researchers have conducted studies with the purpose of exploring and describing a topic of interest but, at times, have not identified a specific qualitative methodology. Qualitative descriptive research is a legitimate method of research that may be the appropriate “label” for studies that have no clearly specified method or when the method was specified but ended with “a comprehensive summary of an event in the everyday terms of these events.” Labeling a study as a specific type (grounded theory, phenomenology, or ethnographic) implies fixed categories of research with distinct boundaries, but the boundaries between methods are more appropriately viewed as permeable. Although the studies result in descriptions and could be labeled as descriptive qualitative studies, most of the researchers are in the exploratory stage of studying the subject of interest.

      DIF: Cognitive Level: Analysis REF: Page 66

6. What are the focal points of the four schools of thought within ethnography? (Select all that apply.)

   1. To relieve oppression and empower a group to take action on its own behalf

   2. To investigate cultural structures, focusing on groups and their social patterns

   3. To construct theories that explain cultural interactions

   4. To understand values and thinking that collectively result in behaviors and symbols of the individuals within a culture

   5. To provide a comprehensive holistic description of a culture

      ANS: A, B, D, E

      Four schools of thought within ethnography have emerged from different philosophical perspectives and these include classical, systematic, interpretive, and critical ethnography. Classical ethnography seeks to provide a comprehensive holistic description of a culture. In contrast, systematic ethnography explores and describes the structures of the culture with an increased focus on groups, patterns of social interaction, organizations, and institutions.

      Interpretive ethnography has as its goal understanding the values and thinking that result in the behaviors and symbols of the people being studied. Critical ethnography has a political purpose of relieving oppression and empowering a group of people to take action on their own behalf. It is not ethnography’s focus to construct theories.

      DIF: Cognitive Level: Synthesis REF: Page 64

7. Which of the following are the general purposes of ethnographic research? (Select all that apply.)

   1. To describe events within a culture in the distant past

   2. To describe a culture

   3. To construct theories that explain cultural interactions

   4. To measure the effect of living conditions on human care, health, and nursing process

   5. To explore meanings of social actions against a cultural backdrop

      ANS: B, E

      Ethnographic research provides a framework for studying cultures. The word ethnography is derived by combining the Greek roots of “ethno” (folk or people) and “graphy” (picture or portrait). Ethnographies are the written reports of a culture from the perspectives of insiders. These reports were initially the products of anthropologists who studied primitive, foreign, or remote cultures. Now, however, a number of other disciplines, including social psychology, sociology, political science, education, and nursing, promote cultural research.

      Anthropologists seek to understand people: their ways of living, believing, acquiring information, transforming knowledge, and socializing the next generation. Studying a culture begins with the philosophical values of respecting, appreciating, and seeking to preserve the values and ways of life of the culture. The philosophical bases of ethnography are naturalism and respect for others. The purpose of anthropological research is to describe a culture and explore “the meanings of social actions within cultures.”

      DIF: Cognitive Level: Synthesis REF: Page 63

8. Which of the following are the general purposes of phenomenological research? (Select all that apply.)

   1. To generate theory

   2. To describe the lived experience

   3. To observe and document interactions within an existent culture

   4. To determine the meaning that an experience has for the individual

   5. To describe the single reality expressed by a group of participants

      ANS: B, D

      The purpose of phenomenological research is to describe experiences (or phenomena) as they are lived—in phenomenological terms, to capture the “lived experience” of study participants. During the process of data collection, the meaning the participants attach to their experience is revealed. All phenomenologists agree that there is not a single reality: each individual has his or her own reality. While phenomenology can be used indirectly in the development of a theory, grounded theory is the method intended to generate theory. Observing and documenting interactions within a culture describes ethnographic research.

      DIF: Cognitive Level: Comprehension REF: Page 60

9. A certain qualitative method takes the position that there is no single reality. Because of this, the reality experienced by each participant is unique. Because experience is subjective, the experienced reality is reality. The method does not perform reality checks in order to determine whether a participant’s story is “true” or not. What is this qualitative method? (Select all that apply.)

   1. Husserlian phenomenology

   2. Ethnography

   3. Historicism

   4. Heideggerian phenomenology

   5. Grounded theory

      ANS: A, D

      The purpose of phenomenological research is to describe experiences (or phenomena) as they are lived—in phenomenological terms, to capture the “lived experience” of study participants. All phenomenologists agree that there is not a single reality; each individual has his or her own reality. Reality is considered subjective, and as a result, unique to the individual.

      DIF: Cognitive Level: Analysis REF: Page 60

10. What are the general truths of symbolic interaction theory, as utilized in grounded theory research? (Select all that apply.)

    1. Perceptions of one’s interactions with others shape one’s self-view.

    2. Perceptions of one’s interactions with others shape subsequent interactions.

    3. A person is “embodied” and experiences the world within that body.

    4. The culture determines behavior; the persons comprise the culture.

    5. Persons within a social structure share symbols that have meaning for them.

       ANS: A, B, E

       Heideggerian phenomenologists believe that the person is a self within a body, which is referred to as a person being embodied. Symbolic interaction theory explores how perceptions of interactions with others shape one’s view of self and subsequent interactions. In social life, groups share meanings. They communicate these shared meanings to others through socialization processes. Ethnography does not require travel to another country or region; however, it requires spending considerable time in the setting observing and gathering data.

       DIF: Cognitive Level: Analysis REF: Page 60

11. Which of the following are the characteristics of grounded theory research? (Select all that apply.)

    1. It focuses on experiences and processes, against the backdrop of society.

    2. It scrutinizes phenomena, past the capabilities of quantitative research.

    3. It always develops theory.

    4. It provides a cohesive description of a phenomenon, fostering understanding.

    5. It is able to be used effectively in a considerable variety of settings.

ANS: A, B, D, E

Grounded theory research is an inductive research technique developed by Glaser and Strauss through their study of the experience of dying. The method’s name means the findings are grounded in the concrete world as experienced by the participants and are interpreted at a more abstract theoretical level. The desired outcome of grounded theory studies is a middle range or substantive theory. Grounded theory researchers have contributed to our understanding of the patient experience across a wide range of settings. Grounded theory research examines experiences and processes with a breadth and depth not usually possible with quantitative research. The reader can intuitively verify these findings through her or his own experiences. The contribution to nursing science is that a clear, cohesive description of the phenomenon allows greater understanding.

DIF: Cognitive Level: Synthes

Chapter 5: Research Problem and Purpose Test Bank

MULTIPLE CHOICE

1. A researcher has conducted 9 clinical studies, some quantitative and others qualitative, all of which focus on depression’s relationship to perceived abandonment. “Depression’s relationship to perceived abandonment” is an example of which of the following?

   1. Research problem

   2. Research topic

   3. Research purpose

   4. Problem statement

      ANS: B

      Research topics are concepts, phenomena of interest, or broad problem areas that researchers can focus on to enhance evidence-based nursing. A research problem is an area of concern where there is a gap in the knowledge base needed for nursing practice. Research topics contain numerous potential research problems, and each problem provides the basis for developing many research purposes. The problem statement identifies the specific gap in the knowledge needed for practice. A nursing situation often includes a variety of research topics or concepts.

      DIF: Cognitive Level: Application REF: Page 73

2. Why is replicating a research study essential for knowledge development?

   1. Each time a study is replicated, its probability of error decreases.

   2. Reproducing a study decreases theoretical knowledge, increasing real knowledge.

   3. Replication helps confirm that the initial results were not reached in error.

   4. Replication studies represent the majority of published nursing literature.

      ANS: C

      Replication involves reproducing or repeating a study to determine if similar findings will be obtained. Replication is essential for knowledge development because it (1) establishes the credibility of the findings, (2) extends the generalizability of the findings over a range of instances and contexts, (3) reduces the number of type I and type II errors, (4) corrects the limitations in studies’ methodologies, (5) supports theory development, and (6) lessens the acceptance of erroneous results. Some researchers replicate studies because they agree with the findings and wonder if the findings will hold up in different settings with different subjects over time. Others want to challenge the findings or interpretations of prior investigators.

      However, the number of nursing studies replicated continues to be limited.

      DIF: Cognitive Level: Synthesis REF: Page 77

3. A nurse researcher working in a subacute orthopedic hospital floor. She notes that her elders with knee replacements sleep as many as 16 hours a day, waking only for physical therapy and meals, but she also notices that those with many visitors sleep fewer hours and seem to experience more pain. She wonders whether sleep in elders after knee replacement prevents pain, or whether elders select the coping strategy of sleeping more, in response to pain, and begins to attempt to identify the relationship between the two. A literature search reveals only three descriptive studies on this topic, one quantitative and two qualitative. What is “the relationship between elders’ hours of sleep following knee replacement and its relationship with report of pain”?

   1. The research aim

   2. The research purpose

   3. The research problem

   4. The research topic

      ANS: C

      Research topics are concepts, phenomena of interest, or broad problem areas that researchers can focus on to enhance evidence-based nursing. A research problem is an area of concern where there is a gap in the knowledge base needed for nursing practice. Research topics contain numerous potential research problems, and each problem provides the basis for developing many research purposes.

      DIF: Cognitive Level: Synthesis REF: Page 73

4. A master’s student who works in cardiothoracic ICU reads a 20-year-old nursing research study; the findings document use of much larger per-kilogram amounts of opioids and anxiolytics postoperatively in adults with open-heart surgery, as opposed to children with open-heart surgery. The student strongly suspects that modern hospitals medicate children and adults more or less the same, on a per-kilogram basis. She decides to replicate the original research in her hospital. What type of replication is this?

   1. Exact replication

   2. Concurrent replication

   3. Systematic replication

   4. Approximate replication

      ANS: D

      Replication involves reproducing or repeating a study to determine whether similar findings will be obtained. Four different types of replication are important in generating sound scientific knowledge for nursing: (1) exact, (2) approximate, (3) concurrent, and (4) systematic extension. An exact, or identical, replication involves duplicating the initial researcher’s study to confirm the original findings. All conditions of the original study must be maintained. An approximate, or operational, replication involves repeating the original study under similar conditions, following the methods as closely as possible. A concurrent, or internal, replication involves the collection of data for the original study and its simultaneous replication to provide a check of the reliability of the original study. A systematic extension or constructive replication is done under distinctly new conditions.

      DIF: Cognitive Level: Application REF: Page 77

5. A research study contains the question, “Can the application of twice-daily cortisone in the period from 6 to 10 weeks postoperatively produce significantly increased range of motion in 50- to 60-year-old rotator-cuff repair patients at the six-month mark?” The study is research.

   1. Ethnographic

   2. Historical

   3. Experimental

   4. Basic

      ANS: C

      Experimental studies are conducted in highly controlled settings and under highly controlled conditions to determine the effect of one or more independent variables on one or more dependent variables. An experimental research question takes the form of, “Does provision of increased A have an effect on B?” where the study variables are A and B, the relationship is a change in A and its effect on B, and the question ends with a question mark.

      DIF: Cognitive Level: Synthesis REF: Page 87

6. A knowledge gap is identified by a nurse researcher. Which of the following may NOT necessarily represent a knowledge gap?

   1. A literature search that shows that no quantitative research, but only qualitative research, exists in the area.

   2. The National Institutes of Health (NIH) identify the area as one of research priority.

   3. The phenomenon of interest is a new disease, just identified in Phoenix, Arizona.

   4. There is one study examining a new intervention, but the research has not yet been replicated.

      ANS: A

      The lack of quantitative research may mean only that the phenomenon or idea of the research is not suited for quantitative research, since some concepts are suitable only for qualitative enquiry. By questioning and reviewing the literature, researchers begin to recognize a specific area of concern and the knowledge gap that surrounds it. The knowledge gap, or what is not known about this clinical problem, determines the complexity and number of studies needed to generate essential knowledge for nursing practice. Since 1975, expert researchers, specialty groups, professional organizations, and funding agencies have identified nursing research priorities.

      DIF: Cognitive Level: Application REF: Page 87

7. Which of the following represents a concise, clear statement of the specific goal or aim of a research study?

   1. The research problem was identified as the general area of ignorance surrounding the causation and diagnosis of meningococcal meningitis, especially among soldiers in uniform, and this constituted a significant gap in the literature.

   2. The purpose of the project, then, was to define changes in the variable of hypertension across time, with the four most prevalent treatment modalities prescribed by primary care physicians in the greater Chicago area.

   3. The phenomenon of depression experienced by the primary schoolchild was focused upon in this study. It is an under-researched topic, especially since recent research has identified correlational links with childhood obesity, especially Hispanic and African-American populations.

   4. Despite the fact that studying the disease, especially from standpoints of prevention and early detection, is costly and time-consuming, it represents a clear priority, since treatment itself is remarkably costly and the afflicted are not likely to experience even short remissions without early intervention.

      ANS: B

      The research purpose is a concise, clear statement of the specific goal or aim of the study that is generated from the research problem. A research problem is an area of concern where there is a gap in the knowledge base needed for nursing practice. Research topics are concepts, phenomena of interest, or broad problem areas that researchers can focus on to enhance evidence-based nursing. One source of research problems is research priorities identified by funding agencies and specialty groups.

      DIF: Cognitive Level: Comprehension REF: Page 74

8. What is the relationship between a research topic and a research problem?

   1. The purpose is the most general statement; the research topic is the most specific to

      the research itself.

   2. Research topics contain numerous potential research problems, and each problem provides the basis for developing many purposes.

   3. The research topic and the research problem are identical.

   4. The research topic specifies setting and population, but the problem does not.

      ANS: A

      Research topics are concepts, phenomena of interest, or broad problem areas that researchers can focus on to enhance evidence-based nursing. Research topics contain numerous potential research problems, and each problem provides the basis for developing many purposes. Thus, the identification of a relevant research topic and a challenging, significant problem can facilitate the development of numerous study purposes to direct a lifetime program of research.

      DIF: Cognitive Level: Analysis REF: Page 73

9. Which of the following is the practicing nurse’s most important source of researchable problems?

   1. The nurse’s own clinical practice

   2. Review of the literature

   3. Nursing theories

   4. Administrative mandates to conduct clinical research on every hospital unit

ANS: A

The practice of nursing must be based on knowledge or evidence generated through research. Thus, clinical practice is an extremely important source for research problems. Problems can evolve from clinical observations. A review of patient records, treatment plans, and procedure manuals might reveal concerns or raise questions about practice that could be the basis for research problems.

DIF: Cognitive Level: Analysis REF: Page 75

MULTIPLE RESPONSE

1. Which of the following are considered evidence-generating? (Select all that apply.)

   1. Replication of previous research

   2. Identification of research topics, followed by basic research

   3. Applied research studies that examine clinical response to interventions

   4. Reviews of the literature

   5. Qualitative research examining responses to diagnosis

      ANS: A, B, C, E

      Research topics are concepts, phenomena of interest, or broad problem areas that researchers can focus on to enhance evidence-based nursing. However, the lack of replication studies severely limits the generation of sound research findings needed for evidence-based practice in nursing. Basic, or pure, research is a scientific investigation that involves the pursuit of “knowledge for knowledge’s sake,” or for the pleasure of learning and finding truth. The purpose of basic research is to generate and refine theory and build constructs; thus, the findings are frequently not directly useful in practice. Replication of previously conducted research is essential for knowledge development. By questioning and reviewing the literature, researchers begin to recognize a specific area of concern and the knowledge gap that surrounds it; however, review of the literature does not generate knowledge—it reviews previous knowledge. Questions focusing on investigating new techniques to improve existing skills, patient responses to techniques, or ways to educate patients and families to perform techniques. . . could add to knowledge needed for evidence-based practice.

      DIF: Cognitive Level: Analysis REF: Page 73

2. Reasons to conduct an exact replication include which of the following? (Select all that apply.)

   1. A different sample is used in the replication, because subjects seldom elect to undergo the same surgical procedure twice.

   2. The same site is again used, in order to decrease variation.

   3. Sample size was adequate, the design was strong, and measurements were robust.

   4. Validation of the truthfulness of the original subjects’ responses is desired.

   5. A similar population is used, in order to verify the findings.

      ANS: B, C, D

      Four different types of replication are important in generating sound scientific knowledge for nursing: (1) exact, (2) approximate, (3) concurrent, and (4) systematic extension. An exact (or identical) replication involves duplicating the initial researcher’s study to confirm the original findings. All conditions of the original study must be maintained. Exact replications might be thought of as ideal to confirm original study findings, but these are frequently not attainable. In addition, one would not want to replicate the errors in an original study, such as small sample size, weak design, or poor-quality measurement methods.

      DIF: Cognitive Level: Analysis REF: Page 77

3. The American Association of Critical Care Nurses (AACN) funds various research projects that focus on its research priorities. A master’s student wants to initiate research to study the relative accuracy of new computer-assisted assessment device that painlessly measures blood glucose values through a probe just distal to the insertion hub of a central line, in patients on insulin drips with hourly Accu-Chek readings. Does this pertain to any of the organization’s research priorities, listed here? (Select all that apply.)

   1. Technology use to achieve patient assessment, management, or outcomes

   2. Prevention and management of complications

   3. Processes and systems that foster the optimal contribution of critical care nurses

   4. Creation of a healing, humane environment

   5. Development of processes and systems that foster the optimal contribution of critical care nurses

      ANS: A, D

      The American Association of Critical Care Nurses (AACN) determined initial research priorities for this specialty in the early 1980s and revised these priorities based on patients needs and the changes in health care. The current AACN (2011) research priorities are identified on this organization’s website as (1) effective and appropriate use of technology to achieve optimal patient assessment, management, or outcomes; (2) creation of a healing, humane environment; (3) processes and systems that foster the optimal contribution of critical care nurses; (4) effective approaches to symptom management; and (5) prevention and management of complications. This research study uses technology. Also, it saves the patient from interruptions in sleep, as the nurse flushes a line and draws blood hourly, or performs hourly Accu-Cheks, if the line will not draw.

      DIF: Cognitive Level: Synthesis REF: Page 79

4. “The purpose of the research will be, most likely, to document how admirable charitable efforts by The Children of the Land were terminated by the well-meaning Los Angeles Police Force.” What is incorrect about this wording? (Select all that apply.)

   1. A police organization cannot be named in a research purpose.

   2. A purpose should specify methodology.

   3. The terms admirable and well-meaning are both subjective.

   4. The purpose must identify the goal of the study, not the “most likely” goal.

   5. The purpose should be stated as “was” or “is” but not “will be.”

      ANS: C, D, E

      The purpose is generated from the problem, identifies the goal or goals of the study, and directs the development of the study. In the research process, the purpose is usually stated after the problem, because the problem identifies the gap in knowledge in a selected area and the purpose clarifies the knowledge to be generated by the study. The research purpose must be stated objectively, that is, in a way that does not reflect particular biases or values of the researcher. Investigators who do not recognize their values might include their biases in the research. This can lead them to generate the answers they want or believe to be true and might add inaccurate information to a discipline’s body of knowledge.

      DIF: Cognitive Level: Evaluation REF: Page 83

5. Children in publicly funded school breakfast programs often have learning delays. These are not readily attributable to single causes. Research on learning delays has revealed that family literacy, measured by parental reading level and comprehension scores, is the most powerful predictor of delay in the primary grades. On the other hand, repeated exposure to eyes-on reading, in the company of a trusted non-parent adult, has been shown to over-ride family literacy as a predictor. No research, however, has studied institution of a reading-and-breakfast program, delivered five days a week before school, intended to over-ride the variable of family literacy. Given this problem statement, which of these purposes would be appropriate for the study? (Select all that apply.)

   1. The purpose of the study was to determine whether providing volunteer readers during school breakfasts for all kindergarten and first-grade children would result in fewer than anticipated learning delays.

   2. The purpose of the study was to determine the lived experience of children with learning delays, against the context of school and home, and to examine the children’s peer relationships.

   3. The purpose of the study was to determine whether a buddy system of one sixth-

      grader, and one kindergartner or first-grader, who ate breakfast together and then read together for 20 minutes, was effective in decreasing the anticipated number learning delays.

   4. The purpose of the study was to experimentally determine what causes learning delays, by introducing various strategies already in place in community primary schools and measuring their effect, using basic research.

   5. The purpose of the study was to measure the effectiveness of using school computers, allowing children to visually scan a story concurrently read by a school teacher over the cafeteria microphone during school breakfast time, in decreasing the incidence and severity of learning delays.

      ANS: A, C, E

      The problem statement identifies the specific gap in the knowledge needed for practice. Each problem may generate many research purposes. The research purpose is a clear, concise statement of the specific goal or aim of the study that is generated from the research problem. The purpose usually indicates the type of study to be conducted and often includes the variables, population, and setting for the study.

      DIF: Cognitive Level: Synthesis REF: Page 73

6. In determining a study’s feasibility, which of the following statements are true, regarding the time needed for study completion? (Select all that apply.)

   1. Some data collection must be performed over an extended period of time, such as measurements of the depth and extent of scar tissue over 18 months.

   2. Sufficient subjects meeting the study criteria may be difficult to access, requiring data collection that extends for months or even years.

   3. The inflationary spiral makes all research funding inadequate.

   4. Computerized records make data analysis much less time-consuming.

   5. Obtaining Institutional Review Board (IRB. approval may be time-consuming, especially if the research uses more than one hospital or agency.

      ANS: A, B, E

      One can approximate the time needed to complete a study by assessing the following factors:

      (1) type and number of subjects needed, (2) number and complexity of the variables to be studied, (3) methods for measuring the variables (are instruments available to measure the variables, or must they be developed?), (4) methods for collecting data, and (5) the data analysis process. Another factor that can increase the time needed for a study is obtaining institutional review board (IRB) approval, especially if more than one clinical agency is used for data collection in a study. Not all research funding is inadequate. Computerized records may be easier or may be more difficult for data retrieval; however, data analysis is not affected by the existence of computerized data.

      DIF: Cognitive Level: Application REF: Page 84

7. How do seasoned nurse researchers, years away from clinical practice, select meaningful research questions? (Select all that apply.)

   1. They continue to conduct research in the same general areas in which they have previously conducted research, with one project leading into the next.

   2. They cannot do so, because they are not working bedside nurses.

   3. They establish working relationships with clinical nurses, sharing authorship of

      research publications.

   4. They collaborate with novice researchers who are closer to the clinical world.

   5. They use research methods that allow data collection through only observation.

      ANS: A, C, D

      Interactions with researchers and peers offer valuable opportunities for generating research problems. Experienced researchers serve as mentors and help novice researchers to identify research topics and formulate problems. This type of relationship could also be developed between an expert researcher and a nurse clinician. Since nursing research is critical to be designated as a Magnet facility, hospitals and healthcare systems employ nurse researchers for the purpose of guiding studies conducted by staff nurses. Building an evidence-based practice for nursing requires collaboration between nurse researchers and clinicians, as well as collaboration with researchers from other health-related disciplines. During data collection, study variables are measured through a variety of techniques, such as observation, interview, questionnaires, scales, and physiological measurement methods.

      DIF: Cognitive Level: Synthesis REF: Page 76

8. A master’s student does not know how to choose a research problem. She has been off work for the past two years. What sources can she use in order to identify a researchable nursing problem? Her work area used to be trauma nursing, but she does not wish to perform research in this area. By using which of the following sources can she identify a nursing research problem? (Select all that apply.)

   1. Talking with nurse friends about questions that have arisen in their work areas

   2. Talking with other master’s students about ideas for study

   3. Reading professional research journals

   4. Depending on her instructors to provide a research problem for her

   5. National Institutes for Nursing Research priorities

      ANS: A, B, C, E

      The major sources for nursing research problems include nursing practice; researcher and peer interactions; literature review; theories; and research priorities identified by individuals, specialty groups, professional organizations, and funding agencies.

      DIF: Cognitive Level: Application REF: Page 75

9. What is the relationship among the research problem, the research purpose, and the research question? (Select all that apply.)

   1. The purpose is but one of many purposes that can be generated from one particular problem statement.

   2. The problem statement is more focused and specific than is the purpose.

   3. The research purpose and the research question should address the same facet of the research problem.

   4. The problem, purpose, and question are all focused upon a specific gap in the knowledge base.

   5. Research can be conducted without a research question, but not without a research purpose.

      ANS: A, C, D

      A research problem is an area of concern where there is a gap in the knowledge based needed for nursing practice. A research problem includes significance, background, and a problem statement. The problem statement identifies the specific gap in the knowledge needed for practice. The research purpose is a clear, concise statement of the specific goal or aim of the study that is generated from the research problem, so the purpose is usually identified after the research purpose is identified. Consequently, more than one purpose can emanate from a given problem statement. Based on the research purpose, specific research objectives, questions, or hypotheses are developed to direct the study.

      DIF: Cognitive Level: Analysis REF: Page 73

10. A researcher gains support of the medical staff, the nursing staff, and the nurse manager of a cardiothoracic ICU within a prestigious private hospital, aligned with a teaching institution. A research proposal, concerning ambulation patterns after bypass surgery, is approved by the Human Subjects Committee. Federal funding is obtained. Just before data collection is to begin, the hospital is sold to a large university with a medical school, the nurse manager is replaced with a manger from another hospital in the corporation, and there is a 30% staff turnover. Choose the factors that are real concerns and could impact feasibility. (Select all that apply.)

    1. Most of the newly hired nurses are BSNs and newly graduated.

    2. The new manager grudgingly allows the research to proceed but makes it clear that she will not support subsequent research until the unit is more stable.

    3. Fewer patients come to this hospital now for bypass surgery, going instead to its sister hospital across town.

    4. Two of the research assistants, who were already trained, take jobs elsewhere.

    5. Staff nurses dislike the new manager and miss the old one.

       ANS: B, C, D

       The feasibility of a study is determined by examining the time and money commitment; the researcher’s expertise; availability of subjects, facility, and equipment; cooperation of others; and the study’s ethical considerations. A study might appear feasible but, without the cooperation of others, it is not. However, most nursing studies involve human subjects and are conducted in hospitals, clinics, schools, offices, or homes. Having the cooperation of people in the research setting, the subjects, and the research assistants involved in data collection is essential. People are frequently willing to cooperate with a study if they view the problem and purpose as significant or if they are personally interested.

       DIF: Cognitive Level: Analysis REF: Page 84

11. A master’s student decides to conduct a pilot study in order to help with which of the following? (Select all that apply.)

    1. Assess working nurses’ responses to having a researcher collect data in the middle of their unit.

    2. Re-evaluate the actual expenditure of the researcher’s time for each subject consented and studied.

    3. Allow potential subjects to sample research participation before they fully commit.

    4. Apply for Human Subjects permission to perform the actual study.

    5. Determine whether the research side has enough research subjects who are interested in participating in the research.

ANS: A

A pilot study is commonly defined as a smaller version of a proposed study conducted to refine the methodology. It is developed much like the proposed study, using similar subjects, the same setting, the same treatment, and the same data collection and analysis techniques. As the research problem and purpose increase in clarity and conciseness, the researcher has greater direction in determining the feasibility of a study. The feasibility of a study is determined by examining the time and money commitment; the researcher’s expertise; availability of subjects, facility, and equipment; cooperation of others; and the study’s ethical considerations. The purpose selected for investigation must be ethical, and Human Subjects permission must be obtained before even a pilot study is conducted. A pilot study is not used to allow potential subjects to sample participation before they commit: Human Subjects permission must be obtained before study participation.

DIF: Cognitive Level: Analysis Chapter 6: Review of Relevant Literature Test Bank

MULTIPLE CHOICE

1. Which of the following would be landmark research?

   1. The discovery that during pancreatitis, the pancreas is actually digested by its own enzymes

   2. A description of the importance of injecting immunizations in the proper location of the deltoid

   3. The third in a series of four papers describing patterns of emergency room use in vacation communities

   4. The first paper on the effect of using insulin for type I diabetes in humans

      ANS: D

      Seminal studies are the first studies that prompted the initiation of the field of research. Landmark studies are the studies that led to an important development or a turning point in the field of research.

      DIF: Cognitive Level: Application REF: Page 100

2. A publication is printed every two months. Its volume number coincides with its year of publication (2008 = 1; 2009 = 2; 2010 = 3; etc.). Its issue number coincides with the order of publication, within a given year (Jan–Feb = 1; Mar–Apr = 2; etc). What kind of a publication is this?

   1. A monograph

   2. A periodical

   3. An e-book

   4. A serial

      ANS: D

      Serials are published over time or may be in multiple volumes, but do not necessarily have a predictable publication date. Periodicals are subsets of serials with predictable publication dates, such as journals, which are published over time and are numbered sequentially for the years published. This sequential numbering is seen in the year, volume, issue, and page numbering of a journal. Monographs, such as books, hard-copy conference proceedings, or pamphlets, are usually written once and may be updated with a new edition as needed.

      Textbooks are monographs written to be used in formal education programs. Entire volumes of books available in a digital or electronic format are called e-books.

      DIF: Cognitive Level: Application REF: Page 100

3. The type of literature that describes concept analyses, models, and frameworks is which of the following?

   1. Empirical

   2. Applicable

   3. Able to be replicated

   4. Theoretical

      ANS: D

      Theoretical literature consists of concept analyses, models, theories, and conceptual frameworks that support a selected research problem and purpose. Empirical literature comprises knowledge derived from research.

      DIF: Cognitive Level: Application REF: Page 100

4. What primary sources might be available to someone writing a biography of Queen Elizabeth I, who died in the 17th century?

   1. An interview with one of her maids-in-waiting

   2. A previous history written about her

   3. An article about her in a 17th-century publication

   4. A diary written by her

      ANS: D

      The published literature contains primary and secondary sources. A primary source is written by the person who originated, or is responsible for generating, the ideas published. A research publication published by the person or people who conducted the research is a primary source. A theoretical book or paper written by the theorist who developed the theory or conceptual content is a primary source. A secondary source summarizes or quotes content from primary sources. Thus, authors of secondary sources paraphrase the works of researchers and theorists. The problem with a secondary source is that the author has interpreted the works of someone else, and this interpretation is influenced by that author’s perception and bias. Authors have sometimes spread errors and misinterpretations by using secondary sources rather than primary sources. You should use mostly primary sources to write literature reviews.

      Secondary sources are used only if primary sources cannot be located or if a secondary source contains creative ideas or a unique organization of information not found in a primary source.

      DIF: Cognitive Level: Application REF: Page 101

5. What is the purpose of the minimal review of relevant studies that the grounded theory researcher undertakes before writing the research proposal?

   1. It compares the anticipated findings with the findings of similar research.

   2. It directs the researcher in how to strategize data collection.

   3. It helps the researcher to identify previous findings that will assist in interpretation of the planned study.

   4. It reveals the need for the planned research by identifying what others have done.

      ANS: D

      In qualitative research, the purpose and timing of the literature review vary based on the type of study to be conducted. In development of a grounded theory study, a minimal review of relevant studies provides the beginning point of the inquiry, but this review is only a means of making the researcher aware of what studies have been conducted. This information, however, is not used to direct the collection of data or interpretation of the findings in a grounded theory study.

      DIF: Cognitive Level: Application REF: Page 98

6. In terms of the literature review, how are quantitative research and ethnographic research similar?

   1. Both require the researcher to review the literature before beginning the study.

   2. Both require the researcher to review the literature after completion of data analysis.

   3. Both require the researcher to utilize the literature as the primary data source.

   4. Both consider the literature review extraneous, postponing it until after the study is published.

      ANS: A

      In qualitative research, the purpose and timing of the literature review vary based on the type of study to be conducted. The purposes for reviewing the literature for ethnographic studies and for exploratory descriptive qualitative research are more similar to the literature review for quantitative research. The researcher develops a general understanding of the concepts to be examined related to the selected culture or topic. The literature review also provides a background for conducting the study and interpreting the findings.

      DIF: Cognitive Level: Analysis REF: Page 98

7. Considering phenomenologists’ belief that experience constitutes reality, how does their approach to the literature review dovetail with that belief?

   1. The literature is exactly as real as the other research data, and it is all analyzed and valued equally during the data analysis portion of the study.

   2. If the literature reports other phenomenologists’ findings, based on experience, these can be considered alternative data sources.

   3. The literature is a false interpretation of reality and cannot be considered, either before or after data analysis is complete.

   4. The literature review is usually postponed until after data analysis completion, so that the understanding of the phenomenon will emanate solely from the data.

      ANS: B

      In qualitative research, the purpose and timing of the literature review depends on the type of study to be conducted. Some phenomenologists believe the literature should not be reviewed until after the data have been collected and analyzed so that the literature will not interfere with the researcher’s ability to suspend what is known and approach the topic with openness.

      DIF: Cognitive Level: Evaluation REF: Page 98

8. In historical research, what is the reason that the literature review begins so early and extends so far into the process?

   1. Historians must include exact dates in their histories. The literature must be checked and double-checked, in order to verify the correctness of these dates.

   2. Historical research demands one extra stage of data review, just prior to publication, since new published data could bring the results under scrutiny.

   3. Historians develop their ideas for research proposals from reading other histories. As discrepancies arise, these provide the ideas for research.

   4. The literature essentially comprises the bulk of the data set. From this, plus other artifacts and interviews, if available, the historian writes the story.

      ANS: D

      In qualitative research, the purpose and timing of the literature review vary based on the type of study to be conducted. In historical research, the initial review of the literature helps the researcher define the study questions and make decisions about relevant sources. The data collection is actually an intense review of published and unpublished documents that the researcher has found.

      DIF: Cognitive Level: Evaluation REF: Page 98

9. Why would the Boolean article OR be used if a researcher is conducting a digital literature search of journals on the topic of prolonged adolescent grieving after parental loss?

   1. It focuses the search on parental loss, the last search term.

   2. It is useful when a researcher is undecided.

   3. It narrows the search to articles containing all terms.

   4. It allows the researcher to enter the search terms without excluding those whose authors did not “keyword” all the words of the topic.

      ANS: D

      The Boolean operators are the three words AND, OR, and NOT. Often they must be capitalized. The Boolean operators AND and NOT are used with the identified concepts. The Boolean operator OR is most useful with synonymous terms or concepts. It is used to search for the presence of any of a group of terms in the same search.

      DIF: Cognitive Level: Application REF: Page 105

10. The original quotation in the fictional text by Atchison, Topeka, and Santa Fe (2009) is as follows:

    “Because of overemphasis on academic excellence, especially test grades, the high schools studied had a disproportionate number of students who reported sleeplessness, nervousness, nightmares, and guilt. These were attributed to various factors, the most significant of which was a very strict principal, who voiced open disapproval of students she felt were underachieving their enormous academic potential. Parents were very accepting of this behavior, echoing it in their interactions with the students.”

    What is the acceptable way to properly attribute this content in a literature review?

1. Parents were very accepting of the principal’s behavior, which included voiced disapproval of underachieving students, echoing it in their interactions with their sons and daughters.

2. Because of overemphasis on academic excellence, especially test grades, the high

   schools studied had a disproportionate number of students who reported sleeplessness, nervousness, nightmares, and guilt. These were attributed to various factors, the most significant of which was a very strict principal, who voiced open disapproval of students she felt were underachieving their enormous academic potential. Parents were very accepting of this behavior, echoing it in their interactions with the students. (Atchison, Topeka, & Santa Fe, 2009).

3. As compared with other high schools, Atchison, Topeka, and Santa Fe (2009) reported a higher incidence of distress manifestations, such as nightmares and nervousness, in a strictly college-prep school with an extremely disapproving principal, who verbally berated students for less-than-expected academic performance.

4. High schools with disapproving authority figures have a higher incidence of somatization (see Atchison et al, 2009).

ANS: C

Rather than using direct quotes from an author, the writer of the literature review should paraphrase the author’s ideas. Use of the author’s exact words represents plagiarism.

Eliminating the quotation marks, and citing an entire paragraph, with the authors’ names at the end, also constitutes plagiarism. Paraphrasing involves expressing the ideas clearly and in one’s own words. The meanings of these sources are then connected to the proposed study.

DIF: Cognitive Level: Application REF: Page 111

MULTIPLE RESPONSE

1. Which of the following might a researcher include in a review of the literature concerning acupuncture and conscious sedation for major surgical procedures? (Select all that apply.)

   1. A research article from the Journal of Acupuncture comparing the use of acupuncture with general anesthesia

   2. Bryson’s Human Physiology textbook

   3. A research synthesis on alternatives to general anesthesia compiled by the Agency for Health Policy and Research

   4. An article in National Enquirer on the dangers of major surgery

   5. A master’s thesis on the use of acupuncture during closed reduction of radial-ulnar fractures

   6. A Wikipedia article on how acupuncture works

   7. A monograph written by a physician in a third world country who used acupuncture to control pain during surgical procedures

      ANS: A, B, C, E, G

      “The literature” consists of all written sources relevant to the selected topic. The literature includes newspapers, monographs, encyclopedias, conference papers, scientific journals, textbooks, other books, theses, dissertations, and clinical journals. Websites and reports developed by government agencies and professional organizations are also included. Online encyclopedias to which anyone can contribute, such as Wikipedia, are not considered scholarly sources.

      DIF: Cognitive Level: Analysis REF: Page 97

2. A student’s first draft of her thesis contains the following:

   Evidence to the contrary was provided in several studies of efficacy but never examined in a context of “the adolescent at sea with the ghost of his losses” (Reynolds, 2011).

   The student’s reference list contains the following citation for this work:

   Reynold, A. R. (2010). Never underestimate depression. Journal of Applied Psychology.

   What is wrong with it? (Select all that apply.)

   1. The reference list should re-state the quotation.

   2. The reference is incomplete, lacking volume number and page numbers.

   3. The years of the citation differ.

   4. The author’s name is spelled differently in the citation and in the reference list.

   5. No page number is provided for the direct quotation.

      ANS: B, C, D, E

      Sources that will be cited in a paper or recorded in a reference list should be cross-checked two or three times to prevent errors. Questions that will identify common errors are displayed in Box 6-1. To prevent these errors, the author checks all the citations within the text of the literature review and each citation in his or her reference list, to assure agreement and completeness.

      DIF: Cognitive Level: Application REF: Page 112

3. In which of the following methods does substantive review of the literature take place after data analysis? (Select all that apply.)

   1. Grounded theory

   2. Historicism

   3. Phenomenology

   4. Ethnography

   5. Quantitative descriptive

      ANS: A, C

      In qualitative research, the purpose and timing of the literature review depends on the type of study to be conducted. Some phenomenologists believe the literature should not be reviewed until after the data have been collected and analyzed so that the literature will not interfere with the researcher’s ability to suspend what is known and approach the topic with openness. In development of a grounded theory study, a minimal review of relevant studies provides the beginning point of the inquiry, but this review is only a means of making the researcher aware of what studies have been conducted. This information, however, is not used to direct the collection of data or interpretation of the findings in a grounded theory study. During the data analysis stage, a core variable is identified and the researcher theoretically samples the literature for extant theories that may assist in explaining and extending the emerging theory. In historical research, the initial review of the literature helps the researcher define the study questions and make decisions about relevant sources. The data collection is actually an intense review of published and unpublished documents that the researcher has found. The purposes for reviewing the literature for ethnographic studies and for exploratory descriptive qualitative research are more similar to the literature review for quantitative research. The researcher develops a general understanding of the concepts to be examined related to the selected culture or topic. The literature review also provides a background for conducting the study and interpreting the findings. The review of literature in quantitative research directs the development and implementation of a study. The focus of the major literature review at the beginning of the research process is to identify a gap in what is known.

      DIF: Cognitive Level: Synthesis REF: Page 98

4. Which of the following are purposes of the literature review in quantitative research concerning patient compliant with alternating leg pressure stockings (ALPs)? (Select all that apply.)

   1. It gives the researcher an overview of anecdotal reports about how it feels to the patient to wear ALPs.

   2. It allows the researcher to use the data from previous research on ALPs to add to his or her database.

   3. It allows the researcher to construct theory about compliance with ALPs.

   4. It gives the researcher something with which to compare his or her findings on compliance with ALPs.

   5. It allows the researcher to discover previous research in the area of ALPs, so as to identify what is not known (the research gap).

      ANS: D, E

      The review of literature in quantitative research directs the development and implementation of a study. The focus of the major literature review at the beginning of the research process is to identify a gap in what is known. The study is designed to add knowledge in the area of the identified gap. After a thorough review of the literature, the researcher identifies a specific gap in knowledge. After the data have been analyzed and the findings described, the researcher will return to the literature in the generalization phase of the research report to integrate knowledge from the literature with new knowledge obtained from the study. The purpose of the literature review is similar for the different types of quantitative studies (descriptive, correlational, quasi-experimental, and experimental).

      DIF: Cognitive Level: Application REF: Page 98

5. In phenomenology, often the review of the literature is conducted after data analysis is complete. What is the reason for this? (Select all that apply.)

   1. The data analysis phase of phenomenology includes a literature review.

   2. Phenomenology is data-free, and analyses are based only on the interpretation of the researcher.

   3. Some phenomenologists do believe that one can “bracket” what is known, in order to perform an unbiased analysis, but it seems pointless to absorb information just to then put it aside, so literature review is usually postponed.

   4. Some phenomenologists don’t believe that one can “bracket” what is known, in order to perform an unbiased analysis of the data, so they try to minimize what they read about the topic of the study until data analysis is complete.

   5. The review of the literature provides an objective cross-check for the researcher’s interpretation.

      ANS: C, D

      In qualitative research, the purpose and timing of the literature review depends on the type of study to be conducted. Some phenomenologists believe the literature should not be reviewed until after the data have been collected and analyzed so that the literature will not interfere with the researcher’s ability to suspend what is known and approach the topic with openness.

      DIF: Cognitive Level: Analysis REF: Page 98

6. It is appropriate to conduct a review of the literature in which of the following circumstances? (Select all that apply.)

   1. An ethnographic study is planned.

   2. A nurse is interested in conducting research on patients who “sundown.”

   3. One requirement for a graduate course paper is a written literature review.

   4. A hospital is attempting to develop a policy on bathing frequency for elders.

   5. The hospital attorney is preparing a brief relative to a fall suffered by a patient.

      ANS: A, B, C, D

      For most course papers, instructors expect students to review published sources related to the paper’s topic. Evidence-based practice guidelines are developed through the synthesis of the literature on the clinical problem. The purpose of the literature review designed to examine the strength of the evidence is to identify all studies that provide evidence of a particular intervention, to critically appraise the quality of each study, and to synthesize all of the studies providing evidence of the effectiveness of a particular intervention. The purposes for reviewing the literature for ethnographic studies and for exploratory descriptive qualitative research are more similar to the literature review for quantitative research. The researcher develops a general understanding of the concepts to be examined related to the selected culture or topic. The literature review also provides a background for conducting the study and interpreting the findings. The focus of the major literature review at the beginning of the research process is to identify a gap in what is known.

      DIF: Cognitive Level: Analysis REF: Page 98

7. The review of literature in quantitative research directs everything from the first ideas about the study variables through recommendations based upon the study’s conclusions. Which of the following are outputs of the literature review in quantitative research? (Select all that apply.)

   1. Development of conceptual definitions of concepts

   2. Determining the statistical power of the sample

   3. Determination of how many subjects will drop out of the study

   4. Description of what studies have been performed, so as to provide initial direction for the study method

   5. Interpretation of the study findings, in comparison with previous research

      ANS: A, D, E

      In quantitative studies, information obtained from the review of literature influences the development of several steps in the research process (Table 6-1), which include, among other items: developing conceptual and operational definitions, defining the purpose of the study, establishing the research gap, synthesizing previous research in the area, selecting a research design, and finally interpreting the study, in light of previous research.

      DIF: Cognitive Level: Analysis REF: Page 99

8. Why would a reputable researcher use a secondary source instead of a primary one? (Select all that apply.)

   1. The primary publication is written in a language not currently spoken.

   2. The primary source person will not consent to be interviewed, but a person who knows the story secondhand will consent.

   3. The primary publication is so steeped in jargon that it is very difficult to decipher.

   4. The researcher has limited time and cannot squander it searching for primary

      sources.

   5. The primary publication describes only the beginnings of a theory, and a later publication presents it in entirety.

   6. There have never been any primary sources in this area.

   7. The primary publication is no longer in print, and there are no extant copies.

ANS: A, B, C, E, G

The published literature contains primary and secondary sources. A primary source is written by the person who originated, or is responsible for generating, the ideas published. A research publication published by the person or people who conducted the research is a primary source. A theoretical book or paper written by the theorist who developed the theory or conceptual content is a primary source. A secondary source summarizes or quotes content from primary sources. Thus, authors of secondary sources paraphrase the works of researchers and theorists. The problem with a secondary source is that the author has interpreted the works of someone else, and this interpretation is influenced by that author’s perception and bias. Authors have sometimes spread errors and misinterpretations by using secondary sources rather than primary sources. One should use mostly primary sources to write literature reviews.

Secondary sources are used when primary sources cannot be located or utilized, or if a secondary source contains creative ideas or a unique organization of information not found in a primary source.

DIF: Cognitive Level: Synthesis REF: Page 101

Chapter 8: Objectives, Questions, Hypotheses and Study Variables Test Bank

MULTIPLE CHOICE

1. Which of the following is the research objective?

   1. To answer the research question

   2. To determine the strength of the statistical relationship among the variables

   3. To determine whether homeless children seem to have longer length of hospital stay, poorer verbal skills, and more fear of separation from their parents than do other children

   4. To measure length of stay, verbal skills, and fear of separation from parents in homeless children admitted to the hospital

      ANS: C

      Research objectives are clear, concise, declarative statements that are expressed in the present tense. For clarity, an objective usually focuses on one or two variables (or concepts) and indicates whether the variables are to be identified or described. Objectives can also identify relationships or associations among variables, determine differences between groups or compare groups on selected variables, and predict a dependent variable based on selected independent variables.

      DIF: Cognitive Level: Application REF: Page 138

2. What is the research question?

   1. Length of hospital stay, verbal skills, and fear of separation from parents have no

      relationship to children’s homelessness.

   2. Does children’s homelessness affect length of hospital stay, verbal skills, and fear of separation from parents?

   3. Was homelessness related to length of hospital stay, verbal skills, and fear of separation from parents in this study?

   4. Is homelessness in children related to length of hospital stay, verbal skills, and fear of separation from parents?

      ANS: D

      A research question is a concise, interrogative statement that is worded in the present tense and includes one or more variables (or concepts). The research questions focus on (1) the description of the variable(s), (2) a determination of differences between two or more groups regarding selected variables, (3) an examination of relationships among variables (relational), and (4) the use of independent variables to predict a dependent variable. In this case (3), the examination of relationships among variables, would be the focus of the research question, since cause is not a focus of study.

      DIF: Cognitive Level: Application REF: Page 140

3. What is the research hypothesis?

   1. Longer length of hospital stay, worse verbal skills, and fear of separation from parents are caused by children’s homelessness.

   2. Homelessness in children is related to length of hospital stay, verbal skills, and fear of separation from parents.

   3. There is no relationship between children’s homelessness and length of hospital stay, verbal skills, and fear of separation from parents.

   4. If a child is homeless, that child is likely to have poor verbal skills, more difficulty separating from parents, and a longer hospital stay.

      ANS: B

      A hypothesis is a formal statement of the expected relationship or relationships between two or more variables in a specified population. The hypothesis translates the problem and purpose into a clear explanation or prediction of the expected results or outcomes of the study. A hypothesis (1) specifies the variables the researcher will manipulate or measure, (2) identifies the population the researcher will examine, (3) indicates the type of research, and (4) directs the conduct of the study. Hypotheses are described using the terms in the following four categories: (1) associative versus causal, (2) simple versus complex, (3) directional versus nondirectional, and (4) null versus research.

      DIF: Cognitive Level: Application REF: Page 142

4. A researcher identifies three variables and formulates a hypothesis that links them. That hypothesis is testable. What does it mean that the hypothesis is testable?

   1. All the variables in the hypothesis are measurable.

   2. The hypothesis must be replaced by a research question.

   3. The value of the hypothesis is low.

   4. The hypothesis is causational.

      ANS: A

      Hypotheses identify different types of relationships and numbers of variables. A well- formulated hypothesis clearly identifies the relationship between the variables. A hypothesis’s value is ultimately derived from whether it can be tested in the real world. A testable hypothesis is one that contains variables that can be measured or manipulated in the world.

      DIF: Cognitive Level: Synthesis REF: Page 144

5. A stimulus or activity that is measured to examine the effect created by the independent variable best describes a(n) variable.

   1. Independent

   2. Demographic

   3. Extraneous

   4. Dependent

      ANS: D

      In quantitative research, the independent variable (intervention, treatment, or experimental variable) is manipulated or varied by the researcher to cause an effect on the dependent variable. The dependent variable (response or outcome variable) is measured to examine the effect created by the independent variable. An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable. A dependent variable is the response behavior or outcome that the researcher wants to predict or explain. Extraneous variables exist in all studies and can affect the measurement of study variables and the relationships among them. Extraneous variables are of primary concern in quantitative studies, because they can obscure one’s understanding of the relational or causal dynamics within the studies. Demographic variables are attributes of the subjects that are measured during the study and used to describe the sample.

      DIF: Cognitive Level: Comprehension REF: Page 145

6. The intervention that the researcher manipulates is the variable.

   1. Independent

   2. Demographic

   3. Extraneous

   4. Dependent

      ANS: A

      In quantitative research, the independent variable (intervention, treatment, or experimental variable) is manipulated or varied by the researcher to cause an effect on the dependent variable. The dependent variable (response or outcome variable) is measured to examine the effect created by the independent variable. An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable. A dependent variable is the response behavior or outcome that the researcher wants to predict or explain. Extraneous variables exist in all studies and can affect the measurement of study variables and the relationships among them. Extraneous variables are of primary concern in quantitative studies, because they can obscure one’s understanding of the relational or causal dynamics within the studies. The extraneous variables that are not recognized until the study is in process or are recognized before the study is initiated but cannot be controlled are referred to as confounding variables. Demographic variables are attributes of the subjects that are measured during the study and used to describe the sample.

      DIF: Cognitive Level: Comprehension REF: Page 145

7. It is important for the researcher to identify extraneous variables so that

   1. All of the extraneous variables can be manipulated by the researcher.

   2. The findings can be explained as clearly and truthfully as possible.

   3. The research results are not critiqued unfairly.

   4. The extraneous variables have no influence on the dependent variable.

      ANS: B

      Extraneous variables exist in all studies and can affect the measurement of study variables and the relationships among them. Extraneous variables are of primary concern in quantitative studies, because they can obscure one’s understanding of the relational or causal dynamics within the studies. Extraneous variables are classified as (1) recognized or unrecognized and

      (2) controlled or uncontrolled. The extraneous variables that are not recognized until the study is in process or are recognized before the study is initiated but cannot be controlled are referred to as confounding variables. Sometimes these variables can be measured during the study and controlled statistically during analysis. In other cases, it is not possible to measure a confounding variable, and the variable thus hinders the interpretation of findings. Such extraneous variables must be identified as limitations or areas of study weakness in the discussion section of a research report.

      DIF: Cognitive Level: Analysis REF: Page 152

8. Simple descriptive statistics may be used to depict the sample characteristics, reflecting demographic variable values, in which kind of research?

   1. Quantitative research only

   2. Qualitative research only

   3. Both quantitative and qualitative research

   4. Only when data has been extracted from an electronic database

      ANS: C

      Demographic variables are attributes of the subjects that are measured during the study and used to describe the sample. Demographic variables are presented as the sample characteristics, using simple descriptive statistics such as frequency and percentage, in both quantitative and qualitative research.

      DIF: Cognitive Level: Application REF: Page 154

9. In the following hypothesis, what is the independent variable?

   Patients with recurrent bowel obstruction due to Crohn’s disease who are assigned to be treated in an emergency room complain less frequently of pain and require less pain medication than those patients admitted, in the usual fashion, and treated on a medical floor.

   1. Bowel obstruction due to Crohn’s disease

   2. Place treated

   3. Number of complaints of pain

   4. Number of doses of pain medication

      ANS: B

      An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable. The independent variable is also called an intervention, treatment, or experimental variable. In this example, place treated (emergency room versus medical floor) is the independent variable.

      DIF: Cognitive Level: Application REF: Page 145

10. In the following purpose statement, what kind of variable is number of days absent from class?

    The purpose of this study was to examine the effects of a generous weekly allowance and twice-weekly text messages from parents on number of days absent from class, in freshman college students.

    1. Demographic variable

    2. Independent variable

    3. Extraneous variable

    4. Dependent variable

       ANS: D

       A dependent variable is the response behavior, or outcome that the researcher wants to predict or explain. In this example, number of days absent from class is the dependent variable. An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable. The independent variable is also called an intervention, treatment, or experimental variable. Demographic variables are attributes of the subjects that are measured during the study and used to describe the sample. Extraneous variables exist in all studies and can affect the measurement of study variables and the relationships among them.

       DIF: Cognitive Level: Application REF: Page 145

11. The following statement is an example of which of the following?

    There is no measurable difference in incidence of incarceration for adolescent children whose mothers work outside the home in comparison with those whose mothers do not work outside the home.

    1. Null hypothesis

    2. Confounding variable

    3. Research objective

    4. Research question

       ANS: A

       A hypothesis is a formal statement of the expected relationship or relationships between two or more variables in a specified population. The null hypothesis, also referred to as a statistical hypothesis, is used for statistical testing and interpretation of statistical outcomes. The null hypothesis can be simple or complex and associative or causal. The null hypothesis states that there is no relationship between two or more variables. Extraneous variables exist in all studies and can affect the measurement of study variables and the relationships among them. The extraneous variables that are not recognized until the study is in process, or that are recognized before the study is initiated but cannot be controlled, are referred to as confounding variables. Research objectives are clear, concise, declarative statements that are expressed in the present tense, focus on one or two variables (or concepts), and indicate whether the variables are to be identified or described. A research question is a concise, interrogative statement that is worded in the present tense and includes one or more variables (or concepts).

       DIF: Cognitive Level: Application REF: Page 142

12. In the following hypothesis, what is the dependent variable?

    There is no measurable difference in incidence of acne in 15-year-olds who are placed on a chocolate-free diet.

    1. Fifteen-year-olds

    2. No chocolate in the diet

    3. Chocolate in the diet

    4. Acne

       ANS: D

       A dependent variable is the response behavior or outcome that the researcher wants to predict or explain. An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable. In this example, acne is the dependent variable and removal of chocolate from the diet is the independent variable.

       DIF: Cognitive Level: Application REF: Page 151

13. What is the relationship between a conceptual definition and an operational definition?

    1. The conceptual definition provides information; the operational definition provides none.

    2. The conceptual definition is concrete, and the operational definition is abstract.

    3. They are the same, in most instances.

    4. The operational definition allows the researcher to create a measurable variable from a concept; the conceptual definition does not.

       ANS: D

       Operationalizing a variable or a concept involves developing conceptual and operational definitions. A conceptual definition provides the theoretical meaning of a concept or variable. The conceptual definition provides a basis for formulating an operational definition. An operational definition is derived from a set of procedures and progressive acts that a researcher performs either to manipulate an independent variable or to measure the existence or degree of existence of the dependent variable.

       DIF: Cognitive Level: Synthesis REF: Page 155

14. In the following research question, what is the independent variable?

    Can diabetics on oral antiglycemic medications achieve better control of blood sugar, as measured by Hgb A1C, if they are taught to meditate and do this on a daily basis?

    1. Oral antiglycemic medications

    2. Hgb A1C

    3. Meditation

    4. Blood sugar

ANS: C

An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable. The independent variable is also called an intervention, treatment, or experimental variable. In this example, nausea and vomiting are dependent variables and guided imagery and relaxation techniques are independent variables.

DIF: Cognitive Level: Application REF: Page 145

MULTIPLE RESPONSE

1. Which of the following are the research variables in this study? (Select all that apply.)

   1. Patient age

   2. Verbal skills

   3. Homelessness

   4. Parental presence

   5. Fear of separation from parents

   6. Whether or not a child is homeless

   7. Length of hospital stay

      ANS: B, E, G

      Research variables or concepts are the qualities, properties, or characteristics that are measured in qualitative studies and selected quantitative studies. Concrete concepts, such as temperature, weight, and blood pressure, are referred to as variables in a study; abstract concepts, such as creativity, empathy, and social support, are sometimes referred to as research concepts.

      DIF: Cognitive Level: Application REF: Page 151

2. Which of the following could be a dependent variable in an experimental study? (Select all that apply.)

   1. Medication A

   2. The number of times the gerbil rings the bell

   3. Quality of life

   4. The number of times the subject is instructed in how to use the experimental equipment

   5. Vomiting

      ANS: B, C, E

      A dependent variable is the response behavior, or outcome that the researcher wants to predict or explain. An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable.

      DIF: Cognitive Level: Synthesis REF: Page 151

3. Which of the following could be an independent variable in an experimental study? (Select all that apply.)

   1. Quality of life

   2. The percentage of moisture in the inspired air the subject breathes

   3. The researcher’s preference for quantitative versus qualitative methodologies

   4. Wearing a hat with a large brim

   5. Seizure activity during the experiment

      ANS: B, D

      An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable. The independent variable is also called an intervention, treatment, or experimental variable. A dependent variable is the response behavior, or outcome that the researcher wants to predict or explain.

      DIF: Cognitive Level: Analysis REF: Page 151

4. Which of the following are operational definitions? (Select all that apply.)

   1. Length of smoking cessation is the subject’s statement of how long it has been since the subject last smoked tobacco.

   2. Pain is whatever the patient says it is, whenever the patient says it is (Margo McCaffrey).

   3. Imagination is the ability to see what will be, not what is.

   4. Startle is the distance the research subject moves when a puppet tarantula is dropped into his field of view, in front of a computer screen.

   5. Nausea is the number the subject provides, on a 0- to 10-point numerical scale, in response to being asked how nauseated the subject is.

      ANS: A, D, E

      An operational definition is derived from a set of procedures and progressive acts that a researcher performs either to manipulate an independent variable or to measure the existence or degree of existence of the dependent variable.

      DIF: Cognitive Level: Application REF: Page 155

5. Which of the following could be a research question? (Select all that apply.)

   1. What does postoperative vomiting feel like, to research subjects?

   2. How is hypnosis related to smoking cessation?

   3. In an English course, how do grading, praise, practice, submitting papers for publication, and writing skills interact?

   4. What are the differences between clients with pre-op orientation and those without, in terms of procedural anxiety?

   5. How does the researcher define loneliness?

      ANS: A, B, C, D

      Research questions meet the following criteria: (1) the identification and/or description of the variable(s), (2) a determination of differences between two or more groups regarding selected variables, (3) an examination of relationships among variables (relational), and (4) the use of independent variables to predict a dependent variable.

      DIF: Cognitive Level: Application REF: Page 140

6. Martha wants to know what happens when she fries bacon in a frying pan, versus microwaving it: does the bacon end up moister and more flavorful when fried, or when microwaved? What are the dependent variables? (Select all that apply.)

   1. Frying bacon

   2. Microwaving bacon

   3. Consistent cooking temperature

   4. Variable cooking temperature

   5. Moistness of bacon

   6. Kitchen burns

   7. Flavor of bacon

      ANS: E, G

      A dependent variable is the response behavior, or outcome that the researcher wants to predict or explain. An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable. In this example, whether the bacon ends up moister and more flavorful is the dependent variable and method of cooking is the independent variable.

      DIF: Cognitive Level: Application REF: Page 145

7. Ralph is an experimental psychologist. He studies rat behavior. He runs rats through a maze, under different scent conditions. At the end of the maze is cheese. Sometimes the maze is lit, and sometimes it is dark. During each run, the rates are subjected to different scents (cat pheromone, the smell of cheddar cheese, tiger pheromone, the smell of rat feces) at crucial decision-points in the maze. Ralph measures the time it takes the rats to finish the maze. Which of the following could be considered independent variables in this study? (Select all that apply.)

   1. The rats

   2. Light versus dark

   3. Ralph

   4. The amount of time the rats take to finish the maze

   5. The scents

   6. The cheese at the end of the maze

   7. Rat behavior

      ANS: B, E

      An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable. The independent variable is also called an intervention, treatment, or experimental variable. In this example, how long in seconds it takes the rats to run through the maze is the dependent variables and different scents are independent variables; light versus dark are the two experimental conditions, and these could also affect the outcome, so they could also be considered independent variables.

      DIF: Cognitive Level: Application REF: Page 145

8. What type of hypothesis is the following? (Select all that apply.)

   Increased intake of dietary fiber in elders and increased fluid intake are associated with fewer episodes of diverticulitis?

   1. Simple hypothesis

   2. Complex hypothesis

   3. Causal hypothesis

   4. Associative hypothesis

   5. Nondirectional hypothesis

   6. Directional hypothesis

      ANS: B, D, F

      A hypothesis is a formal statement of the expected relationship or relationships between two or more variables in a specified population. A simple hypothesis predicts the relationship (associative or causal) between two variables. A complex hypothesis predicts the relationship (associative or causal) among three or more variables. The relationships identified in hypotheses are associative or causal. An associative relationship identifies variables that occur or exist together in the real world. Causal relationships identify a cause-and-effect interaction between two or more variables. A nondirectional hypothesis states that a relationship exists but does not predict the nature of the relationship. A directional hypothesis states the nature or direction of the relationship between two or more variables.

      DIF: Cognitive Level: Analysis REF: Page 142

9. What type of hypothesis is the following? (Select all that apply.)

   Taking lessons to learn how to play bridge, and weekly practice in playing bridge, have an effect on beginning bridge players’ win-loss ratio.

   1. Simple hypothesis

   2. Complex hypothesis

   3. Causal hypothesis

   4. Associative hypothesis

   5. Nondirectional hypothesis

   6. Directional hypothesis

      ANS: B, C, E

      A hypothesis is a formal statement of the expected relationship or relationships between two or more variables in a specified population. A simple hypothesis predicts the relationship (associative or causal) between two variables. A complex hypothesis predicts the relationship (associative or causal) among three or more variables. The relationships identified in hypotheses are associative or causal. An associative relationship identifies variables that occur or exist together in the real world. Causal relationships identify a cause-and-effect interaction between two or more variables. A nondirectional hypothesis states that a relationship exists but does not predict the nature of the relationship. A directional hypothesis states the nature or direction of the relationship between two or more variables.

      DIF: Cognitive Level: Analysis REF: Page 142

10. What type of hypothesis is the following? (Select all that apply.)

    Having one’s house and yard professionally sprayed yearly by an extermination service has an effect on infestations of common garden ants.

    1. Simple hypothesis

    2. Complex hypothesis

    3. Causal hypothesis

    4. Associative hypothesis

    5. Nondirectional hypothesis

    6. Directional hypothesis

       ANS: A, C, E

       A hypothesis is a formal statement of the expected relationship or relationships between two or more variables in a specified population. A simple hypothesis predicts the relationship (associative or causal) between two variables. A complex hypothesis predicts the relationship (associative or causal) among three or more variables. The relationships identified in hypotheses are associative or causal. An associative relationship identifies variables that occur or exist together in the real world. Causal relationships identify a cause-and-effect interaction between two or more variables. A nondirectional hypothesis states that a relationship exists but does not predict the nature of the relationship. A directional hypothesis states the nature or direction of the relationship between two or more variables.

       DIF: Cognitive Level: Analysis REF: Page 142

11. What type of hypothesis is the following? (Select all that apply.)

    Providing early written feedback to undergraduate nursing students in the clinical setting increases the incidence of desired behaviors of safe medication administration, work efficiency, accurate charting, and competent time management.

    1. Simple hypothesis

    2. Complex hypothesis

    3. Causal hypothesis

    4. Associative hypothesis

    5. Nondirectional hypothesis

    6. Directional hypothesis

       ANS: A, C, F

       A hypothesis is a formal statement of the expected relationship or relationships between two or more variables in a specified population. A simple hypothesis predicts the relationship (associative or causal) between two variables. A complex hypothesis predicts the relationship (associative or causal) among three or more variables. The relationships identified in hypotheses are associative or causal. An associative relationship identifies variables that occur or exist together in the real world. Causal relationships identify a cause-and-effect interaction between two or more variables. A nondirectional hypothesis states that a relationship exists but does not predict the nature of the relationship. A directional hypothesis states the nature or direction of the relationship between two or more variables.

       DIF: Cognitive Level: Analysis REF: Page 142

12. What type of hypothesis is the following? (Select all that apply.)

    Number of hours spent daily playing video games is negatively related to student achievement in high school history class.

1. Simple hypothesis

2. Complex hypothesis

3. Causal hypothesis

4. Associative hypothesis

5. Nondirectional hypothesis

6. Directional hypothesis

   ANS: A, D, F

   A hypothesis is a formal statement of the expected relationship or relationships between two or more variables in a specified population. A simple hypothesis predicts the relationship (associative or causal) between two variables. A complex hypothesis predicts the relationship (associative or causal) among three or more variables. The relationships identified in hypotheses are associative or causal. An associative relationship identifies variables that occur or exist together in the real world. Causal relationships identify a cause-and-effect interaction between two or more variables. A nondirectional hypothesis states that a relationship exists but does not predict the nature of the relationship. A directional hypothesis states the nature or direction of the relationship between two or more variables.

   DIF: Cognitive Level: Analysis REF: Page 142

• What type of hypothesis is the following? (Select all that apply.)

  The number of children in the home is associated with noise level in that home, and with parental stress.

  1. Simple hypothesis

  2. Complex hypothesis

  3. Causal hypothesis

  4. Associative hypothesis

  5. Nondirectional hypothesis

  6. Directional hypothesis

     ANS: B, D, E

     A hypothesis is a formal statement of the expected relationship or relationships between two or more variables in a specified population. A simple hypothesis predicts the relationship (associative or causal) between two variables. A complex hypothesis predicts the relationship (associative or causal) among three or more variables. The relationships identified in hypotheses are associative or causal. An associative relationship identifies variables that occur or exist together in the real world. Causal relationships identify a cause-and-effect interaction between two or more variables. A nondirectional hypothesis states that a relationship exists but does not predict the nature of the relationship. A directional hypothesis states the nature or direction of the relationship between two or more variables.

     DIF: Cognitive Level: Analysis REF: Page 142

• What type of hypothesis is the following? (Select all that apply.)

  The number of minutes a 16-year-old girl spends applying her makeup in the morning is related to her perceived personal attractiveness.

  1. Simple hypothesis

  2. Complex hypothesis

  3. Causal hypothesis

  4. Associative hypothesis

  5. Nondirectional hypothesis

  6. Directional hypothesis

     ANS: A, D, E

     A hypothesis is a formal statement of the expected relationship or relationships between two or more variables in a specified population. A simple hypothesis predicts the relationship (associative or causal) between two variables. A complex hypothesis predicts the relationship (associative or causal) among three or more variables. The relationships identified in hypotheses are associative or causal. An associative relationship identifies variables that occur or exist together in the real world. Causal relationships identify a cause-and-effect interaction between two or more variables. A nondirectional hypothesis states that a relationship exists but does not predict the nature of the relationship. A directional hypothesis states the nature or direction of the relationship between two or more variables.

     DIF: Cognitive Level: Analysis REF: Page 142

• What type of hypothesis is the following? (Select all that apply.)

  Decreasing the time allotted for weekly in-class pop quizzes increases student anxiety and decreases student grades.

  1. Simple hypothesis

  2. Complex hypothesis

  3. Causal hypothesis

  4. Associative hypothesis

  5. Nondirectional hypothesis

  6. Directional hypothesis

ANS: B, C, F

A hypothesis is a formal statement of the expected relationship or relationships between two or more variables in a specified population. A simple hypothesis predicts the relationship (associative or causal) between two variables. A complex hypothesis predicts the relationship (associative or causal) among three or more variables. The relationships identified in hypotheses are associative or causal. An associative relationship identifies variables that occur or exist together in the real world. Causal relationships identify a cause-and-effect interaction between two or more variables. A nondirectional hypothesis states that a relationship exists but does not predict the nature of the relationship. A directional hypothesis states the nature or direction of the relationship between two or more variables.

DIF: Cognitive Level: Analysis REF: Page 142

Chapter 9: Ethics in Research Test Bank

MULTIPLE CHOICE

1. A research study offers elderly men who have, in the past, been prison inmates $1,500 for participation in an all-day workshop at which they agree to be hypnotized and tell stories of incarceration, which are later published. The research participants are allowed to listen to the tapes of what they say under hypnosis and to withdraw permission to use any part of the information. Why is this scenario a violation of self-determination?

   1. Allowing participants to withdraw permission to use part of the research information violates the study integrity and represents deception.

   2. It is an example of coercion.

   3. Prisoners are a vulnerable population and should not be used as research subjects.

   4. What is said under hypnosis may not be true.

      ANS: B

      The right to self-determination is based on the ethical principle of respect for persons. This principle holds that because humans are capable of self-determination, or controlling their own destiny, they should be treated as autonomous agents who have the freedom to conduct their lives as they choose without external controls. A subject’s right to self-determination can be violated through the use of (1) coercion, (2) covert data collection, and (3) deception.

      Coercion occurs when an overt threat of harm or excessive reward is intentionally presented by one person to another to obtain his or her compliance. In the example, offering elderly men

      $1,500 for one day could be considered offering an excessive reward: therefore, it is an act of coercion violating the human right to self-determination.

      DIF: Cognitive Level: Analysis REF: Page 164

2. A researcher working for Google collects data on fair treatment in the workplace. He attempts to attach one of the raw data forms to a message to himself, so that he can finish the data analysis at home that evening, but accidentally sends it to another employee who had provided data for the study. The two employees, coincidentally, have an identical opinion about fair treatment in the workplace. This best describes an example of a violation of which of the following human rights?

   1. Confidentiality

   2. Fair treatment

   3. Protection from harm

   4. None of these—no ethical violation occurred, because the two subjects share a point of view.

      ANS: A

      Confidentiality is the researcher’s management of private information shared by a subject that must not be shared with others without the authorization of the subject. In the example, sending one research subject the raw data of a different subject is a direct breach of confidentiality. A breach in confidentiality can occur when a researcher, by accident or direct action, allows an unauthorized person to gain access to raw study data. The right to fair treatment is based on the ethical principle of justice. This principle holds that each person should be treated fairly and should receive what he or she is due or owed. The right to protection from discomfort and harm is based on the ethical principle of beneficence, which holds that one should do good and, above all, do no harm.

      DIF: Cognitive Level: Application REF: Page 172

3. In a study of outpatients experiencing panic attacks, a researcher was working in a busy clinic waiting room and left his computer to consent a new study participant. A transcription of a patient interview was displayed, and at the end of the transcription was the patient’s medical record number and a list of medications currently taken. The researcher had not closed down the screen, and when he returned to his computer, he found an adult patient playing a video game on the computer. This best describes an example of a violation of which of the following human rights?

   1. Protection from the harm of exposure

   2. Security

   3. Confidentiality

   4. Privacy

      ANS: D

      Privacy is an individual’s right to determine the time, extent, and general circumstances under which personal information will be shared with or withheld from others. This information consists of one’s attitudes, beliefs, behaviors, opinions, and records. The Privacy Act of 1974 provided the initial protection of an individual’s privacy. Because of this act, data collection methods were to be scrutinized to protect subjects’ privacy, and data cannot be gathered from subjects without their knowledge. Individuals also have the right to access their records and to prevent access by others. The intent of this act was to prevent the invasion of privacy that occurs when private information is shared without an individual’s knowledge or against his or her will. Invading an individual’s privacy might cause loss of dignity, friendships, or employment or create feelings of anxiety, guilt, embarrassment, or shame. The HIPAA Privacy Rule expanded the protection of an individual’s privacy, specifically his or her protected individually identifiable health information, and described the ways in which covered entities can use or disclose this information. De-identifying health data involves removing 18 elements that could be used to identify an individual. An important one on this list is the individual’s medical record number. In the example, the researcher’s use of an actual patient identification number on a transcription risks the human right to privacy; a code number should have been used instead.

      DIF: Cognitive Level: Application REF: Page 169

4. Ellen is a participant in a research study. She will receive either the customary medication to treat her metastatic colon cancer or a new medication that has shown better results in animal studies and one small human study. This is research.

   1. Coercive

   2. Correlational

   3. Therapeutic

   4. Dangerous

      ANS: C

      Therapeutic research gives the patient an opportunity to receive an experimental treatment that might have beneficial results. Nontherapeutic research is conducted to generate knowledge for a discipline, and the results from the study might benefit future patients but will probably not benefit those acting as research subjects. The Declaration of Helsinki differentiated therapeutic research from nontherapeutic research. Neither descriptive nor correlational research involves treatment or manipulation of a variable. There is no evidence of coercion.

      DIF: Cognitive Level: Application REF: Page 160

5. A graduate student receives a mailed survey asking her to participate in research about unpleasant experiences in graduate school. She is asked to return the survey, and the instructions say, “Return of this instrument implies consent.” Why does this constitute consent?

   1. Studies like this are exempt from institutional review board oversight, so consent is not required.

   2. Not returning the survey constitutes refusal, and subjects may indeed refuse by not completing the survey. The opposite is equally true.

   3. The study is anonymous, so there is no risk of disclosure.

   4. Only interventional research requires consent.

      ANS: B

      The requirements for written consent may be waived in research that “presents no more than minimal risk of harm to subjects and involves no procedures for which written consent is normally required outside of the research context.” For example, if questionnaires are used to collect relatively harmless data, a signed consent form from the subjects would not be required. The subject’s completion of the questionnaire may serve as consent. The top of the questionnaire might contain a statement such as “Your completion of this questionnaire indicates your consent to participate in this study.”

      DIF: Cognitive Level: Analysis REF: Page 180

6. Both a subject in an experimental group who receives an experimental treatment and a subject in a control group who receives a control treatment are considered to be subjects in therapeutic research. Why is this?

   1. A patient in an experimental research study who elects to be a member of the experimental group knows he or she will be receiving the experimental treatment.

   2. Each patient who is consented to be a research subject in an experimental study in which the treatment has potentially beneficial results has the potential to receive a therapeutic intervention.

   3. The research is designed to measure the effect of the therapeutic treatment as compared with the usual therapeutic treatment; hence, this is therapeutic research.

   4. Each subject is blind to treatment.

      ANS: C

      Therapeutic research gives the patient an opportunity to receive an experimental treatment that might have beneficial results. In experimental research this means only that the subject is recruited into the study and randomly assigned to either a treatment or control group, not that the subject receives the experimental treatment.

      DIF: Cognitive Level: Evaluation REF: Page 160

7. In what way could the researchers in the Willowbrook study have designed their research on the hepatitis virus so that it was ethically acceptable?

   1. The researchers could have given each participant a chance to assent.

   2. The researchers could have performed their study on persons who were capable of full assent.

   3. The researchers could have made the study available at many institutions for the mentally retarded.

   4. The researchers could have performed descriptive research on persons already infected with hepatitis.

      ANS: D

      From the mid-1950s to the early 1970s, research on hepatitis was conducted by Dr. Krugman at Willowbrook, an institution for the mentally retarded. The subjects, all children, were deliberately infected with the hepatitis virus. During the 20-year study, Willowbrook closed its doors to new inmates because of overcrowded conditions. However, the research ward continued to admit new inmates. To gain their child’s admission to the institution, the parents were forced to give permission for the child to be a subject in the study. Because, the principal of beneficence requires the researcher to do good and “above all, do no harm,” the only way to study a virus that clearly harms people is non-interventionally: through descriptive or correlational research.

      DIF: Cognitive Level: Synthesis REF: Page 161

8. The right an individual has to be told that he is a potential participant in a research study and may decide not to be so best defines which of the following human rights?

   1. Beneficence

   2. Justice

   3. Privacy

   4. Self-determination

      ANS: D

      The right to self-determination holds that because humans are capable of self-determination, or controlling their own destiny, they should be treated as autonomous agents who have the freedom to conduct their lives as they choose without external controls. Privacy is an individual’s right to determine the time, extent, and general circumstances under which personal information will be shared with or withheld from others. Justice holds that each person should be treated fairly and should receive what he or she is due or owed. The right to protection from discomfort and harm is based on the ethical principle of beneficence, which holds that one should do good and, above all, do no harm.

      DIF: Cognitive Level: Application REF: Page 162

9. The right an individual has to receive treatment even if he decides not to participate in the research best defines which of the following human rights?

   1. Beneficence

   2. Justice

   3. Privacy

   4. Respect

      ANS: B

      The right to fair treatment is based on the ethical principle of justice. Privacy is the right an individual has to determine the time, extent, and general circumstances under which personal information will be shared or withheld from others. Such information consists of one’s attitudes, beliefs, behaviors, opinions, and records. The right to protection from discomfort and harm is based on the ethical principle of beneficence, which holds that one should do good and, above all, do no harm. The right to self-determination is based on the ethical principle of respect for persons.

      DIF: Cognitive Level: Application REF: Page 164

10. To take positive action to prevent any harm to the research subjects best defines which of the following principles?

    1. Beneficence

    2. Justice

    3. Privacy

    4. Respect

       ANS: A

       The right to protection from discomfort and harm is based on the ethical principle of beneficence, which holds that one should do good and, above all, do no harm. This includes positive actions taken to prevent harm to research subjects. Privacy is the right an individual has to determine the time, extent, and general circumstances under which personal information will be shared or withheld from others. Such information consists of one’s attitudes, beliefs, behaviors, opinions, and records. The right to fair treatment is based on the ethical principle of justice. The right to self-determination is based on the ethical principle of respect for persons.

       DIF: Cognitive Level: Comprehension REF: Page 164

11. An institutional review board (IRB) ensures that (1) the rights and welfare of the individuals involved were protected, (2) the appropriate methods were used to secure informed consent, and (3) the potential benefits of the investigation were greater than the risks. Which of the following is an example of how an IRB determines the level of potential risk?

    1. It requires the researcher to provide a list of potential benefits to the clients, as well as the results of a pilot study verifying this.

    2. It compels the researcher to disclose his consenting process.

    3. It provides for a supervisor from the IRB to be present for all data collection.

    4. It reviews the researcher’s description of the study’s potential risks and compares them with everyday risk.

       ANS: D

       The functions and operations of an IRB involve the review of research at three different levels: (1) exempt from review, (2) expedited review, and (3) complete review. The level of the review required for each study is decided by the IRB chairperson and/or committee, not by the researcher, based on information provided by the researcher. Studies are usually exempt from review if they pose no apparent risks for the research subjects. Studies that have some risks, which are viewed as minimal, are expedited in the review process.

       DIF: Cognitive Level: Synthesis REF: Page 183

12. A researcher who is also a university professor is performing a multi-site study in which on- site interviews are conducted with nurses in five hospitals in a major city. Each hospital has an institutional review board (IRB). From how many IRBs or committees must the researcher obtain permission to conduct the study?

    1. Six: each of the five hospitals, and the university

    2. One: only the university

    3. Five: only the hospitals

    4. None: educational research is exempt from review

       ANS: A

       Universities and healthcare agencies have IRBs that function in a similar way to review research following federal regulations. If both a university and a hospital, or if more than one hospital, should be involved in a research study, both IRBs must give permission for the study to be conducted. This poses significant expenditure of time for such research.

       DIF: Cognitive Level: Application REF: Page 183

13. What specific area of ethics does HIPAA address?

    1. Privacy

    2. Justice

    3. Coercion to participate in a research study

    4. Informed consent

       ANS: A

       The Health Insurance Portability and Accountability Act (HIPAA) was implemented in 2003 to protect an individual’s health information. The U.S. DHHS developed regulations titled the Standards for Privacy of Individually Identifiable Health Information, and compliance with these regulations is known as the Privacy Rule.

       DIF: Cognitive Level: Comprehension REF: Page 159

14. A researcher is applying for renewal of a large federal grant, without which his very promising research on panic disorder cannot continue. He is completing renewal forms, which include a synopsis of his results to date. If he excludes two of the subjects with very severe panic disorder, and three with mental health disorders of another kind, the results are statistically significant. He writes the report and does not mention the five subjects he excluded. This is an instance of which of the following?

    1. Beneficence

    2. Fabrication

    3. Falsification

    4. Plagiarism

       ANS: C

       Fabrication in research is the making up of results and recording or reporting them. Falsification of research is manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record. Plagiarism is the appropriation of another person’s ideas, processes, results, or words without giving appropriate credit, including those obtained through confidential review of others’ research proposals and manuscripts. The principle of beneficence requires the researcher to do good and “above all, do no harm.”

       DIF: Cognitive Level: Application REF: Page 188

15. A researcher is applying for a grant renewal on the subject of a promising new treatment for liver cancer. His research group has used the treatment for 13 subjects. The results—9 responded and 4 did not—are not statistically significant. However, if the researcher entered each patient as three different people and reported the results as 27 responded and 12 did not, the results would be statistically significant. If he chose to do this, what would it represent?

    1. Beneficence

    2. Fabrication

    3. Falsification

    4. Plagiarism

       ANS: B

       Fabrication in research is the making up of results and recording or reporting them. Falsification of research is manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record. Plagiarism is the appropriation of another person’s ideas, processes, results, or words without giving appropriate credit, including those obtained through confidential review of others’ research proposals and manuscripts. The principle of beneficence requires the researcher to do good and “above all, do no harm.”

       DIF: Cognitive Level: Application REF: Page 188

16. A master’s student knows next to nothing about Maslow’s theory related to hierarchy of needs but, on her advisor’s recommendation, decides to use it as a theoretical framework for her thesis. The student goes to the library and accesses an old master’s thesis that also uses the theory and copies three pages, word for word. She uses the other student’s reference to Maslow’s work. This is an example of which of the following?

    1. Nonmaleficence

    2. Fabrication

    3. Falsification

    4. Plagiarism

       ANS: D

       Plagiarism is the appropriation of another person’s ideas, processes, results, or words without giving appropriate credit, including those obtained through confidential review of others’ research proposals and manuscripts. Fabrication in research is the making up of results and recording or reporting them. Falsification of research is manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record. The principle of beneficence requires the researcher to do good and “above all, do no harm.”

       DIF: Cognitive Level: Application REF: Page 188

17. A master’s student knows next to nothing about Maslow’s theory related to hierarchy of needs but, on her advisor’s recommendation, decides to use it as a theoretical framework for her thesis. The student goes online and finds a Wikipedia page and copies the description of Maslow’s theory verbatim, putting a citation at the end of the paragraph but not using quotation marks. This is an example of which of the following?

    1. Nonmaleficence

    2. Fabrication

    3. Falsification

    4. Plagiarism

       ANS: D

       Plagiarism is the appropriation of another person’s ideas, processes, results, or words without giving appropriate credit, including those obtained through confidential review of others’ research proposals and manuscripts. Fabrication in research is the making up of results and recording or reporting them. Falsification of research is manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record. The principle of beneficence requires the researcher to do good and “above all, do no harm.”

       DIF: Cognitive Level: Application REF: Page 188

18. A researcher receives permission to use the information in a hospital data set, without patient identifiers. What level of subject consent is required?

    1. Partial: the subjects must all be notified that their data is being re-used.

    2. None.

    3. Partial: the subjects must all be notified if the results are published.

    4. Full: all subjects must be contacted and must agree to have their data used.

       ANS: B

       Covered entities (healthcare provider, health plan, and healthcare clearinghouse) may use and disclose a limited data set to a researcher for a study without an individual subject’s authorization or an IRB waiver.

       DIF: Cognitive Level: Comprehension REF: Page 170

19. A researcher is applying for institutional review board (IRB) approval, and the form specifies that the researcher indicate the probable level of risk. The research creates situations in which the RN research subjects are placed in unusual code-like situations in which they do not know what action to take, and actors play the parts of other healthcare providers. The RN subjects are then asked to describe their feelings and their levels of confidence as they go through 15 scenarios. What level of risk does this study pose?

    1. No anticipated effects

    2. Temporary discomfort

    3. Unusual discomfort

    4. Risk of permanent harm

       ANS: B

       Studies that cause temporary discomfort are described as minimal-risk studies, in which the discomfort encountered is similar to what the subject would experience in his or her daily life and ceases with the termination of the study. Many nursing studies require the subjects to complete questionnaires or participate in interviews, which usually involve minimal risk. The physical discomforts might be fatigue, headache, or muscle tension. The emotional and social risks might entail the anxiety or embarrassment associated with responding to certain questions. The economic risks might consist of the time spent participating in the study or travel costs to the study site. Participation in many nursing studies is considered a mere inconvenience for the subject, with no foreseeable risks of harm. Most clinical nursing studies examining the impact of a treatment involve minimal risk.

       DIF: Cognitive Level: Comprehension REF: Page 174

20. Dr. Adamson is conducting research on a new and promising chemotherapy treatment for breast cancer that improves survival and decreases adverse symptoms. Sixty subjects will be recruited; of these, thirty will be assigned to the experimental group, receiving the new treatment, and thirty to the control group, receiving the usual chemotherapy. His wife, newly diagnosed with breast cancer, is randomly assigned to the treatment group; he removes her from the treatment group and places her in the experimental group. What ethical violation has occurred?

    1. Mrs. Adamson has a right to self-determination: her husband has decided her group assignment for her.

    2. Mrs. Adamson’s husband has no right to know about her breast cancer: this is a violation of confidentiality.

    3. Mrs. Adamson shouldn’t be a member of the study: it’s a conflict of interest.

    4. Mrs. Adamson has no right to be included in the experimental group: it unfairly excludes someone else from this special benefit.

       ANS: D

       A concern with subject selection that is related to justice is that some researchers select certain people as subjects because they like them and want them to receive the specific benefits of a study. Other researchers have been swayed by power or money to make certain individuals subjects so that they can receive potentially beneficial treatments. It is especially important in research not to show preference in assigning subjects. That is the benefit of random assignment: it is fair.

       DIF: Cognitive Level: Application REF: Page 173

21. From an ethical point of view, what is the point of determining that a potential research subject is incompetent?

    1. An incompetent subject must receive more extensive explanation before consenting to participate in research.

    2. According to HIPAA, a different level of records security must ensue.

    3. Inclusion of the subject necessitates a different consenting process.

    4. The researcher has a responsibility to exclude all incompetent persons from research participation.

       ANS: C

       Some persons have diminished autonomy or are vulnerable and less advantaged because of legal or mental incompetence, terminal illness, or confinement to an institution. These persons require additional protection of their right to self-determination, because they have a decreased ability, or an inability, to give informed consent. In addition, these persons are vulnerable to coercion and deception.

       DIF: Cognitive Level: Synthesis REF: Page 165

22. How would a professor who wants to have his students provide data for a research study go about achieving this without involving coercion?

    1. Mention that participation provides extra points.

    2. Have a research assistant consent all subjects and collect all data.

    3. Offer extra points to the whole class if 50% of them act as subjects.

    4. Open the study to all students on campus and provide a nonacademic incentive.

ANS: D

A subject’s right to self-determination can be violated through the use of (1) coercion, (2) covert data collection, and (3) deception. Coercion occurs when one person intentionally presents another with an overt threat of harm or the lure of excessive reward to obtain compliance. Sometimes students feel forced to participate in research to protect their grades or prevent negative relationships with the faculty conducting the research. They are being coerced.

DIF: Cognitive Level: Analysis REF: Page 164

MULTIPLE RESPONSE

1. Why are research ethics essential? (Select all that apply.)

   1. Research subjects must be protected from accidental disclosure of information.

   2. Institutional review boards exist to protect patient rights.

   3. Researcher misconduct may result in dissemination of potentially harmful results.

   4. Results published in professional journals represent a clear violation of privacy.

   5. Research subjects must be protected from deliberate violation of their rights.

      ANS: A, C, E

      Ethical research is essential to generate sound knowledge for practice. The ethical conduct of research has been a focus since the 1940s because of the mistreatment of human subjects in selected studies. Human rights are claims and demands that have been justified in the eyes of an individual or by the consensus of a group of individuals. Having rights is necessary for the self-respect, dignity, and health of an individual. The human rights that require protection in research are (1) self-determination, (2) privacy, (3) anonymity and confidentiality, (4) fair treatment, and (5) protection from discomfort and harm. Although institutional review boards exist to protect patient rights, this is not a reason that research ethics are essential. Results published in professional journals do not represent a violation of privacy if the researcher has attended to ethical mandates.

      DIF: Cognitive Level: Synthesis REF: Page 159

2. Why are vulnerable populations considered vulnerable and to what are they vulnerable? (Select all that apply.)

   1. Physical harm because of a preexistent mental or physical condition

   2. The possibility of being assigned to the experimental group

   3. Unethical researchers

   4. Coercion

   5. Diminished autonomy because of an impaired ability to consent

      ANS: A, D, E

      Some persons have diminished autonomy or are vulnerable and less advantaged because of legal or mental incompetence, terminal illness, or confinement to an institution. These persons require additional protection of their right to self-determination, because they have a decreased ability, or an inability, to give informed consent. In addition, these persons are vulnerable to coercion and deception. The U.S. DHHS has identified certain vulnerable groups of individuals, including pregnant women, human fetuses, neonates, children, mentally incompetent persons, and prisoners, who require additional protection in the conduct of research. Neonates are extremely vulnerable and require extra protection to determine their involvement in research. Some hospitalized patients are survivors of trauma (such as auto accidents, gunshot wounds, or physical and sexual abuse) who are very vulnerable and who often have decreased decision-making capacities. Sometimes students feel forced to participate in research to protect their grades or prevent negative relationships with the faculty conducting the research. Other subjects are coerced to participate in studies because they believe that they cannot refuse the excessive rewards offered, such as large sums of money, specialized health care, special privileges, and jobs.

      DIF: Cognitive Level: Analysis REF: Page 165

3. Which one of the following are considered vulnerable populations from an ethical point of view? (Select all that apply.)

   1. Students

   2. Persons with osteoporosis who are subject to hip fracture

   3. Persons who are depressed

   4. Prisoners

   5. Persons who have recently suffered loss of a spouse

      ANS: A, D

      Some persons have diminished autonomy or are vulnerable and less advantaged because of legal or mental incompetence, terminal illness, or confinement to an institution. These persons require additional protection of their right to self-determination, because they have a decreased ability, or an inability, to give informed consent. In addition, these persons are vulnerable to coercion and deception. The U.S. DHHS has identified certain vulnerable groups of individuals, including pregnant women, human fetuses, neonates, children, mentally incompetent persons, and prisoners, who require additional protection in the conduct of research. Sometimes students feel forced to participate in research to protect their grades or prevent negative relationships with the faculty conducting the research.

      DIF: Cognitive Level: Analysis REF: Page 165

4. A nurse plans to interview prisoners as part of her master’s thesis on treatment of health problems in correctional institutions. What special measures must she take before she studies these potential subjects? (Select all that apply.)

   1. Justify to an institutional review board why she must use prisoners as subjects.

   2. Devise a consent process that provides for a conservator’s signature.

   3. Destroy all of her records.

   4. Devise interview questions that avoid any mention of prisons or prisoners.

   5. Bracket her previous beliefs about prisoners.

   6. Assure that the consent process involves no coercion.

      ANS: A, F

      The U.S. DHHS has identified certain vulnerable groups of individuals, including pregnant women, human fetuses, neonates, children, mentally incompetent persons, and prisoners, who require additional protection in the conduct of research. Researchers need to justify their use of subjects with diminished autonomy in a study, and the need for justification increases as the subjects’ risk and vulnerability. Subjects with diminished autonomy may be subject to coercion.

      DIF: Cognitive Level: Analysis REF: Page 165

5. A researcher conducts a mixed-methods study on exercise as a modality of controlling hyperglycemia. The study has both quantitative results, describing the amount that glucose falls with various amounts of exercise, and qualitative results, describing participants’ mood and sense of well-being with different kinds of exercise. The researcher decides to publish an article based on the quantitative findings immediately but wait to publish the qualitative results later. What are the reasons that this would not be an instance of researcher misconduct? (Select all that apply.)

   1. The data from the quantitative part of the study are reported completely and honestly.

   2. The journal does not accept qualitative research.

   3. Both “arms” of the study are freestanding.

   4. Nobody will know that a qualitative study was performed.

   5. No denial of the full scope of data collection is made.

      ANS: A, C, E

      Research misconduct is defined as “the fabrication, falsification, or plagiarism in processing, performing, or reviewing research, or in reporting research results. It does not include honest error or differences in opinion.” Fabrication in research is the making up of results and recording or reporting them. Falsification of research is manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record. The data from this study were neither fabricated nor falsified; it is the researcher’s decision when to disseminate research results.

      DIF: Cognitive Level: Evaluation REF: Page 188

6. Which of the following represent a breach in confidentiality? (Select all that apply.)

   1. The teenaged son of a researcher reads some of the raw interview data on the researcher’s computer.

   2. The researcher accidentally includes the real names of one participant’s husband and two daughters in the finished article, instead of changing these to pseudonyms.

   3. A researcher presents her findings at a research conference.

   4. A tape of a research interview is misplaced in the researcher’s home and is never found.

   5. The researcher mentions to a colleague that all of the participants in a recent research project on anger were divorced women.

      ANS: A, B, D

      A breach of confidentiality can occur when a researcher, by accident or direct action, allows an unauthorized person to gain access to the study raw data. Confidentiality can also be breached in the reporting or publication of a study when a subject’s identity is accidentally revealed, violating the subject’s right to anonymity. Breaches of confidentiality can harm subjects psychologically and socially, as well as destroy the trust they had in the researchers. Breaches of confidentiality can be especially harmful to a research participant if they involve

      (1) religious preferences; (2) sexual practices; (3) employment; (4) racial prejudices; (5) drug use; (6) child abuse; and (7) personal attributes, such as intelligence, honesty, and courage.

      DIF: Cognitive Level: Comprehension REF: Page 172

7. An improvement in research ethics could prevent some or all of which of the following? (Select all that apply.)

   1. Breaches of anonymity

   2. Researchers’ failures to report their funding sources in publications

   3. Minimal risk to research participants

   4. Unauthorized data collection

   5. Patients’ inability to understand complex research designs

      ANS: A, B, D

      Ethical research is essential to generate sound knowledge for practice. The ethical conduct of research has been a focus since the 1940s because of the mistreatment of human subjects in selected studies. Human rights are claims and demands that have been justified in the eyes of an individual or by the consensus of a group of individuals. Having rights is necessary for the self-respect, dignity, and health of an individual. The human rights that require protection in research are (1) self-determination, (2) privacy, (3) anonymity and confidentiality, (4) fair treatment, and (5) protection from discomfort and harm. Although Institutional Review Boards exist to protect patient rights, this is not a reason that research ethics are essential.

      Results published in professional journals do not represent a violation of privacy, if the researcher has attended to ethical mandates.

      DIF: Cognitive Level: Synthesis REF: Page 159

8. In order for consent to be voluntary, which must occur? (Select all that apply.)

   1. The subject must sign a consent form.

   2. The subject cannot be mentally incompetent.

   3. The subject cannot be shamed, forced, or cajoled into participation.

   4. The subject cannot be paid (remunerated), because this would be coercive.

   5. The researcher must confirm that the person signing the consent form truly understands what the research will involve.

      ANS: C, E

      Voluntary consent means that the prospective subject has decided to take part in a study of his or her own volition without coercion or any unique influence. Voluntary consent is obtained after the prospective subject has been given essential information about the study and has shown comprehension of this information. In some studies, the consent form may be replaced by oral consent or the consent form may be used but the subject’s signature is waived. A person who is mentally incompetent or incapacitated may be a research subject, but his or her legal representative must consent for participation. If an individual is judged incompetent and incapable of consent, the researcher must seek approval from the prospective subject and his or her legally authorized representative. It is the researcher’s responsibility to confirm that the person signing the consent form truly understands what the research entails. Sometimes nursing studies have included a small financial reward of $10 to $30 or support for transportation to increase participation, but this would not be considered coercive.

      DIF: Cognitive Level: Analysis REF: Page 180

9. Which of these statements concerning guidelines for consenting children for research participation are true? (Select all that apply.)

   1. No infant or child may be used in research if he or she refuses treatment.

   2. Emancipated minors may consent for themselves.

   3. Coercion is wrong, but begging a child to participate is acceptable.

   4. An 11-year-old should be asked to assent for research participation.

   5. If infants and children participate in research, they should sign a consent form.

   6. Infants cannot refuse to participate in research if their parents consent.

      ANS: B, D, F

      The unique vulnerability of children makes the decision to include them as research subjects particularly important. To safeguard their interests and protect them from harm, special ethical and regulatory considerations have been put in place for research involving children.

      However, the laws defining the minor status of a child are statutory and vary from state to state. Often a child’s competency to consent is governed by age, with incompetence being nonrefutable up to age 7 years. Thus, a child younger than 7 years is not believed to be mature enough to assent or consent to research. A child 7 years or older with normal cognitive development can provide assent or dissent to participation in a study, and the process for obtaining the assent should be included in the research proposal. To obtain informed consent, federal regulations require both the assent of the children (when capable) and the permission of their parents or guardians. An infant is not capable of speech or of understanding the purpose of a research study.

      DIF: Cognitive Level: Synthesis REF: Page 166

10. The Tuskegee study was ethically objectionable because informed consent was flawed, an available treatment was not provided, and deception was practiced. If informed consent had been properly administered and research subjects informed of the availability of penicillin when it became available, why would this still represent an ethically objectionable study? (Select all that apply.)

    1. The researcher has an obligation to actively do good for the research subjects; merely informing them of the availability of penicillin would not have been sufficient to meet this obligation.

    2. It took place in one state of the Union and so had limited generalizability.

    3. Some of the research subjects were illiterate and could not provide consent.

    4. There was no need for the study to be performed in the first place, since enough was known about syphilis at the time.

    5. Since African American men in Alabama were in an inferior social position, they constituted an underrepresented and potentially vulnerable population; every effort should have been made to include participants from other ethnic groups.

       ANS: A, E

       In 1932, the U.S. Public Health Service (U.S. PHS) initiated a study of syphilis in black men in the small rural town of Tuskegee, Alabama. The study, which continued for 40 years, was conducted to determine the natural course of syphilis in the adult black male. The research subjects were organized into two groups: one group consisted of 400 men who had untreated syphilis and the other consisted of a control group of 200 men without syphilis. Many of the subjects who consented to participate in the study were not informed about the purpose and procedures of the research. Some individuals were unaware that they were subjects in a study. The subjects were examined periodically but were not treated for syphilis, even after penicillin was determined to be an effective treatment for the disease in the 1940s. There was insufficient knowledge about the natural course of syphilis at the time the study was begun.

       Consent of illiterate subjects does not prohibit consent. Single-site research is not considered ethically objectionable per se.

       DIF: Cognitive Level: Analysis REF: Page 180

11. A researcher obtains consent from a person with a recent traumatic brain injury (TBI) to observe the person and test her at intervals, using cognitive survey instruments. The person has not yet regained the ability to speak, and can understand and obey only simple commands. She nods yes, and shakes her head for no. The subject’s husband, who has the authority to consent for his wife because he has legal power of attorney for health care, is consented for the study, and the patient is asked to assent.. Does this fulfill the requirements for consenting someone with diminished capabilities? Why or why not? (Select all that apply.)

    1. Yes, it does.

    2. No, it does not.

    3. The subject should have been told the purpose of the study over and over again, and the tests the researcher planned to administer, until the subject nodded that she understood. Her husband should not make this decision for her.

    4. The researcher must obtain consent from both the legal representative and the subject.

    5. The researcher need not obtain assent for research involving persons with decreased ability or total inability to give informed consent. The subject will probably not remember any of this later, anyhow.

    6. The subject should have been asked to consent, and the husband to assent. That is the proper procedure.

    7. The prospective subject can understand only simple commands but, because of her TBI, she is not competent to consent.

    8. The subject is asked to assent in case she has an opinion about this and might understand the purpose of the study. Eliciting her cooperation is wise in either case.

       ANS: A, G, H

       Some persons have diminished autonomy or are vulnerable and less advantaged because of legal or mental incompetence, terminal illness, or confinement to an institution (Fry et al., 2011). These persons require additional protection of their right to self-determination, because they have a decreased ability, or an inability, to give informed consent. In addition, these persons are vulnerable to coercion and deception. Neonates and children (minors), the mentally impaired, and unconscious patients are legally or mentally incompetent to give informed consent. They should, however, be asked to assent, since their cooperation is essential for high-quality data collection. If an individual is judged incompetent and incapable of consent, the researcher must seek approval from the prospective subject and his or her legally authorized representative.

       DIF: Cognitive Level: Analysis REF: Page 165

12. In the Jewish Chronic Disease Hospital Study, 22 patients were injected—unknowingly—with a suspension containing live cancer cells that had been generated from human cancer tissue. What ethical principles apply here? (Select all that apply.)

    1. Beneficence

    2. Self-determination

    3. Anonymity

    4. Confidentiality

    5. Fair treatment

       ANS: A, B, E

       A highly publicized example of unethical research was a study conducted at the Jewish Chronic Disease Hospital in the 1960s. Its purpose was to determine the patients’ rejection responses to live cancer cells. Twenty-two patients were injected with a suspension containing live cancer cells that had been generated from human cancer tissue. An extensive investigation of this study revealed the patients were not informed that they were taking part in research or that the injections they received were live cancer cells. In addition, the Jewish Chronic Disease Hospital Institutional Review Board never reviewed the study; even the physicians caring for the patients were unaware that the study was being conducted. In addition, the principle of beneficence requires the researcher to do good and “above all, do no harm.”

       DIF: Cognitive Level: Application REF: Page 162

13. Monica is a nurse researcher. She completes her paperwork for an institutional review board (IRB). Her application for approval is returned to her, with comments as to how it should be revised and resubmitted. Which of the following comments are within the scope of the IRB? (Select all that apply.)

    1. “You have failed to provide a copy of your survey. Please do so.”

    2. “Your study protocol does not provide information on potential risks to anonymity. Please indicate this in Section 1g.”

    3. “Because of inexperience in this area, the IRB invites you to meet with us as one of the reviewers of this protocol.”

    4. “We can only provide provisional approval of your study.”

    5. “You have not included information about the risk-to-benefit ratio of this research. Please do so.”

       ANS: A, B, E

       An institutional review board (IRB) is a committee that reviews research to ensure that the investigator is conducting the research ethically. Universities, hospital corporations, and many managed care centers have IRBs to promote the conduct of ethical research and protect the rights of prospective subjects at these institutions. Each IRB has at least five members of various backgrounds (cultural, economic, educational, gender, racial) to promote a complete, scholarly, and fair review of research that is commonly conducted in an institution. If an institution regularly reviews studies with vulnerable subjects, such as children, neonates, pregnant women, prisoners, and mentally disabled persons, the IRB should include one or more members with knowledge about and experience in working with these individuals. The members must have sufficient experience and expertise to review a variety of studies, including quantitative, outcomes, intervention, and qualitative research (Munhall, 2012b). The IRB members must not have a conflicting interest related to a study conducted in an institution. Any member having a conflict of interest with a research project being reviewed must excuse himself or herself from the review process, except to provide information requested by the IRB. In reviewing the research, the reviewers may exercise all of the authorities of the IRB such as require revision of a study protocol or study documents and disapproval of the research. The IRB reviews research in progress at least yearly.

       DIF: Cognitive Level: Application REF: Page 183

14. Which of the following statements are true? (Select all that apply.)

    1. HIPAA regulations were formulated to address ethical treatment of research subjects.

    2. If electronic medical records had not been invented, HIPAA would not have been

       necessary.

    3. Data held by health insurance companies sparked the emergence of HIPAA.

    4. Ethics and HIPAA regulations overlap in the area of justice.

    5. Ethics and HIPAA regulations overlap in the area of anonymity.

       ANS: B, C, E

       One of the more recent regulations, the Health Insurance Portability and Accountability Act (HIPAA), was enacted in 2003 to protect the privacy of an individual’s health information and was necessitated by the electronic storage and exchange of health information. The principle of justice holds that human subjects should be treated fairly. Anonymity exists if the subject’s identity cannot be linked, even by the researcher, with his or her individual responses.

       DIF: Cognitive Level: Synthesis REF: Page 159

15. Research articles may be considered fraudulent in which of the following instances? (Select all that apply.)

    1. The person who designed the study and performed all of the research is not mentioned as an author.

    2. The authors hired someone other than themselves to collect, analyze, and interpret the data.

    3. Graduate students collected the data but did not analyze it.

    4. A statistician was hired to perform all of the statistical tests.

    5. Both quantitative and qualitative results were reported in the same article.

    6. The authors used another researcher’s raw data without permission.

ANS: A, B, F

Editors of journals have a major role in monitoring and preventing research misconduct in the published literature. Friedman identified criteria for classifying a publication as fraudulent, questionable, or valid. According to these criteria, research articles were classified as “fraudulent if there was documentation or testimony from coauthors that the publication did not reflect what had actually been done.” Articles were questionable if no coauthor could produce the original data or if no coauthor had personally observed or performed each phase of the research or participation. A research article was considered valid “if some coauthor had personally performed or participated in each aspect of the research and publication.”

DIF: Cognitive Level: Evaluation REF:

Chapter 9: Ethics in Research Test Bank

MULTIPLE CHOICE

1. A research study offers elderly men who have, in the past, been prison inmates $1,500 for participation in an all-day workshop at which they agree to be hypnotized and tell stories of incarceration, which are later published. The research participants are allowed to listen to the tapes of what they say under hypnosis and to withdraw permission to use any part of the information. Why is this scenario a violation of self-determination?

   1. Allowing participants to withdraw permission to use part of the research information violates the study integrity and represents deception.

   2. It is an example of coercion.

   3. Prisoners are a vulnerable population and should not be used as research subjects.

   4. What is said under hypnosis may not be true.

      ANS: B

      The right to self-determination is based on the ethical principle of respect for persons. This principle holds that because humans are capable of self-determination, or controlling their own destiny, they should be treated as autonomous agents who have the freedom to conduct their lives as they choose without external controls. A subject’s right to self-determination can be violated through the use of (1) coercion, (2) covert data collection, and (3) deception.

      Coercion occurs when an overt threat of harm or excessive reward is intentionally presented by one person to another to obtain his or her compliance. In the example, offering elderly men

      $1,500 for one day could be considered offering an excessive reward: therefore, it is an act of coercion violating the human right to self-determination.

      DIF: Cognitive Level: Analysis REF: Page 164

2. A researcher working for Google collects data on fair treatment in the workplace. He attempts to attach one of the raw data forms to a message to himself, so that he can finish the data analysis at home that evening, but accidentally sends it to another employee who had provided data for the study. The two employees, coincidentally, have an identical opinion about fair treatment in the workplace. This best describes an example of a violation of which of the following human rights?

   1. Confidentiality

   2. Fair treatment

   3. Protection from harm

   4. None of these—no ethical violation occurred, because the two subjects share a point of view.

      ANS: A

      Confidentiality is the researcher’s management of private information shared by a subject that must not be shared with others without the authorization of the subject. In the example, sending one research subject the raw data of a different subject is a direct breach of confidentiality. A breach in confidentiality can occur when a researcher, by accident or direct action, allows an unauthorized person to gain access to raw study data. The right to fair treatment is based on the ethical principle of justice. This principle holds that each person should be treated fairly and should receive what he or she is due or owed. The right to protection from discomfort and harm is based on the ethical principle of beneficence, which holds that one should do good and, above all, do no harm.

      DIF: Cognitive Level: Application REF: Page 172

3. In a study of outpatients experiencing panic attacks, a researcher was working in a busy clinic waiting room and left his computer to consent a new study participant. A transcription of a patient interview was displayed, and at the end of the transcription was the patient’s medical record number and a list of medications currently taken. The researcher had not closed down the screen, and when he returned to his computer, he found an adult patient playing a video game on the computer. This best describes an example of a violation of which of the following human rights?

   1. Protection from the harm of exposure

   2. Security

   3. Confidentiality

   4. Privacy

      ANS: D

      Privacy is an individual’s right to determine the time, extent, and general circumstances under which personal information will be shared with or withheld from others. This information consists of one’s attitudes, beliefs, behaviors, opinions, and records. The Privacy Act of 1974 provided the initial protection of an individual’s privacy. Because of this act, data collection methods were to be scrutinized to protect subjects’ privacy, and data cannot be gathered from subjects without their knowledge. Individuals also have the right to access their records and to prevent access by others. The intent of this act was to prevent the invasion of privacy that occurs when private information is shared without an individual’s knowledge or against his or her will. Invading an individual’s privacy might cause loss of dignity, friendships, or employment or create feelings of anxiety, guilt, embarrassment, or shame. The HIPAA Privacy Rule expanded the protection of an individual’s privacy, specifically his or her protected individually identifiable health information, and described the ways in which covered entities can use or disclose this information. De-identifying health data involves removing 18 elements that could be used to identify an individual. An important one on this list is the individual’s medical record number. In the example, the researcher’s use of an actual patient identification number on a transcription risks the human right to privacy; a code number should have been used instead.

      DIF: Cognitive Level: Application REF: Page 169

4. Ellen is a participant in a research study. She will receive either the customary medication to treat her metastatic colon cancer or a new medication that has shown better results in animal studies and one small human study. This is research.

   1. Coercive

   2. Correlational

   3. Therapeutic

   4. Dangerous

      ANS: C

      Therapeutic research gives the patient an opportunity to receive an experimental treatment that might have beneficial results. Nontherapeutic research is conducted to generate knowledge for a discipline, and the results from the study might benefit future patients but will probably not benefit those acting as research subjects. The Declaration of Helsinki differentiated therapeutic research from nontherapeutic research. Neither descriptive nor correlational research involves treatment or manipulation of a variable. There is no evidence of coercion.

      DIF: Cognitive Level: Application REF: Page 160

5. A graduate student receives a mailed survey asking her to participate in research about unpleasant experiences in graduate school. She is asked to return the survey, and the instructions say, “Return of this instrument implies consent.” Why does this constitute consent?

   1. Studies like this are exempt from institutional review board oversight, so consent is not required.

   2. Not returning the survey constitutes refusal, and subjects may indeed refuse by not completing the survey. The opposite is equally true.

   3. The study is anonymous, so there is no risk of disclosure.

   4. Only interventional research requires consent.

      ANS: B

      The requirements for written consent may be waived in research that “presents no more than minimal risk of harm to subjects and involves no procedures for which written consent is normally required outside of the research context.” For example, if questionnaires are used to collect relatively harmless data, a signed consent form from the subjects would not be required. The subject’s completion of the questionnaire may serve as consent. The top of the questionnaire might contain a statement such as “Your completion of this questionnaire indicates your consent to participate in this study.”

      DIF: Cognitive Level: Analysis REF: Page 180

6. Both a subject in an experimental group who receives an experimental treatment and a subject in a control group who receives a control treatment are considered to be subjects in therapeutic research. Why is this?

   1. A patient in an experimental research study who elects to be a member of the experimental group knows he or she will be receiving the experimental treatment.

   2. Each patient who is consented to be a research subject in an experimental study in which the treatment has potentially beneficial results has the potential to receive a therapeutic intervention.

   3. The research is designed to measure the effect of the therapeutic treatment as compared with the usual therapeutic treatment; hence, this is therapeutic research.

   4. Each subject is blind to treatment.

      ANS: C

      Therapeutic research gives the patient an opportunity to receive an experimental treatment that might have beneficial results. In experimental research this means only that the subject is recruited into the study and randomly assigned to either a treatment or control group, not that the subject receives the experimental treatment.

      DIF: Cognitive Level: Evaluation REF: Page 160

7. In what way could the researchers in the Willowbrook study have designed their research on the hepatitis virus so that it was ethically acceptable?

   1. The researchers could have given each participant a chance to assent.

   2. The researchers could have performed their study on persons who were capable of full assent.

   3. The researchers could have made the study available at many institutions for the mentally retarded.

   4. The researchers could have performed descriptive research on persons already infected with hepatitis.

      ANS: D

      From the mid-1950s to the early 1970s, research on hepatitis was conducted by Dr. Krugman at Willowbrook, an institution for the mentally retarded. The subjects, all children, were deliberately infected with the hepatitis virus. During the 20-year study, Willowbrook closed its doors to new inmates because of overcrowded conditions. However, the research ward continued to admit new inmates. To gain their child’s admission to the institution, the parents were forced to give permission for the child to be a subject in the study. Because, the principal of beneficence requires the researcher to do good and “above all, do no harm,” the only way to study a virus that clearly harms people is non-interventionally: through descriptive or correlational research.

      DIF: Cognitive Level: Synthesis REF: Page 161

8. The right an individual has to be told that he is a potential participant in a research study and may decide not to be so best defines which of the following human rights?

   1. Beneficence

   2. Justice

   3. Privacy

   4. Self-determination

      ANS: D

      The right to self-determination holds that because humans are capable of self-determination, or controlling their own destiny, they should be treated as autonomous agents who have the freedom to conduct their lives as they choose without external controls. Privacy is an individual’s right to determine the time, extent, and general circumstances under which personal information will be shared with or withheld from others. Justice holds that each person should be treated fairly and should receive what he or she is due or owed. The right to protection from discomfort and harm is based on the ethical principle of beneficence, which holds that one should do good and, above all, do no harm.

      DIF: Cognitive Level: Application REF: Page 162

9. The right an individual has to receive treatment even if he decides not to participate in the research best defines which of the following human rights?

   1. Beneficence

   2. Justice

   3. Privacy

   4. Respect

      ANS: B

      The right to fair treatment is based on the ethical principle of justice. Privacy is the right an individual has to determine the time, extent, and general circumstances under which personal information will be shared or withheld from others. Such information consists of one’s attitudes, beliefs, behaviors, opinions, and records. The right to protection from discomfort and harm is based on the ethical principle of beneficence, which holds that one should do good and, above all, do no harm. The right to self-determination is based on the ethical principle of respect for persons.

      DIF: Cognitive Level: Application REF: Page 164

10. To take positive action to prevent any harm to the research subjects best defines which of the following principles?

    1. Beneficence

    2. Justice

    3. Privacy

    4. Respect

       ANS: A

       The right to protection from discomfort and harm is based on the ethical principle of beneficence, which holds that one should do good and, above all, do no harm. This includes positive actions taken to prevent harm to research subjects. Privacy is the right an individual has to determine the time, extent, and general circumstances under which personal information will be shared or withheld from others. Such information consists of one’s attitudes, beliefs, behaviors, opinions, and records. The right to fair treatment is based on the ethical principle of justice. The right to self-determination is based on the ethical principle of respect for persons.

       DIF: Cognitive Level: Comprehension REF: Page 164

11. An institutional review board (IRB) ensures that (1) the rights and welfare of the individuals involved were protected, (2) the appropriate methods were used to secure informed consent, and (3) the potential benefits of the investigation were greater than the risks. Which of the following is an example of how an IRB determines the level of potential risk?

    1. It requires the researcher to provide a list of potential benefits to the clients, as well as the results of a pilot study verifying this.

    2. It compels the researcher to disclose his consenting process.

    3. It provides for a supervisor from the IRB to be present for all data collection.

    4. It reviews the researcher’s description of the study’s potential risks and compares them with everyday risk.

       ANS: D

       The functions and operations of an IRB involve the review of research at three different levels: (1) exempt from review, (2) expedited review, and (3) complete review. The level of the review required for each study is decided by the IRB chairperson and/or committee, not by the researcher, based on information provided by the researcher. Studies are usually exempt from review if they pose no apparent risks for the research subjects. Studies that have some risks, which are viewed as minimal, are expedited in the review process.

       DIF: Cognitive Level: Synthesis REF: Page 183

12. A researcher who is also a university professor is performing a multi-site study in which on- site interviews are conducted with nurses in five hospitals in a major city. Each hospital has an institutional review board (IRB). From how many IRBs or committees must the researcher obtain permission to conduct the study?

    1. Six: each of the five hospitals, and the university

    2. One: only the university

    3. Five: only the hospitals

    4. None: educational research is exempt from review

       ANS: A

       Universities and healthcare agencies have IRBs that function in a similar way to review research following federal regulations. If both a university and a hospital, or if more than one hospital, should be involved in a research study, both IRBs must give permission for the study to be conducted. This poses significant expenditure of time for such research.

       DIF: Cognitive Level: Application REF: Page 183

13. What specific area of ethics does HIPAA address?

    1. Privacy

    2. Justice

    3. Coercion to participate in a research study

    4. Informed consent

       ANS: A

       The Health Insurance Portability and Accountability Act (HIPAA) was implemented in 2003 to protect an individual’s health information. The U.S. DHHS developed regulations titled the Standards for Privacy of Individually Identifiable Health Information, and compliance with these regulations is known as the Privacy Rule.

       DIF: Cognitive Level: Comprehension REF: Page 159

14. A researcher is applying for renewal of a large federal grant, without which his very promising research on panic disorder cannot continue. He is completing renewal forms, which include a synopsis of his results to date. If he excludes two of the subjects with very severe panic disorder, and three with mental health disorders of another kind, the results are statistically significant. He writes the report and does not mention the five subjects he excluded. This is an instance of which of the following?

    1. Beneficence

    2. Fabrication

    3. Falsification

    4. Plagiarism

       ANS: C

       Fabrication in research is the making up of results and recording or reporting them. Falsification of research is manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record. Plagiarism is the appropriation of another person’s ideas, processes, results, or words without giving appropriate credit, including those obtained through confidential review of others’ research proposals and manuscripts. The principle of beneficence requires the researcher to do good and “above all, do no harm.”

       DIF: Cognitive Level: Application REF: Page 188

15. A researcher is applying for a grant renewal on the subject of a promising new treatment for liver cancer. His research group has used the treatment for 13 subjects. The results—9 responded and 4 did not—are not statistically significant. However, if the researcher entered each patient as three different people and reported the results as 27 responded and 12 did not, the results would be statistically significant. If he chose to do this, what would it represent?

    1. Beneficence

    2. Fabrication

    3. Falsification

    4. Plagiarism

       ANS: B

       Fabrication in research is the making up of results and recording or reporting them. Falsification of research is manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record. Plagiarism is the appropriation of another person’s ideas, processes, results, or words without giving appropriate credit, including those obtained through confidential review of others’ research proposals and manuscripts. The principle of beneficence requires the researcher to do good and “above all, do no harm.”

       DIF: Cognitive Level: Application REF: Page 188

16. A master’s student knows next to nothing about Maslow’s theory related to hierarchy of needs but, on her advisor’s recommendation, decides to use it as a theoretical framework for her thesis. The student goes to the library and accesses an old master’s thesis that also uses the theory and copies three pages, word for word. She uses the other student’s reference to Maslow’s work. This is an example of which of the following?

    1. Nonmaleficence

    2. Fabrication

    3. Falsification

    4. Plagiarism

       ANS: D

       Plagiarism is the appropriation of another person’s ideas, processes, results, or words without giving appropriate credit, including those obtained through confidential review of others’ research proposals and manuscripts. Fabrication in research is the making up of results and recording or reporting them. Falsification of research is manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record. The principle of beneficence requires the researcher to do good and “above all, do no harm.”

       DIF: Cognitive Level: Application REF: Page 188

17. A master’s student knows next to nothing about Maslow’s theory related to hierarchy of needs but, on her advisor’s recommendation, decides to use it as a theoretical framework for her thesis. The student goes online and finds a Wikipedia page and copies the description of Maslow’s theory verbatim, putting a citation at the end of the paragraph but not using quotation marks. This is an example of which of the following?

    1. Nonmaleficence

    2. Fabrication

    3. Falsification

    4. Plagiarism

       ANS: D

       Plagiarism is the appropriation of another person’s ideas, processes, results, or words without giving appropriate credit, including those obtained through confidential review of others’ research proposals and manuscripts. Fabrication in research is the making up of results and recording or reporting them. Falsification of research is manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record. The principle of beneficence requires the researcher to do good and “above all, do no harm.”

       DIF: Cognitive Level: Application REF: Page 188

18. A researcher receives permission to use the information in a hospital data set, without patient identifiers. What level of subject consent is required?

    1. Partial: the subjects must all be notified that their data is being re-used.

    2. None.

    3. Partial: the subjects must all be notified if the results are published.

    4. Full: all subjects must be contacted and must agree to have their data used.

       ANS: B

       Covered entities (healthcare provider, health plan, and healthcare clearinghouse) may use and disclose a limited data set to a researcher for a study without an individual subject’s authorization or an IRB waiver.

       DIF: Cognitive Level: Comprehension REF: Page 170

19. A researcher is applying for institutional review board (IRB) approval, and the form specifies that the researcher indicate the probable level of risk. The research creates situations in which the RN research subjects are placed in unusual code-like situations in which they do not know what action to take, and actors play the parts of other healthcare providers. The RN subjects are then asked to describe their feelings and their levels of confidence as they go through 15 scenarios. What level of risk does this study pose?

    1. No anticipated effects

    2. Temporary discomfort

    3. Unusual discomfort

    4. Risk of permanent harm

       ANS: B

       Studies that cause temporary discomfort are described as minimal-risk studies, in which the discomfort encountered is similar to what the subject would experience in his or her daily life and ceases with the termination of the study. Many nursing studies require the subjects to complete questionnaires or participate in interviews, which usually involve minimal risk. The physical discomforts might be fatigue, headache, or muscle tension. The emotional and social risks might entail the anxiety or embarrassment associated with responding to certain questions. The economic risks might consist of the time spent participating in the study or travel costs to the study site. Participation in many nursing studies is considered a mere inconvenience for the subject, with no foreseeable risks of harm. Most clinical nursing studies examining the impact of a treatment involve minimal risk.

       DIF: Cognitive Level: Comprehension REF: Page 174

20. Dr. Adamson is conducting research on a new and promising chemotherapy treatment for breast cancer that improves survival and decreases adverse symptoms. Sixty subjects will be recruited; of these, thirty will be assigned to the experimental group, receiving the new treatment, and thirty to the control group, receiving the usual chemotherapy. His wife, newly diagnosed with breast cancer, is randomly assigned to the treatment group; he removes her from the treatment group and places her in the experimental group. What ethical violation has occurred?

    1. Mrs. Adamson has a right to self-determination: her husband has decided her group assignment for her.

    2. Mrs. Adamson’s husband has no right to know about her breast cancer: this is a violation of confidentiality.

    3. Mrs. Adamson shouldn’t be a member of the study: it’s a conflict of interest.

    4. Mrs. Adamson has no right to be included in the experimental group: it unfairly excludes someone else from this special benefit.

       ANS: D

       A concern with subject selection that is related to justice is that some researchers select certain people as subjects because they like them and want them to receive the specific benefits of a study. Other researchers have been swayed by power or money to make certain individuals subjects so that they can receive potentially beneficial treatments. It is especially important in research not to show preference in assigning subjects. That is the benefit of random assignment: it is fair.

       DIF: Cognitive Level: Application REF: Page 173

21. From an ethical point of view, what is the point of determining that a potential research subject is incompetent?

    1. An incompetent subject must receive more extensive explanation before consenting to participate in research.

    2. According to HIPAA, a different level of records security must ensue.

    3. Inclusion of the subject necessitates a different consenting process.

    4. The researcher has a responsibility to exclude all incompetent persons from research participation.

       ANS: C

       Some persons have diminished autonomy or are vulnerable and less advantaged because of legal or mental incompetence, terminal illness, or confinement to an institution. These persons require additional protection of their right to self-determination, because they have a decreased ability, or an inability, to give informed consent. In addition, these persons are vulnerable to coercion and deception.

       DIF: Cognitive Level: Synthesis REF: Page 165

22. How would a professor who wants to have his students provide data for a research study go about achieving this without involving coercion?

    1. Mention that participation provides extra points.

    2. Have a research assistant consent all subjects and collect all data.

    3. Offer extra points to the whole class if 50% of them act as subjects.

    4. Open the study to all students on campus and provide a nonacademic incentive.

ANS: D

A subject’s right to self-determination can be violated through the use of (1) coercion, (2) covert data collection, and (3) deception. Coercion occurs when one person intentionally presents another with an overt threat of harm or the lure of excessive reward to obtain compliance. Sometimes students feel forced to participate in research to protect their grades or prevent negative relationships with the faculty conducting the research. They are being coerced.

DIF: Cognitive Level: Analysis REF: Page 164

MULTIPLE RESPONSE

1. Why are research ethics essential? (Select all that apply.)

   1. Research subjects must be protected from accidental disclosure of information.

   2. Institutional review boards exist to protect patient rights.

   3. Researcher misconduct may result in dissemination of potentially harmful results.

   4. Results published in professional journals represent a clear violation of privacy.

   5. Research subjects must be protected from deliberate violation of their rights.

      ANS: A, C, E

      Ethical research is essential to generate sound knowledge for practice. The ethical conduct of research has been a focus since the 1940s because of the mistreatment of human subjects in selected studies. Human rights are claims and demands that have been justified in the eyes of an individual or by the consensus of a group of individuals. Having rights is necessary for the self-respect, dignity, and health of an individual. The human rights that require protection in research are (1) self-determination, (2) privacy, (3) anonymity and confidentiality, (4) fair treatment, and (5) protection from discomfort and harm. Although institutional review boards exist to protect patient rights, this is not a reason that research ethics are essential. Results published in professional journals do not represent a violation of privacy if the researcher has attended to ethical mandates.

      DIF: Cognitive Level: Synthesis REF: Page 159

2. Why are vulnerable populations considered vulnerable and to what are they vulnerable? (Select all that apply.)

1. Physical harm because of a preexistent mental or physical condition

2. The possibility of being assigned to the experimental group

3. Unethical researchers

4. Coercion

5. Diminished autonomy because of an impaired ability to consent

   ANS: A, D, E

   Some persons have diminished autonomy or are vulnerable and less advantaged because of legal or mental incompetence, terminal illness, or confinement to an institution. These persons require additional protection of their right to self-determination, because they have a decreased ability, or an inability, to give informed consent. In addition, these persons are vulnerable to coercion and deception. The U.S. DHHS has identified certain vulnerable groups of individuals, including pregnant women, human fetuses, neonates, children, mentally incompetent persons, and prisoners, who require additional protection in the conduct of research. Neonates are extremely vulnerable and require extra protection to determine their involvement in research. Some hospitalized patients are survivors of trauma (such as auto accidents, gunshot wounds, or physical and sexual abuse) who are very vulnerable and who often have decreased decision-making capacities. Sometimes students feel forced to participate in research to protect their grades or prevent negative relationships with the faculty conducting the research. Other subjects are coerced to participate in studies because they believe that they cannot refuse the excessive rewards offered, such as large sums of money, specialized health care, special privileges, and jobs.

   DIF: Cognitive Level: Analysis REF: Page 165

• Which one of the following are considered vulnerable populations from an ethical point of view? (Select all that apply.)

  1. Students

  2. Persons with osteoporosis who are subject to hip fracture

  3. Persons who are depressed

  4. Prisoners

  5. Persons who have recently suffered loss of a spouse

     ANS: A, D

     Some persons have diminished autonomy or are vulnerable and less advantaged because of legal or mental incompetence, terminal illness, or confinement to an institution. These persons require additional protection of their right to self-determination, because they have a decreased ability, or an inability, to give informed consent. In addition, these persons are vulnerable to coercion and deception. The U.S. DHHS has identified certain vulnerable groups of individuals, including pregnant women, human fetuses, neonates, children, mentally incompetent persons, and prisoners, who require additional protection in the conduct of research. Sometimes students feel forced to participate in research to protect their grades or prevent negative relationships with the faculty conducting the research.

     DIF: Cognitive Level: Analysis REF: Page 165

• A nurse plans to interview prisoners as part of her master’s thesis on treatment of health problems in correctional institutions. What special measures must she take before she studies these potential subjects? (Select all that apply.)

  1. Justify to an institutional review board why she must use prisoners as subjects.

  2. Devise a consent process that provides for a conservator’s signature.

  3. Destroy all of her records.

  4. Devise interview questions that avoid any mention of prisons or prisoners.

  5. Bracket her previous beliefs about prisoners.

  6. Assure that the consent process involves no coercion.

     ANS: A, F

     The U.S. DHHS has identified certain vulnerable groups of individuals, including pregnant women, human fetuses, neonates, children, mentally incompetent persons, and prisoners, who require additional protection in the conduct of research. Researchers need to justify their use of subjects with diminished autonomy in a study, and the need for justification increases as the subjects’ risk and vulnerability. Subjects with diminished autonomy may be subject to coercion.

     DIF: Cognitive Level: Analysis REF: Page 165

• A researcher conducts a mixed-methods study on exercise as a modality of controlling hyperglycemia. The study has both quantitative results, describing the amount that glucose falls with various amounts of exercise, and qualitative results, describing participants’ mood and sense of well-being with different kinds of exercise. The researcher decides to publish an article based on the quantitative findings immediately but wait to publish the qualitative results later. What are the reasons that this would not be an instance of researcher misconduct? (Select all that apply.)

  1. The data from the quantitative part of the study are reported completely and honestly.

  2. The journal does not accept qualitative research.

  3. Both “arms” of the study are freestanding.

  4. Nobody will know that a qualitative study was performed.

  5. No denial of the full scope of data collection is made.

     ANS: A, C, E

     Research misconduct is defined as “the fabrication, falsification, or plagiarism in processing, performing, or reviewing research, or in reporting research results. It does not include honest error or differences in opinion.” Fabrication in research is the making up of results and recording or reporting them. Falsification of research is manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record. The data from this study were neither fabricated nor falsified; it is the researcher’s decision when to disseminate research results.

     DIF: Cognitive Level: Evaluation REF: Page 188

• Which of the following represent a breach in confidentiality? (Select all that apply.)

  1. The teenaged son of a researcher reads some of the raw interview data on the researcher’s computer.

  2. The researcher accidentally includes the real names of one participant’s husband and two daughters in the finished article, instead of changing these to pseudonyms.

  3. A researcher presents her findings at a research conference.

  4. A tape of a research interview is misplaced in the researcher’s home and is never found.

  5. The researcher mentions to a colleague that all of the participants in a recent research project on anger were divorced women.

     ANS: A, B, D

     A breach of confidentiality can occur when a researcher, by accident or direct action, allows an unauthorized person to gain access to the study raw data. Confidentiality can also be breached in the reporting or publication of a study when a subject’s identity is accidentally revealed, violating the subject’s right to anonymity. Breaches of confidentiality can harm subjects psychologically and socially, as well as destroy the trust they had in the researchers. Breaches of confidentiality can be especially harmful to a research participant if they involve

     (1) religious preferences; (2) sexual practices; (3) employment; (4) racial prejudices; (5) drug use; (6) child abuse; and (7) personal attributes, such as intelligence, honesty, and courage.

     DIF: Cognitive Level: Comprehension REF: Page 172

• An improvement in research ethics could prevent some or all of which of the following? (Select all that apply.)

  1. Breaches of anonymity

  2. Researchers’ failures to report their funding sources in publications

  3. Minimal risk to research participants

  4. Unauthorized data collection

  5. Patients’ inability to understand complex research designs

     ANS: A, B, D

     Ethical research is essential to generate sound knowledge for practice. The ethical conduct of research has been a focus since the 1940s because of the mistreatment of human subjects in selected studies. Human rights are claims and demands that have been justified in the eyes of an individual or by the consensus of a group of individuals. Having rights is necessary for the self-respect, dignity, and health of an individual. The human rights that require protection in research are (1) self-determination, (2) privacy, (3) anonymity and confidentiality, (4) fair treatment, and (5) protection from discomfort and harm. Although Institutional Review Boards exist to protect patient rights, this is not a reason that research ethics are essential.

     Results published in professional journals do not represent a violation of privacy, if the researcher has attended to ethical mandates.

     DIF: Cognitive Level: Synthesis REF: Page 159

• In order for consent to be voluntary, which must occur? (Select all that apply.)

  1. The subject must sign a consent form.

  2. The subject cannot be mentally incompetent.

  3. The subject cannot be shamed, forced, or cajoled into participation.

  4. The subject cannot be paid (remunerated), because this would be coercive.

  5. The researcher must confirm that the person signing the consent form truly understands what the research will involve.

     ANS: C, E

     Voluntary consent means that the prospective subject has decided to take part in a study of his or her own volition without coercion or any unique influence. Voluntary consent is obtained after the prospective subject has been given essential information about the study and has shown comprehension of this information. In some studies, the consent form may be replaced by oral consent or the consent form may be used but the subject’s signature is waived. A person who is mentally incompetent or incapacitated may be a research subject, but his or her legal representative must consent for participation. If an individual is judged incompetent and incapable of consent, the researcher must seek approval from the prospective subject and his or her legally authorized representative. It is the researcher’s responsibility to confirm that the person signing the consent form truly understands what the research entails. Sometimes nursing studies have included a small financial reward of $10 to $30 or support for transportation to increase participation, but this would not be considered coercive.

     DIF: Cognitive Level: Analysis REF: Page 180

• Which of these statements concerning guidelines for consenting children for research participation are true? (Select all that apply.)

  1. No infant or child may be used in research if he or she refuses treatment.

  2. Emancipated minors may consent for themselves.

  3. Coercion is wrong, but begging a child to participate is acceptable.

  4. An 11-year-old should be asked to assent for research participation.

  5. If infants and children participate in research, they should sign a consent form.

  6. Infants cannot refuse to participate in research if their parents consent.

     ANS: B, D, F

     The unique vulnerability of children makes the decision to include them as research subjects particularly important. To safeguard their interests and protect them from harm, special ethical and regulatory considerations have been put in place for research involving children.

     However, the laws defining the minor status of a child are statutory and vary from state to state. Often a child’s competency to consent is governed by age, with incompetence being nonrefutable up to age 7 years. Thus, a child younger than 7 years is not believed to be mature enough to assent or consent to research. A child 7 years or older with normal cognitive development can provide assent or dissent to participation in a study, and the process for obtaining the assent should be included in the research proposal. To obtain informed consent, federal regulations require both the assent of the children (when capable) and the permission of their parents or guardians. An infant is not capable of speech or of understanding the purpose of a research study.

     DIF: Cognitive Level: Synthesis REF: Page 166

• The Tuskegee study was ethically objectionable because informed consent was flawed, an available treatment was not provided, and deception was practiced. If informed consent had been properly administered and research subjects informed of the availability of penicillin when it became available, why would this still represent an ethically objectionable study? (Select all that apply.)

  1. The researcher has an obligation to actively do good for the research subjects; merely informing them of the availability of penicillin would not have been sufficient to meet this obligation.

  2. It took place in one state of the Union and so had limited generalizability.

  3. Some of the research subjects were illiterate and could not provide consent.

  4. There was no need for the study to be performed in the first place, since enough was known about syphilis at the time.

  5. Since African American men in Alabama were in an inferior social position, they constituted an underrepresented and potentially vulnerable population; every effort should have been made to include participants from other ethnic groups.

     ANS: A, E

     In 1932, the U.S. Public Health Service (U.S. PHS) initiated a study of syphilis in black men in the small rural town of Tuskegee, Alabama. The study, which continued for 40 years, was conducted to determine the natural course of syphilis in the adult black male. The research subjects were organized into two groups: one group consisted of 400 men who had untreated syphilis and the other consisted of a control group of 200 men without syphilis. Many of the subjects who consented to participate in the study were not informed about the purpose and procedures of the research. Some individuals were unaware that they were subjects in a study. The subjects were examined periodically but were not treated for syphilis, even after penicillin was determined to be an effective treatment for the disease in the 1940s. There was insufficient knowledge about the natural course of syphilis at the time the study was begun.

     Consent of illiterate subjects does not prohibit consent. Single-site research is not considered ethically objectionable per se.

     DIF: Cognitive Level: Analysis REF: Page 180

• A researcher obtains consent from a person with a recent traumatic brain injury (TBI) to observe the person and test her at intervals, using cognitive survey instruments. The person has not yet regained the ability to speak, and can understand and obey only simple commands. She nods yes, and shakes her head for no. The subject’s husband, who has the authority to consent for his wife because he has legal power of attorney for health care, is consented for the study, and the patient is asked to assent.. Does this fulfill the requirements for consenting someone with diminished capabilities? Why or why not? (Select all that apply.)

  1. Yes, it does.

  2. No, it does not.

  3. The subject should have been told the purpose of the study over and over again, and the tests the researcher planned to administer, until the subject nodded that she understood. Her husband should not make this decision for her.

  4. The researcher must obtain consent from both the legal representative and the subject.

  5. The researcher need not obtain assent for research involving persons with decreased ability or total inability to give informed consent. The subject will probably not remember any of this later, anyhow.

  6. The subject should have been asked to consent, and the husband to assent. That is the proper procedure.

  7. The prospective subject can understand only simple commands but, because of her TBI, she is not competent to consent.

  8. The subject is asked to assent in case she has an opinion about this and might understand the purpose of the study. Eliciting her cooperation is wise in either case.

     ANS: A, G, H

     Some persons have diminished autonomy or are vulnerable and less advantaged because of legal or mental incompetence, terminal illness, or confinement to an institution (Fry et al., 2011). These persons require additional protection of their right to self-determination, because they have a decreased ability, or an inability, to give informed consent. In addition, these persons are vulnerable to coercion and deception. Neonates and children (minors), the mentally impaired, and unconscious patients are legally or mentally incompetent to give informed consent. They should, however, be asked to assent, since their cooperation is essential for high-quality data collection. If an individual is judged incompetent and incapable of consent, the researcher must seek approval from the prospective subject and his or her legally authorized representative.

     DIF: Cognitive Level: Analysis REF: Page 165

• In the Jewish Chronic Disease Hospital Study, 22 patients were injected—unknowingly—with a suspension containing live cancer cells that had been generated from human cancer tissue. What ethical principles apply here? (Select all that apply.)

  1. Beneficence

  2. Self-determination

  3. Anonymity

  4. Confidentiality

  5. Fair treatment

     ANS: A, B, E

     A highly publicized example of unethical research was a study conducted at the Jewish Chronic Disease Hospital in the 1960s. Its purpose was to determine the patients’ rejection responses to live cancer cells. Twenty-two patients were injected with a suspension containing live cancer cells that had been generated from human cancer tissue. An extensive investigation of this study revealed the patients were not informed that they were taking part in research or that the injections they received were live cancer cells. In addition, the Jewish Chronic Disease Hospital Institutional Review Board never reviewed the study; even the physicians caring for the patients were unaware that the study was being conducted. In addition, the principle of beneficence requires the researcher to do good and “above all, do no harm.”

     DIF: Cognitive Level: Application REF: Page 162

• Monica is a nurse researcher. She completes her paperwork for an institutional review board (IRB). Her application for approval is returned to her, with comments as to how it should be revised and resubmitted. Which of the following comments are within the scope of the IRB? (Select all that apply.)

  1. “You have failed to provide a copy of your survey. Please do so.”

  2. “Your study protocol does not provide information on potential risks to anonymity. Please indicate this in Section 1g.”

  3. “Because of inexperience in this area, the IRB invites you to meet with us as one of the reviewers of this protocol.”

  4. “We can only provide provisional approval of your study.”

  5. “You have not included information about the risk-to-benefit ratio of this research. Please do so.”

     ANS: A, B, E

     An institutional review board (IRB) is a committee that reviews research to ensure that the investigator is conducting the research ethically. Universities, hospital corporations, and many managed care centers have IRBs to promote the conduct of ethical research and protect the rights of prospective subjects at these institutions. Each IRB has at least five members of various backgrounds (cultural, economic, educational, gender, racial) to promote a complete, scholarly, and fair review of research that is commonly conducted in an institution. If an institution regularly reviews studies with vulnerable subjects, such as children, neonates, pregnant women, prisoners, and mentally disabled persons, the IRB should include one or more members with knowledge about and experience in working with these individuals. The members must have sufficient experience and expertise to review a variety of studies, including quantitative, outcomes, intervention, and qualitative research (Munhall, 2012b). The IRB members must not have a conflicting interest related to a study conducted in an institution. Any member having a conflict of interest with a research project being reviewed must excuse himself or herself from the review process, except to provide information requested by the IRB. In reviewing the research, the reviewers may exercise all of the authorities of the IRB such as require revision of a study protocol or study documents and disapproval of the research. The IRB reviews research in progress at least yearly.

     DIF: Cognitive Level: Application REF: Page 183

• Which of the following statements are true? (Select all that apply.)

  1. HIPAA regulations were formulated to address ethical treatment of research subjects.

  2. If electronic medical records had not been invented, HIPAA would not have been

     necessary.

  3. Data held by health insurance companies sparked the emergence of HIPAA.

  4. Ethics and HIPAA regulations overlap in the area of justice.

  5. Ethics and HIPAA regulations overlap in the area of anonymity.

     ANS: B, C, E

     One of the more recent regulations, the Health Insurance Portability and Accountability Act (HIPAA), was enacted in 2003 to protect the privacy of an individual’s health information and was necessitated by the electronic storage and exchange of health information. The principle of justice holds that human subjects should be treated fairly. Anonymity exists if the subject’s identity cannot be linked, even by the researcher, with his or her individual responses.

     DIF: Cognitive Level: Synthesis REF: Page 159

• Research articles may be considered fraudulent in which of the following instances? (Select all that apply.)

  1. The person who designed the study and performed all of the research is not mentioned as an author.

  2. The authors hired someone other than themselves to collect, analyze, and interpret the data.

  3. Graduate students collected the data but did not analyze it.

  4. A statistician was hired to perform all of the statistical tests.

  5. Both quantitative and qualitative results were reported in the same article.

  6. The authors used another researcher’s raw data without permission.

ANS: A, B, F

Editors of journals have a major role in monitoring and preventing research misconduct in the published literature. Friedman identified criteria for classifying a publication as fraudulent, questionable, or valid. According to these criteria, research articles were classified as “fraudulent if there was documentation or testimony from coauthors that the publication did not reflect what had actually been done.” Articles were questionable if no coauthor could produce the original data or if no coauthor had personally observed or performed each phase of the research or participation. A research article was considered valid “if some coauthor had personally performed or participated in each aspect of the research and publication.”

DIF: Cognitive Level: Evaluation REF: Page 189 Chapter 10: Understanding Quantitative Research Design Test Bank

MULTIPLE CHOICE

1. What is the best research approach for investigating the actual representation of Hispanic managers within health care institutions, and the workplace beliefs and prejudices that perpetuate their disproportionate representation?

   1. Triangulated approach

   2. Quantitative approach

   3. Qualitative approach

   4. Outcomes approach

      ANS: A

      Triangulation is the combined use of two or more theories, methods, data sources, investigators, or analysis methods in the study of the same phenomenon. Five types of triangulation are proposed: (1) data triangulation, (2) investigator triangulation, (3) theoretical triangulation, (4) methodological triangulation, and (5) analysis triangulation. Multiple triangulation is the combination of more than one of these types. In the example, methodological triangulation should be used in the study of the research problem.

      Triangulation is used to ensure that the most comprehensive approach is taken to solve a research problem.

      DIF: Cognitive Level: Application REF: Page 208

2. What is the principal disadvantage of triangulated research?

   1. Its results are difficult to understand.

   2. Because of its complexity, researchers from different research traditions may collaborate to produce a triangulated study.

   3. The time required to complete a triangulated project is approximately double that of completing one that utilizes only one method.

   4. Publication opportunities are limited.

      ANS: C

      Triangulation is the combined use of two or more theories, methods, data sources, investigators, or analysis methods in the study of the same phenomenon. There is concern that triangulation will be used in studies for which it is not appropriate. An additional concern is that the popularization of the method will generate a number of triangulated studies that have been poorly conducted. With methodological triangulation, both data collection and data analysis are more time-consuming, because essentially two closely related studies are conducted simultaneously or in close succession. These strategies require many observations and result in large volumes of data for analysis. The results are no more difficult to understand than are the results of any study. Most doctorally prepared researchers have both quantitative and qualitative preparation; however, because researchers tend to acquire their research training within a particular research tradition, attempts to incorporate another research tradition may be poorly achieved. Publication opportunities are increased with triangulated research, since quantitative and qualitative portions of the study are often published separately.

      DIF: Cognitive Level: Synthesis REF: Page 208

3. Causality is tested through which of the following?

   1. Grounded theory

   2. Experimentation

   3. All quantitative research

   4. Triangulated studies

      ANS: B

      The first assumptions one must make in examining causality are that things have causes and that causes lead to effects. The original criteria for causation required that a variable should cause an identified effect each time the cause occurred. Probability addresses relative, rather than absolute, causality. From a perspective of probability, a cause will not produce a specific effect each time that particular cause occurs. The reasoning behind probability is more in keeping with the complexity of multicausality. The purpose of an experimental design is to examine cause and effect. The independent variable in a study is expected to be the cause, and the dependent variable is expected to reflect the effect of the independent variable.

      DIF: Cognitive Level: Comprehension REF: Page 195

4. Why is selection of an appropriate design for a research study important?

   1. If the design is an incorrect one, the researcher will examine variables and their interactions in a way that does not answer the research question.

   2. The design provides a blueprint or diagram that appears in the concept map.

   3. If there is no design, critique is impossible.

   4. If the design is appropriate, the researcher can eliminate error.

      ANS: A

      A research design is the blueprint for conducting a study. It maximizes control over factors that could interfere with the validity of the study findings. Being able to identify the study design and to evaluate design flaws that might threaten the validity of findings is an important part of critically appraising studies. When conducting a study, the research design guides the researcher in planning and implementing a study in a way to achieve accurate results. The control achieved through the quantitative study design increases the probability that the study findings are an accurate reflection of reality.

      DIF: Cognitive Level: Analysis REF: Page 195

5. Thirty patients with psoriasis are treated with ultraviolet light B phototherapy, delivered by a therapist. Their symptoms become worse at first, and then improve. During the summer their symptoms become better without treatment. Then fall arrives, and symptoms worsen. Patients go back to UVL B, and they improve. Why, according to Hume, can the relationship between UVL B phototherapy and symptom severity not be considered a classically causal one?

   1. Ultraviolet light B phototherapy wasn’t invented during Hume’s lifetime.

   2. There must be a strong relationship between the proposed cause and the effect.

   3. The cause (phototherapy) has to be present whenever the effect occurs.

   4. The cause must precede the effect in time.

      ANS: C

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

      DIF: Cognitive Level: Application REF: Page 195

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

   1. Statistical conclusion validity

   2. Internal validity

   3. Construct validity

   4. External validity

      ANS: D

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

      DIF: Cognitive Level: Synthesis REF: Page 202

7. John Stuart Mill and the essentialists insisted that a cause be necessary and sufficient for an effect to occur. In a modern study alcohol dependency is found to lead eventually to permanent liver damage, except when the alcoholic consumes a diet plentiful in the B- vitamins. In addition, liver damage can emerge in the absence of alcohol dependency. What would John Stuart Mill and essentialists say about the causative relationship between alcohol dependency and liver damage?

   1. The proposed cause is necessary, but not sufficient.

   2. The proposed cause is neither necessary nor sufficient.

   3. The proposed cause is sufficient, but not necessary.

   4. The proposed cause is both necessary and sufficient.

      ANS: B

      A philosophical group known as essentialists proposed that two concepts must be considered in determining causality: necessary and sufficient. The proposed cause must be necessary for the effect to occur. (The effect cannot occur unless the cause first occurs.) The proposed cause must also be sufficient (requiring no other factors) for the effect to occur. This leaves no room for a variable that may sometimes, but not always, serves as the cause of an effect.

      DIF: Cognitive Level: Analysis REF: Page 195

8. Random selection of 300 subjects yields a sample, but demographic analysis of that sample reveals that there are 99 teachers in the sample, despite the fact that there are far fewer than 33% teachers in the total sample. The sample can be said to be

   1. Biased

   2. Controlled

   3. Multicausal

   4. Based on probability

      ANS: A

      The term bias means to slant away from the true or expected. A biased sample’s composition differs from that of the population from which the sample was drawn. Bias is of great concern in research because of the potential effect on the meaning of the study findings. Multicausality refers to a scenario in which interrelating variables cause a particular effect Control means having the power to direct or manipulate factors to achieve a desired outcome. Error is often discussed in relation to the researchers ability to make accurate conclusions. Probability addresses relative, rather than absolute, causality. From the perspective of probability, a cause will not produce a specific effect each time that particular cause occurs.

      DIF: Cognitive Level: Application REF: Page 197

9. The researcher divides his lab rats into two groups and administers IV methamphetamine to one of the groups, in order to determine its effect on the fear-flight response. This is an example of which of the following?

   1. Bias

   2. Control

   3. Correlation

   4. Multicausality

      ANS: B

      Control means having the power to direct or manipulate factors to achieve a desired outcome. The idea of control is very important to research, particularly to experimental and quasi- experimental studies. The greater the amount of control the researcher has of the study situation, the more credible the study findings. The purpose of the research design is to maximize control factors in the study situation. The term bias means to slant away from the true or expected. A biased opinion has failed to include both sides of the question.

      Correlational research examines linear relationships between two or more variables and determines the type (positive or negative) and degree (strength) of the relationship, not cause.

      DIF: Cognitive Level: Application REF: Page 197

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

    1. Statistical conclusion validity

    2. Internal validity

    3. Construct validity

    4. External validity

       ANS: A

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

       DIF: Cognitive Level: Analysis REF: Page 198

11. A researcher is comparing a new and less expensive treatment with an established treatment, in hopes of showing that there is no difference in outcome. The researcher does not perform a power analysis and, consequently, selects a sample size that is smaller than what would be recommended for an analysis of variance. The results show that there is a significant difference in outcome between the two treatments, and that the new treatment has poorer outcomes. What is the negative result of the researcher’s decision to use a smaller sample?

    1. The statistical conclusions reached are incorrect.

    2. There is no negative result.

    3. The study will have to be replicated, because its sample was small.

    4. The researcher is guilty of misconduct.

       ANS: B

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

       DIF: Cognitive Level: Analysis REF: Page 198

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

    1. Statistical conclusion validity

    2. Internal validity

    3. Construct validity

    4. External validity

       ANS: B

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

       DIF: Cognitive Level: Analysis REF: Page 200

13. A researcher tests a new intervention for nausea associated with chemotherapy, in hospitalized patients. He does not want to suggest nausea to the patients, so as his dependent variable, he uses the answer the patients give to the question, “How are you feeling this morning?” This is a threat to which type of validity?

    1. Statistical conclusion validity

    2. Internal validity

    3. Construct validity

    4. External validity

       ANS: C

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

       DIF: Cognitive Level: Analysis REF: Page 200

14. A researcher conducts research and uses a small sample that is not randomly selected. When he replicates the study, twice, he again uses the same site and another small sample that is not randomly selected. This is a threat to which type of validity?

    1. Statistical conclusion validity

    2. Internal validity

    3. Construct validity

    4. External validity

       ANS: D

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

       DIF: Cognitive Level: Analysis REF: Page 200

15. If a researcher plans to study graduate-level achievement in all students who were educated under the Vermont public school system, in a small town that used both state-mandated texts and enrichment texts of the school board’s choosing, the researcher would be using a fairly small sample, bound by geography and time. Which type of validity is decreased by a study like this one?

    1. Construct validity

    2. Statistical conclusion validity

    3. External validity

    4. Internal validity

       ANS: C

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

       DIF: Cognitive Level: Analysis REF: Page 202

16. What is the essential difference between a control group and a comparison group?

    1. A control group’s data is collected at the same time as the experimental group’s data. A comparison group’s data is collected before that of the experimental group.

    2. A control group is larger in size than a comparison group.

    3. A control group exists only is a basic lab situation. All nursing studies use comparison groups.

    4. A control group is randomly assigned. A comparison group is not.

       ANS: D

       If the study involves an experimental treatment, the design usually calls for a comparison. Outcome measures for individuals who receive the experimental treatment are compared with outcome measures for those who do not receive the experimental treatment. This comparison requires a control group—subjects who do not receive the experimental treatment. However, in nursing studies, all patients require care, and those who do not receive the study intervention receive standard care. Nurse researchers often refer to the group receiving standard care, but no treatment, as the comparison group rather than the control group.

       Essentially, the main difference between these terms is that control groups are nearly identical to their experimental groups, except for assignment. Comparison groups differ, because of the time at which data are collected, the way they are constituted, or other circumstances that make them less likely to be nearly identical, leading to a higher occurrence of threats to internal validity.

       DIF: Cognitive Level: Application REF: Page 203

17. A school nurse researcher studying bullying discovers that the type of victimization she is observing is different for different racial groups and genders within her school district. She wants to study the effect of peer support on bullying and chooses to make sure that the experimental and control groups, although randomly assigned, contain equal percentages of children of all races. What does this strategy exemplify?

    1. Carryover

    2. Blocking

    3. Counterbalancing

    4. Sequencing

       ANS: B

       In blocking, the researcher includes subjects with various levels of an extraneous variable in the sample but controls the numbers of subjects at each level of the variable and their random assignment to groups within the study. Designs using blocking are referred to as randomized block designs. The extraneous variable is then used as an independent variable in the data analysis. Therefore, the extraneous variable must be included in the framework and the study hypotheses.

       DIF: Cognitive Level: Application REF: Page 206

18. A researcher uses matching to constitute his control group, while performing a study on psychotherapy as an adjunct treatment for substance addiction. What type of validity might be enhanced by matching, in this instance?

    1. Construct validity

    2. Statistical conclusion validity

    3. External validity

    4. Internal validity

       ANS: D

       Matching is used when a subject in the experimental group is randomly selected and then a subject similar in relation to important extraneous variables is randomly selected for the control group. For example, subjects in the experimental and control groups might be matched for age, gender, severity of illness, or number of chronic illnesses. Statistical conclusion validity is concerned with whether the conclusions about relationships or differences drawn from statistical analysis are an accurate reflection of the real world: it is not affected by use of matching. Internal validity is the extent to which the effects detected in the study are a true reflection of reality rather than the result of extraneous variables: matching can increase internal validity if the researcher can correctly identify the principal extraneous variables.

       Construct validity examines the fit between the conceptual definitions and operational definitions of variables: matching has no effect on this. External validity is concerned with the extent to which study findings can be generalized beyond the sample used in the study; matching does not affect external validity, to any extent.

       DIF: Cognitive Level: Synthesis REF: Page 207

19. Immediately after the intervention in an experimental study of the negative effects of smoking tobacco, the state tax on cigarettes increases the cost from $4 to $8 per pack. Which threat to internal validity does this pose?

    1. Mortality

    2. History

    3. Testing

    4. Selection

       ANS: B

       History is an event that is not related to the planned study but that occurs during the time of the study. History could influence a subject's response to the treatment and alter the outcome of the study. The attrition threat is due to subjects who drop out of a study before completion. The circumstances in which a study is conducted (history) influence the treatment and thus the generalizability of the findings. Sometimes, the effect being measured (testing) can be due to the number of times the subject’s responses have been tested. The subject may remember earlier, inaccurate responses and modify them, thus altering the outcome of teh study.

       DIF: Cognitive Level: Application REF: Page 199

20. Subjects in a multiple group experimental study are tested for how much time it takes them to navigate a maze and find the chocolate. The maze is reconstructed after each run, and three different floor plans are used. Each group is tested eight times in eight hours. at a different time of day. The runs later in the day have faster times than the earlier ones. Which threat to internal validity might account for this difference?

    1. Instrumentation

    2. Selection

    3. Maturation

    4. Statistical regression toward the mean

       ANS: C

       Effects can be due to changes in measurement instruments (instrumentation) between the pretest and the posttest rather than a result of the treatment. Selection addresses the process by which subjects are chosen to take part in a study and how subjects are grouped within a study. Maturation is defined as growing older, wiser, stronger, hungrier, more tired, or more experienced during the study. The subkects in this study may have been through the three different floor plans enough times to learn them. Such unplanned changes can influence the findings of the study. Experimenter expectancy occurs when a researcher expects a particular intervention to relieve pain.

       DIF: Cognitive Level: Application REF: Page 199

21. A researcher believes that therapy is more effective if patients exercise. He tells his patients that he has arranged for them to use the hospital gym, if they so desire—and that if they are interested, they will then be in the experimental group. This represents which threat to internal validity?

    1. Maturation

    2. Reliability of the implementation

    3. History

    4. Selection

       ANS: D

       Selection addresses the process by which subjects are chosen to take part in a study and how subjects are grouped within a study. A selection threat is more likely to occur in studies in which random assignment is not possible. In some studies, people selected for the study may differ in some important way from people not selected for the study. In other studies, the threat is due to differences in subjects selected for study groups. In this study, subjects choose to be in the experimental group because they were willing to exercise; in this way, they differ from the rest of the group—possibly they are less depressed—and this could introduce bias into the study.

       DIF: Cognitive Level: Application REF: Page 199

22. What is the antidote to the carryover effect?

    1. Random assignment

    2. Counterbalancing

    3. Sequencing

    4. Bias control

       ANS: B

       Sometimes the application of one treatment can influence the response to later treatments, a phenomenon referred to as a carryover effect. If a carryover effect is known to occur, it is not advisable for a researcher to use this design strategy for the study. However, even when no carryover effect is known, the researcher may take precautions against the possibility that this effect will influence outcomes. In one such precaution, known as counterbalancing, the various treatments are administered in random order rather than being provided consistently in the same sequence.

       DIF: Cognitive Level: Comprehension REF: Page 204

23. What is the best research approach for investigating the actual representation of male labor- delivery nurses within healthcare institutions and the workplace beliefs and prejudices that perpetuate their disproportionate representation?

    1. Mixed methods approach

    2. Quantitative approach

    3. Qualitative approach

    4. Outcomes approach

       ANS: A

       Mixed methods research is characterized as research that contains elements of both qualitative and quantitative approaches. The philosophical underpinnings of mixed methods research and what paradigms best fit these research methods are still evolving. Over the last few years, many researchers have departed from the idea that one paradigm or one research strategy is right and have taken the perspective that the search for the truth requires the use of all available strategies. A single approach to measuring a concept may be inadequate to justify a claim that it is a valid measure of a theoretical concept. Testing a single theory may leave the results open to the challenge of rival hypotheses from other theories. To capitalize on the representativeness and generalizability of quantitative research and the in-depth, contextual nature of qualitative research, mixed methods are combined in a single research study.

       DIF: Cognitive Level: Application REF: Page 208

24. As Denzin claimed, there is an advantage to performing mixed methods or triangulated research. In a study of pain and fatigue control after hip replacement, what would the primary advantage be of conducting both a quantitative descriptive portion and a grounded theory portion?

    1. The results would be more difficult to understand, but more scholarly.

    2. It would force a multiple-authorship arrangement, assisting each scholar.

    3. Bias would decrease.

    4. The time required to complete the study would be approximately double that of completing one that utilized only one method.

       ANS: C

       Denzin (1989) believed that combining multiple theories, methods, observers, and data sources can assist researchers in overcoming the intrinsic bias that comes from single-theory, single-methods, and single-observer studies. Triangulation evolved to include using multiple data collection and analysis methods, multiple data sources, multiple analysts, and multiple theories or perspectives. The concept of triangulation is now commonly replaced with the idea of mixed methods approaches

       DIF: Cognitive Level: Application REF: Page 208

25. A researcher tests the effect of a new laparoscopic treatment for chronic shoulder dislocation. The results are statistically significant, and the researcher states in his findings that there is evidence that the treatment has promise for widespread application. A subsequent replication study fails to show statistical significance. A third study produces the same effects as the second. What is the most likely explanation here?

    1. Type I error occurred in the first study.

    2. Type II error occurred in the second and third studies.

    3. Random error produced insufficient power.

    4. Bias was introduced by replicating the study.

ANS: A

A serious concern in research is incorrectly concluding that a relationship or difference exists when it does not (type I error, rejecting a true null). If only one of three studies supported the new treatment, it is most likely that a type I error occurred in the first study. Low statistical power increases the probability of concluding that there is no significant difference between samples when actually there is a difference (Type II error, failing to reject a false null). A type II error is most likely to occur when the sample size is small ro when the power of the statistical test to determine differences is low. Random error has no effect on power.

Replication of research identifies areas of bias; it does not introduce bias.

DIF: Cognitive Level: Analysis REF: Page 198

MULTIPLE RESPONSE

1. Threats to statistical conclusion validity include which of the following? (Select all that apply.)

   1. Fishing

   2. Low statistical power

   3. Maturation

   4. Violated assumptions of statistical tests

   5. History threat

      ANS: A, B, D

      Statistical conclusion validity is concerned with whether the conclusions about relationships or differences drawn from statistical analysis are an accurate reflection of the real world. Low statistical power increases the probability of concluding that there is no significant difference between samples when actually there is a difference (type II error, failing to reject a false null) (see Chapter 8 for discussion of the null hypothesis). Most statistical tests have assumptions about the data collected, which include the following: (1) the data are at least at the interval level, (2) the sample was randomly obtained, and (3) the distribution of scores was normal. If these assumptions are violated, the statistical analysis may provide inaccurate results. The risk of type I error increases when the researcher conducts multiple statistical analyses of relationships or differences; this procedure is referred to as fishing.

      DIF: Cognitive Level: Comprehension REF: Page 198

2. Causality is tested through which of the following? (Select all that apply.)

   1. Grounded theory research

   2. Experimental research

   3. All quantitative research

   4. Mixed methods research

   5. Quasi-experimental research

      ANS: B, E

      The first assumption you must make in examining causality is that causes lead to effects. The only two of the primary quantitative methods that routinely examine classic causality are experimental and quasi-experimental research.

      DIF: Cognitive Level: Comprehension|Cognitive Level: Application REF: Page 195

3. Quantitative experimental researchers often “brainstorm” after each study, discussing the findings with colleagues, in order to interpret them and create new theories and strategies for testing them. Then they proceed to the next study. This is similar to a sine wave—first quantitative, then qualitative, and then quantitative, and so on. This represents an informal and ongoing combination of what research strategies? (Select all that apply.)

   1. Mixed methods

   2. Sequential explanatory

   3. Blocking

   4. Multicausality

   5. Content analysis

   6. Sequential exploratory

   7. Sequential transformative

      ANS: B, F, G

      With the sequential explanatory strategy the researcher collects and analyzes quantitative data followed by the collection and analysis of qualitative data. Integration of the data occurs during the interpretation phase. The purpose of this approach is to assist in explaining and interpreting quantitative data. It is useful when unexpected quantitative results are revealed.

      Qualitative examination of the phenomenon facilitates a fuller understanding and is well suited to explaining and interpreting relationships. There may or may not be a theoretical perspective to the study. This approach is easy to implement, because the steps fall in sequential stages, but the two-stage approach extends the length of time involved in data collection and is seen as a weakness of the design.

      DIF: Cognitive Level: Comprehension|Cognitive Level: Application REF: Page 209

4. Which of the following statements would lend support to the hypothesis that increasing scientific knowledge allows humans to grasp multicausality, when single causation was previously assumed to be the case in the time of the essentialists? (Select all that apply.)

   1. Adolescents and young adults with entitlement issues may have been raised with deprivation, not indulgence.

   2. Scientific knowledge is increasing, as the gene is mapped.

   3. The weather cannot be controlled, but it can be affected by geologic events such as volcanic eruption.

   4. Gender of the fetus, although determined by the father, may be more likely to be either male or female, depending on the timing of sexual relations.

   5. Genetic migrations can be tracked fairly effectively, by calculating the relative

      frequency of various Landsteiner blood types in different countries.

      ANS: A, C, E

      A philosophical group known as essentialists proposed that two concepts must be considered in determining causality: necessary and sufficient. The proposed cause must be necessary for the effect to occur. (The effect cannot occur unless the cause first occurs.) The proposed cause must also be sufficient (requiring no other factors) for the effect to occur. This leaves no room for a variable that may sometimes, but not always, serves as the cause of an effect. “Spare the rod and spoil the child.” “Everybody talks about the weather, but nobody does anything about it.” “The father effectively “decides” the gender of the child by passing on either an X or a Y to the offspring.”

      DIF: Cognitive Level: Application REF: Page 209

5. In which instances could bias in measuring embarrassment be decreased? (Select all that apply.)

   1. Use more than only one way of collecting the data (such as a verbal response + an external rater).

   2. Use more than only one question to elicit the response (such as Yes–No + how much).

   3. Use more than only one modality of measurement (such as Yes–No + a physiologic instrument).

   4. Hypnotize subjects, so that they give absolutely honest answers.

   5. Replicate the study.

      ANS: A, B, C

      Mono-operation bias occurs when only one method of measurement is used to assess a construct. When only one method of measurement is used, fewer dimensions of the construct are measured. Construct validity greatly improves if the researcher uses more than one instrument. It is often possible to apply more than one measurement of the dependent variable with little increase in time, effort, or cost. In monomethod bias, the researcher uses more than one measure of a variable, but all the measures use the same method of recording.

      DIF: Cognitive Level: Analysis REF: Page 201

6. A researcher wants to make sure that his experimental group and his control group are equivalent, so he uses random sampling followed by random assignment to group. What else must the researcher do to assure the consumers of his research that the groups were equivalent? (Select all that apply.)

   1. Report the sameness or difference of potentially extraneous variables, using post hoc statistical testing.

   2. Eliminate all other extraneous variables from the analysis.

   3. Rebalance the samples, controlling for all potentially extraneous variables, by moving subjects back and forth until both groups have the same distribution of all variables.

   4. Randomly assign the sample again, hoping for a better outcome the second time.

   5. Report the sameness or difference of subgroups possessing unequal proportions of any potentially extraneous variable, with respect to the dependent variable.

      ANS: A, E

      The most effective strategy for achieving equivalence is random sampling followed by random assignment to groups. However, this strategy does not guarantee equivalence. Even when randomization has been used, the researcher must examine the extent of equivalence by measuring and comparing characteristics for which the groups must be equivalent. This comparison is usually reported in the description of the sample.

      DIF: Cognitive Level: Synthesis REF: Page 203

7. A researcher plans to study graduate-level achievement in all students who were educated under the Vermont public school system, in a small town that used both state-mandated texts and enrichment texts of the school board’s choosing. Considering the limitations to generalizability, how can the researcher justify conducting the study to the institutional review board? (Select all that apply.)

   1. The researcher does not have to justify conducting the study. It has not been performed before, and so there is a gap in the literature.

   2. The researcher could argue that if graduate-level achievement is markedly lower in this group, the results could cautiously suggest revision of the town’s educational practices.

   3. The researcher could write a proposal to study all towns in Vermont, so as to have been generalizability, and then study only this one.

   4. The researcher could justify conducting the study on the basis that it might enlighten the public school system in its decisions to mandate chosen texts.

   5. The researcher could reason that if graduate-level achievement is markedly higher in this group, the results could cautiously suggest a similar educational approach for other similar communities.

      ANS: B, D, E

      External validity is concerned with the extent to which study findings can be generalized beyond the sample used in the study. With the most serious threat, the findings would be meaningful only for the group being studied. To some extent, the significance of the study depends on the number of types of people and situations to which the findings can be applied. Sometimes, the factors influencing external validity are subtle and may not be reported in research reports; however, the researcher must be responsible for these factors. Generalization is usually narrower for a single study than for multiple replications of a study using different samples, perhaps from different populations in different settings.

      DIF: Cognitive Level: Analysis REF: Page 202

8. Why does subject attrition affect internal validity?

   1. A study in which the majority of the subjects die calls into question whether the treatment itself is safe.

   2. Subjects who drop out may differ from those who stay in the study, in terms of an important extraneous variable.

   3. If subjects drop out of the control group, and not the experimental group, it strongly implies that there is some benefit to participation of which the researchers may not be aware.

   4. Subject mortality may result in a sample that is so much smaller than anticipated that type II error may result.

   5. Type I error is almost guaranteed with very unequal sample sizes.

      ANS: B, C

      The subject attrition threat is due to subjects who drop out of a study before completion. Participants’ attrition becomes a threat when (1) those who drop out of a study are a different type of person from those who remain in the study or (2) there is a difference between the kinds of people who drop out of the experimental group and the people who drop out of the control or comparison group

      DIF: Cognitive Level: Synthesis REF: Page 200

9. Aside from random assignment using a large sample, what are ways to structure a design that control for known extraneous variables? (Select all that apply.)

   1. Matching

   2. Selection of a heterogeneous sample

   3. Selecting a homogeneous sample

   4. Blocking

   5. Stratification

      ANS: A, C, D, E

      Homogeneity is a more extreme form of equivalence in which the researcher limits the subjects to only one level of an extraneous variable to reduce its impact on the study findings. To use this strategy, you must have previously identified the extraneous variables. Matching is used when a subject in the experimental group is randomly selected and then a subject similar in relation to important extraneous variables is randomly selected for the control group.

      Heterogeneity is designed to increase generalizability of the study findings, not to control for extraneous variables. In blocking, the researcher includes subjects with various levels of an extraneous variable in the sample but controls the numbers of subjects at each level of the variable and their random assignment to groups within the study. Stratification involves the distribution of subjects throughout the sample, using sampling techniques similar to those used in blocking, but the purpose of the procedure is even distribution throughout the sample. The extraneous variable is not included in the data analysis. Distribution of the extraneous variable is included in the description of the sample.

      DIF: Cognitive Level: Analysis REF: Page 206

10. What is the most effective way to minimize the effect of all extraneous variables between the experimental group and the control group? (Select all that apply.)

1. Match the groups by hand.

2. Randomly assign subjects to group.

3. Use a large sample.

4. Place subjects into groups according to the extraneous variables they possess.

5. Allow subjects to choose the groups to which they want to belong.

ANS: B, C

Design strategies used to control extraneous variables include random sampling, random assignment to groups, selecting subjects that are homogeneous in terms of a particular extraneous variable, selecting a heterogeneous sample, blocking, stratification, matching subjects between groups in relation to a particular variable, and statistical control. Random sampling increases the probability that subjects with various levels of an extraneous variable are included and are randomly dispersed throughout the groups within the study (Thompson, 2002). This strategy is particularly important for controlling unidentified extraneous variables.

DIF: Cognitive Level: Application REF: Page 204

Chapter 11: Selecting a Quantitative Research Design Test Bank

MULTIPLE CHOICE

1. How does a comparative descriptive design differ from a typical descriptive design?

   1. It compares statistics between the current time and an earlier time, whereas the typical descriptive design focuses on only one time period.

   2. It compares a number of variables and examines the relationship between them, whereas a typical descriptive design never does this.

   3. It differs in name only; both have the same design.

   4. It describes data from two different groups, whereas a typical descriptive design focuses on a single group.

      ANS: D

      The commonly used descriptive study design examines characteristics of a single sample. It identifies a phenomenon of interest and the variables within the phenomenon, develops conceptual and operational definitions of the variables, and describes the variables. The comparative descriptive design examines and describes differences in variables in two or more groups that occur naturally in the setting. Descriptive statistics and inferential statistical analyses may be used to examine differences between or among groups.

      DIF: Cognitive Level: Analysis REF: Page 216

2. Why is the threat of subject attrition more problematic in longitudinal designs than in other types of descriptive research?

   1. Subjects are elderly.

   2. Data analysis is complex, and missing data points necessitate dropping the subject from the analysis.

   3. Data collection occurs over a much longer period of time.

   4. There is selection bias because of the study requirements.

      ANS: C

      Longitudinal designs examine changes in the same subjects over time. They are expensive and require a long period of researcher and subject commitment. Measurement must be carefully planned and implemented, because the measures will be used repeatedly over time. There is often a bias in selection of subjects because of the requirement for a long-term commitment.

      In addition, loss of subjects (attrition—subject quits participating in the study) can be high and can decrease the validity of findings.

      DIF: Cognitive Level: Analysis REF: Page 219

3. What do cross-sectional designs, trend designs, and event-partitioning designs have in common?

   1. They all study subjects at one time.

   2. They all focus on change over time.

   3. They all involve data collection over months or year.

   4. They are identical to longitudinal designs.

      ANS: B

      Cross-sectional designs examine groups of subjects in various stages of development, trends, patterns, and changes simultaneously with the intent to describe changes in the phenomenon across stages. The assumption is that the stages are part of a process that will progress over time. Selecting subjects at various points in the process provides important information about the totality of the process, even though the same subjects are not monitored through the entire process. Trend designs examine changes in the general population in relation to a particular phenomenon. The researchers select different samples of subjects from the same population at preset intervals of time, and at each selected time, they collect data from that particular sample. A merger of the cross-sectional or longitudinal and trend designs, the event- partitioning design, is used in some cases to increase sample size and to avoid the effects of history on the validity of findings. Cook and Campbell referred to these as cohort designs with treatment partitioning. True longitudinal designs examine changes in the same subjects over time. They are expensive and require a long period of researcher and subject commitment.

      Measurement must be carefully planned and implemented because the measures will be used repeatedly over time.

      DIF: Cognitive Level: Synthesis REF: Page 220

4. The difference between a randomized block design and the more modern variant of including the extraneous variable in a multivariate analysis is which of the following?

   1. The potentially extraneous variable is treated as an ordinal variable in the randomized block design but can be considered as a ratio or interval variable in a multivariate analysis.

   2. In a multivariate analysis, the extraneous variable is excluded from analysis.

   3. In a randomized block design two to three times as many subjects were required for statistical analysis.

   4. In a randomized block design, the sample is chosen so that it lacks the potentially extraneous variable.

      ANS: A

      The randomized block design uses the two-group pretest-posttest or the two-group posttest pattern with the addition of a blocking variable. The blocking variable, if uncontrolled, is expected to confound the findings of the study. To prevent confounding of the findings, the subjects are rank ordered in relation to the blocking variable. This procedure ensures that the experimental group and the comparison group are equal in relation to the potentially confounding variable. The effect of blocking can also be accomplished statistically (through the use of analysis of covariance) without categorizing the confounding variable into discrete components.

      DIF: Cognitive Level: Analysis REF: Page 246

5. A factorial design study measures the effect upon hemoglobin levels of four independent variables, each administered randomly and independently. How many distinct groups are there in this factorial design?

   1. 4

   2. 8

   3. 12

   4. 16

      ANS: D

      In a factorial design, two or more different characteristics, treatments, or events are independently varied within a single study. This design is a logical approach to examining multicausality. The simplest arrangement is one in which two treatments or factors are involved and, within each factor, two levels are manipulated (for example, the presence or absence of the treatment); this is referred to as a 2  2 factorial design. A 2  2 factorial design produces a study with four cells (A through D). Each cell must contain an approximately equivalent number of subjects. Cells B and C allow the researcher to examine of each intervention separately. Cell D subjects receive no treatment and serve as a control group. Cell A allows the researcher to examine the interaction between the two independent variables.

      This design can be used, as in the randomized block design, to control for confounding variables. With four independent variables, M, N, O, and P are randomly applied, and so there are sixteen groups. The formula is that the number of possibilities is equal to the number 2 to the power of how many binary variables there are. One variable is 2, two variables are 4, three variables are 8, and four are 16.

      M	N	O	P	Variables
      Group 1	+	+	+	–	M, N, O
      Group 2	+	–	+	–	M, O
      Group 3	+	+	–	–	M, N
      Group 4	+	–	–	–	M
      Group 5	–	+	+	–	N, O
      Group 6	–	–	+	–	O
      Group 7	–	+	–	–	N
      Group 8	–	–	–	–	None
      Group 9	+	+	+	+	M, N, O, P
      Group 10	+	–	+	+	M, O, P
      Group 11	+	+	–	+	M, N, P
      Group 12	+	–	–	+	M, P
      Group 13	–	+	+	+	N, O, P
      Group 14	–	–	+	+	O, P
      Group 15	–	+	–	+	N, P
      Group 16	–	–	–	+	P

      DIF: Cognitive Level: Evaluation REF: Page 247

6. The following diagram represents what type of design?

   Group Subject selection Measurement Treatment Measurement Experimental R M T M Comparison NR M M

   1. Posttest only design

   2. Factorial design

   3. Pretest-posttest control group design

   4. Time series design

      ANS: C

      The pretest and posttest design with a comparison group is the most commonly used design in social science research. Subject selection is random (R) for only the experimental group, and non-random (NR) for the comparison group. Measurements for both groups (M) occur both before and after treatment. This quasi-experimental design is the first design discussed here that is generally interpretable. The uncontrolled threats to validity are primarily due to the absence of randomization and, in some studies, to the inability of the researcher to manipulate the treatment.

      DIF: Cognitive Level: Analysis REF: Page 237

7. Nurses who give discharge teaching to patients after colonoscopy call these patients the day after the procedure to check on their status. At that time, patients who have had polyps removed invariably ask how long it will be until they receive their results. The nurses decide to design a study in which they will change their discharge teaching, in order to include information about the timeframe for biopsy results, and measure the results, comparing them with the results for the next month, before the change. Which of the following types of research will they use?

   1. Correlational

   2. Quasi-experimental

   3. Experimental

   4. Descriptive

      ANS: B

      The intent of the study is to examine the effect of an intervention; thus, only quasi- experimental or experimental designs are appropriate. Quasi-experimental and experimental designs examine causality. The power of the design to accomplish this purpose depends on the extent to which the actual effects of the experimental treatment (the independent variable) can be detected by measuring the dependent variable. Because data collection will not occur simultaneously in both groups, the study cannot use random assignment to group, which means that it is quasi-experimental, not experimental. The posttest-only design with comparison group is the specific study design here. With a posttest-only design with comparison group, selection threat is a problem. The lack of a pretest would ordinarily be a serious impediment to defining change, but because very few subjects will know the timeline for receipt of biopsy results, this objection is of little concern.

      DIF: Cognitive Level: Application REF: Page 234

8. Several television programs, such as American Idol, allows viewers to text in votes for their favorite performer. From a research point of view, this is what kind of a design?

   1. Survey

   2. Predictive design

   3. Model testing design

   4. One-group pretest-posttest design

      ANS: A

      The term survey is used in two ways within scientific thought. It is used in a broad sense to mean any descriptive or correlational study; in this sense, survey tends to mean nonexperimental. In a narrower sense, survey is used to describe a data collection technique in which the researcher uses questionnaires or personal interviews to gather data about an identified population. Surveys, in the narrower definition, are used to gather data that can be acquired through self-report. Because of this limitation in data, some researchers view surveys as rather shallow and as contributing in only a limited way to scientific knowledge.

      DIF: Cognitive Level: Application REF: Page 224

9. If a one-group pretest-posttest study uses subjects as their own controls, which is the study design?

   1. Experimental

   2. Quasi-experimental

   3. Correlational

   4. Descriptive

      ANS: B

      Quasi-experimental and experimental designs examine causality. Quasi-experimental study designs were developed to provide alternative means of examining causality in situations not conducive to experimental controls.

      DIF: Cognitive Level: Comprehension REF: Page 231

10. Identify the type of research design employed in the following study: “In order to determine nursing students’ stress throughout the four semesters of the major, nursing students in all four semesters were surveyed as class groups at the mid-point of two contiguous semesters of coursework. Stress was assessed by a researcher-composed quantitative questionnaire.”

    1. Cross-sectional design

    2. Longitudinal design

    3. Event-partitioning design

    4. Case-study design

       ANS: C

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

       DIF: Cognitive Level: Application REF: Page 215

11. Why does testing of a hypothesized causal model require a large sample?

    1. Many variables are present, so sample size must be large.

    2. The research is experimental, so a large multi-site sample is preferred.

    3. Causation cannot be demonstrated in a small sample.

    4. Differences are often miniscule, and so the effect size is small.

       ANS: A

       Some studies are designed specifically to test the accuracy of a hypothesized causal model. The model-testing design requires that all variables relevant to the model be measured. A large, heterogeneous sample is required.

       DIF: Cognitive Level: Synthesis REF: Page 227

12. A group of twenty-five Labrador retrievers and their owners, are brought to the research lab one by one. The Labrador retrievers are shown various stimuli, including a squirrel that runs along a wire at the top of the lab, to elicit barking. Then the owners command the dogs to stop barking, and the stimulus is repeated. The duration of barking is measured. Then the owners are taught a different technique for quieting their barking dogs. A week later, the dogs and their owners return to the lab, the stimuli are introduced, and the duration of barking is measured. This is an example of what type of design?

    1. One-group posttest-only design

    2. One-group pretest-posttest design

    3. Pretest and posttest design with comparison group

    4. Pretest and posttest design with removed-treatment

       ANS: B

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

       DIF: Cognitive Level: Application REF: Page 234

13. What is the study design used in the following research project?

    Twenty patients, all of whom have bipolar mania, have been placed on lithium and also begun on a medication believed to prevent rapid cycling. The patients are followed for 12 months, at which time they are seen by a psychiatrist monthly, to adjust their dosages.

    Medication compliance, emergency department visits, and mental health hospitalizations are measured. These are compared with another group of patients with the same mental illness, being treated on lithium alone.

    1. Posttest-only design with comparison group

    2. Pretest-posttest design with comparison group

    3. Pretest-posttest design with removed treatment

    4. Pretest-posttest design with two comparison treatments

       ANS: A

       The posttest-only design with comparison group offers an improvement on the one-group posttest-only design, because of the addition of a nonequivalent comparison group. However, subjects are tested only after the treatment; the group is not pretested, so there is no direct way to measure change. In the example given, there is no mention of pretesting. In the pretest and posttest design with a comparison group, both the experimental group and the comparison group are tested both before and after the experimental group is treated. The pretest and posttest design with removed-treatment creates conditions that approximate the conceptual requirements of a control group receiving no treatment. The design is basically a one-group pretest-posttest design. However, after a delay, a third measure of the dependent variable is taken, followed by an interval in which the treatment is removed, followed by a fourth measure of the dependent variable. Pretest-posttest design with two comparison treatments are used when two experimental treatments are being compared to determine which is most effective. In most cases, this design is used when one treatment is the currently identified treatment of choice and the researcher has identified a treatment that might lead to even better outcomes.

       DIF: Cognitive Level: Application REF: Page 237

14. Researchers studied alcohol recovery, comparing the success rate using 1) Alcoholics Anonymous, 2) residence in a recovery house, 3) residence in alcohol rehabilitation, and 4) individual psychotherapy. They measured sobriety at 18 months post treatment initiation. What study design was used for this research project?

    1. Factorial design

    2. Predictive correlational design

    3. Crossover strategy

    4. Classic experimental design

       ANS: B

       Predictive designs are used to predict the value of one variable on the basis of values obtained from another variable or variables. Prediction is one approach used to examine causal relationships between variables. In a factorial design, two or more different characteristics, treatments, or events are independently varied within a single study. This design is a logical approach to examining multicausality. Crossover, or counterbalancing, is a strategy designed to guard against possible erroneous conclusions resulting from carryover effects. With counterbalancing, subjects are randomly assigned to a specific sequencing of treatment conditions. This approach distributes the carryover effects equally throughout all the conditions of the study, thus canceling them out. The original, or classic, experimental design, is still the most commonly used experimental design. In this design, subjects are randomly assigned to treatment or control groups, and an intervention is enacted upon them by the researcher.

       DIF: Cognitive Level: Analysis REF: Page 226

15. A study’s hypothesis that a new surgical approach produces safer outcomes in immunosuppressed patients is tested in a fourteen-site research study across the United States. Subjects at all sites are randomly selected and randomly assigned to experimental versus control groups. What study design is used in this research project?

    1. Quasi-experimental design

    2. Randomized controlled trial

    3. Model testing design

    4. Counterbalanced design

       ANS: B

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

       DIF: Cognitive Level: Analysis REF: Page 231

16. Methodological designs are used to develop the validity and reliability of instruments to measure constructs used as variables in research. The process is lengthy and complex. The average length of researcher time required to develop a research tool to the point of appropriate use in a study is five years. Methodological studies include assessment of content validity, evaluation of the conceptual structure of a scale, construct validity, and assessment of reliability. A researcher is developing a tool to measure pre-delinquent behaviors in pre- adolescence. He has already reviewed the literature, gathered qualitative data from experts, pilot-tested hundreds of pre-delinquent preadolescents, and analyzed the findings. It is clear that the tool actually measures what it is supposed to measure. This reflects the tool’s

    1. Validity

    2. Utilizability

    3. Reliability

    4. Lack of bias

ANS: A

Methodological designs are used to develop the validity and reliability of instruments to measure constructs used as variables in research. The process is lengthy and complex and should begin with a thorough literature review. Qualitative data is often collected when there is not much known about a construct and will allow the researcher to identify key factors/concepts associated with the construct which might be used to create a checklist.

Validity refers to a tool’s ability to measure what the researcher intends it to measure.

DIF: Cognitive Level: Synthesis REF: Page 225

MULTIPLE RESPONSE

1. What is the disadvantage of using an event partitioning design? (Select all that apply.)

   1. It avoids complicated statistical analyses.

   2. The validity of its results depends on the assumption the all persons in the study are similar.

   3. It does not require as much time for data collection as does a longitudinal study.

   4. It measures small increments of an intervention instead of the whole intervention.

   5. It makes the assumption that a key event continues to occur in the same way.

      ANS: C, E

      A merger of the cross-sectional or longitudinal and trend designs, the event-partitioning design, is used in some cases to increase sample size and to avoid the effects of history on the validity of findings. Cook and Campbell referred to these as cohort designs with treatment partitioning. The term treatment is used loosely here to mean a key event that is thought to lead to change. In a descriptive study, the researcher would not cause or manipulate the key event but rather would clearly define it so that when it occurred naturally, it would be recognized. Data across subjects is assumed to be comparable, and a larger sample size would be available for later studies of changes over time.

      DIF: Cognitive Level: Analysis REF: Page 222

2. Patients in an outpatient treatment center receiving daily dressing changes were studied by means of a quasi-experimental design using a crossover strategy. Patients were administered either Morphine Contin or Percocet, by random assignment, on one day, and the other medication on the following day. Pain scores were obtained for both days, recorded and analyzed. Why was a crossover strategy used? (Select all that apply.)

   1. Because dressing changes may become less painful in some patients over time, as wounds heal, this strategy balanced the pain scores, across participants.

   2. Because dressing changes may become more painful over time, as debridement occurs, exposing raw tissue, this strategy balanced the pain scores, across participants.

   3. Because patients were not consented for the study and had to receive at least one traditional treatment.

   4. Because dressing changes may become less painful over time, as patients know what to expect, this strategy compensated by alternating first-treatment across patients.

      ANS: A, B, D

      Crossover, or counterbalancing, is a strategy designed to guard against possible erroneous conclusions resulting from carryover effects. With counterbalancing, subjects are randomly assigned to a specific sequencing of treatment conditions. This approach distributes the carryover effects equally throughout all the conditions of the study, thus canceling them out. The carryover effect, in this case, was pain related to healing and pain expectation.

      DIF: Cognitive Level: Analysis REF: Page 249

3. A researcher states in an article, “The subjects acted as their own controls.” If this is true, it implies which of the following? (Select all that apply.)

   1. The result measured by the researchers was something that varies more from person to person than it does within a single person.

   2. There were so few subjects that a separate control group could not be obtained.

   3. Measurement of the subjects was made at least twice.

   4. Two studies were performed.

   5. The methodology was quasi-experimental.

   6. The study was interventional.

      ANS: A, C, E, F

      The rationale for using a design in which subjects act as their own controls is that whatever is being measured varies quite a bit between persons, and the researcher is more interested in showing a change in the subjects than producing a given number value; because of this, a separate control group makes little sense. Examples of this are pain, nausea, and panic. If subjects act as their own controls, they must be measured at least once in the control condition and at least once in the experimental condition. Experimental research requires a separate control group; some quasi-experimental research allows subjects to act as their own controls. Correlational and descriptive research does not use controls—it uses comparison subjects.

      Quasi-experimental research is interventional.

      DIF: Cognitive Level: Evaluation REF: Page 249

4. In a quantitative research study, burn patients either washed their own wounds or had them washed by nursing staff daily. Patients performed self-washing on alternate days. Pain was measured at intervals during dressing changes. Patients were also interviewed near the end of hospitalization, from the theoretical perspective of symbolic interactionism in order to determine what factors made their pain more severe or less severe, under each condition. What study designs were used in this research project?

   1. Grounded theory research

   2. Model testing design

   3. Pretest-posttest with a removed treatment

   4. Mixed methods research

      ANS: A, C, D

      Pretest-posttest with a removed treatment is basically a one-group pretest-posttest design. Then the treatment is removed, followed by another measure of the dependent variable. The treatment may again be added, followed by another measure of the dependent variable, in which case this is called a “repeated reversal” approach. The periods between measures must be equivalent. Mixed methods research is characterized as research that contains elements of both qualitative and quantitative approaches. Grounded theory is congruent with, and its philosophy is derived from the theories of, symbolic interactionism. In a model-testing design, the accuracy of a hypothesized causal model is tested using both linear and multiple regression to differentiate variables that contribute from those which do not. A large, heterogeneous sample is required. All the paths expressing relationships between concepts are identified, and a conceptual map is developed.

      DIF: Cognitive Level: Synthesis REF: Page 227

5. The differences between the simple quasi-experimental pretest-posttest design and an experimental version of the same design with a control group, in which there was random assignment to group, would be which of the following? (Select all that apply.)

   1. The experimental design controls for more variables.

   2. Subjects are blind to group assignment in the experimental design.

   3. There is now a means of two-group comparison.

   4. The design controls for changes due to maturation or history.

   5. The researcher collects data more frequently.

      ANS: A, C, D

      The one-group pretest-posttest design is one of the more commonly used quasi-experimental designs. However, it has such serious weaknesses that findings are often uninterpretable.

      Pretest scores cannot adequately serve the same function as a comparison group. Events can occur between the pretest and posttest that alter responses to the posttest. The original, or classic, experimental design, or pretest-posttest control group design, is still the most commonly used experimental design. There are two randomized groups, one receiving the experimental treatment and one receiving no treatment, a placebo treatment, or the routine or standard care. By comparing pretest scores and the groups’ demographic characteristics, one can evaluate the effectiveness of randomization in providing equivalent groups. The researcher implements the treatment or independent variable under very controlled conditions. The dependent variable is measured twice, before and after the manipulation of the independent variable.

      DIF: Cognitive Level: Synthesis REF: Page 245

6. A posttest-only design with a comparison group, which is a quasi-experimental study, lacks conditions present in an experimental study. Which of the following are lacking in this type of study design? (Select all that apply.)

   1. There is no control group.

   2. There is no intervention.

   3. There is no random assignment to group.

   4. Group size is not predetermined.

   5. Generalization is not possible.

      ANS: A, C

      Quasi-experimental and experimental designs examine causality. The power of the design to accomplish this purpose depends on the extent to which the actual effects of the experimental treatment (the independent variable) can be detected by measuring the dependent variable.

      Quasi-experimental study designs were developed to provide alternative means of examining causality in situations not conducive to experimental controls. Experimental research must use random assignment to group, and it must have a true control group.

      DIF: Cognitive Level: Evaluation REF: Page 225

7. Correlational research has which of the following characteristics? (Select all that apply.)

   1. Examines the strength of a relationship, to determine causality

   2. Allows independent variables to be manipulated

   3. Examines relationships among existing variables

   4. Is always used to generate rather than test hypotheses

   5. Examines differences under at least two conditions

   6. Is non-interventional

      ANS: C, F

      Descriptive and correlational research are both non-interventional, in that the researcher does not do anything to the research subjects except measure them. No attempt is made to control or manipulate the situation. Correlational study designs examine the degree of relationship between or among variables. Neophyte researchers tend to make two serious errors with correlational studies. First, they often attempt to establish causality by correlation, reasoning that if two variables are related, one must cause the other. Second, they confuse studies in which differences are examined with studies in which relationships are examined. Although the existence of a difference assumes the existence of a relationship, the design and statistical analysis of studies examining differences are not the same as those examining relationships.

      DIF: Cognitive Level: Comprehension REF: Page 231

8. A nurse notes that of her clients with multiple tattoos, many are missing quite a few of their teeth. She designs a study to measure causation. Why is this problematic? (Select all that apply.)

   1. Tattooing can be expensive.

   2. Causing subjects to become multiply tattooed, so as to cause their teeth to fall out, is ethically questionable.

   3. Random assignment to group would be impossible.

   4. The researcher cannot cause subjects’ teeth to fall out; that would be ethically questionable.

   5. The study would have to be designed as a large-sample, multisite design.

      ANS: B, D

      Quasi-experimental and experimental designs examine causality. The power of the design to accomplish this purpose depends on the extent to which the actual effects of the experimental treatment (the independent variable) can be detected by measuring the dependent variable.

      Not every correlational observation lends itself to an experimental design, because in an experimental design the researcher must cause one of the events to happen, in order to examine its effect on the other variable. This has obvious ethical implications. The principle of beneficence requires the researcher to do good and “above all, do no harm.”

      DIF: Cognitive Level: Evaluation REF: Page 231

9. A hospital manager reviews charting to determine what kind of oral care patients have actually been receiving, who has been delivering the oral care, and oral care’s relationship with infection of all sources. This study could be which of the following? (Select all that apply.)

   1. Prospective

   2. Retrospective

   3. Correlational

   4. Descriptive

   5. Quasi-experimental

      ANS: B, C, D

      In retrospective studies, both the proposed cause and the proposed effect have already occurred. In a prospective cohort study, causes may have occurred, but the proposed effect has not. When both cause and effect have occurred prior to the initiation of the study, the research is referred to as non-interventional: the researcher did nothing to the research subjects.

      Descriptive and correlational designs examine variables in natural environments, such as home, and do not include researcher-designed treatments or interventions. Quasi-experimental and experimental designs examine the effects of an intervention by comparing differences between groups that have received the intervention and those that have not received the intervention. Retrospective research examines data collected in the past, typified by review of medical records. Retrospective research may be either correlational or descriptive in nature.

      DIF: Cognitive Level: Synthesis REF: Page 219

10. In a national health study, begun in 2012, thousands of nurses are participating in ongoing research to better understand the effects of omega-3 fish oil and Vitamin D-3 upon cardiovascular health and bone health. Subjects are randomly assigned to experimental or control group, for the two variables. Data about cardiovascular health and bone health is in progress and planned to continue until 2017. This study could be an example of what types of research? (Select all that apply.)

    1. Prospective

    2. Retrospective

    3. Factorial study

    4. Event-partitioning

    5. Descriptive

    6. Correlational

    7. Experimental

    8. Quasi-experimental

       ANS: A, C, G

       In retrospective studies, both the proposed cause and the proposed effect have already occurred. In a prospective cohort study, causes may or may not have occurred, but the proposed effect has not. Descriptive and correlational designs are both non-interventional, since they examine variables in natural environments, such as home, and do not include researcher-designed treatments or interventions. Quasi-experimental and experimental designs are both interventional, since they examine the effects of an intervention by comparing differences between groups that have received the intervention and those that have not received the intervention. A merger of the cross-sectional or longitudinal and trend designs, the event-partitioning design, is used in some cases to increase sample size and to avoid the effects of history on the validity of findings. Cook and Campbell referred to these as cohort designs with treatment partitioning. The term treatment is used loosely here to mean a key event that is thought to lead to change. In a descriptive study, the researcher would not cause or manipulate the key event but rather would clearly define it so that when it occurred naturally, it would be recognized. Data across subjects is assumed to be comparable, and a larger sample size would be available for later studies of changes over time. In a factorial design, two or more different characteristics, treatments, or events are independently varied within a single study. This design is a logical approach to examining multicausality.

       DIF: Cognitive Level: Synthesis REF: Page 219

11. A study that studies non-smoking women with stage IV non-small cell lung cancer, following the progression of the disease in response to treatment, could have which of the following designs? (Select all that apply.)

    1. Comparative descriptive

    2. Time-dimensional

    3. Experimental

    4. Cross-sectional

    5. Trend designs

    6. Longitudinal

    7. Event partitioning

       ANS: B, D, F, G

       The comparative descriptive design examines and describes differences in variables in two or more groups that occur naturally in the setting. Time-dimensional designs examine trends over time, growth, or sequences and patterns of change. The dimension of time, then, becomes an important factor. The samples in time-dimensional studies are called cohorts. Experimental designs involve a researcher intervention, measuring its effect. Cross-sectional designs examine groups of subjects in various stages of development, trends, patterns, and changes simultaneously with the intent to describe changes in the phenomenon across stages. Trend designs examine changes in the general population in relation to a particular phenomenon.

       Longitudinal designs examine changes in the same subjects over time. A merger of the cross- sectional or longitudinal and trend designs, the event-partitioning design, is used in some cases to increase sample size and to avoid the effects of history on the validity of findings.

       DIF: Cognitive Level: Analysis REF: Page 217

12. A researcher is designing a fully randomized clinical trial. What must a fully randomized clinical trial contain? (Select all that apply.)

    1. Random collection of data in both groups

    2. Random operationalization of the dependent variable

    3. Random assignment to group

    4. Random selection

    5. Random application of the independent variable

       ANS: C, D

       A randomized clinical trial is a planned experiment designed to determine the efficacy of a treatment or independent variable in a study where the experimental group receives the treatment and the control group does not. The research subjects are obtained by random selection. The experimental group and the control group are constituted through random assignment. Then the researcher enacts the independent variable on the experimental group only. In clinical trials, data collection proceeds simultaneously for both groups.

       DIF: Cognitive Level: Analysis REF: Page 250

13. Predictive correlational studies are designed to provide a way to predict the value of one variable, in relation to another variable. Which of the following research studies is predictive correlational in design? (Select all that apply.)

    1. One that studies the relationship of admission blood alcohol level in chronic alcoholics upon the amount of time that elapses before delirium tremens begin

    2. One that classifies patients coming to an emergency department as critically ill, acutely ill, or not acutely ill

    3. One that quantifies the probability that adolescents completing a one-day type I diabetes workshop will develop ketoacidosis in the following year

    4. One that studies both girls and boys in grammar school and counts the number of interactions they have with one another daily

    5. One that examines the outcomes of post-term labor

    6. One that measures the effect of a researcher-applied independent variable upon a dependent variable

       ANS: A, C

       The aim of a predictive design is to predict the level of the dependent variable from the independent variable or variables.

       DIF: Cognitive Level: Application REF: Page 226

14. Which of the following research methods test for causality? (Select all that apply.)

    1. Experimental research

    2. Causational modeling

    3. Case study research

    4. Quasi-experimental research

    5. Cross-sectional research

ANS: A, D

Quasi-experimental and experimental designs examine causality. The power of the design to accomplish this purpose depends on the degree to which the actual effects of the experimental treatment (the independent variable) can be detected by measuring the dependent or outcome variable. Correlational studies examine relationships between variables, but do not provide information on causality. The case study design involves an intensive exploration of a single unit of study, such as a person, family, group, community, or institution, or a small number of subjects who are examined intensively. Cross-sectional designs are not causational.

DIF: Cognitive Level: Analysis REF: Page 231

Chapter 12: Qualitative Research Methodology Test Bank

MULTIPLE CHOICE

1. In addition to the aim or goal of the study, the purpose statement for a qualitative study should include The phenomenon of interest, the population, and the

   1. Setting

   2. Rationale for conducting the study

   3. Theoretical framework used

   4. Hypothesis

      ANS: A

      The purpose statement for a qualitative study should include the phenomenon and population being studied and the setting. The rationale for conducting the study is not included in the purpose statement for qualitative research. The theoretical framework used is not a part of the purpose statement. Qualitative studies do not use hypothesis statements since stating expected outcomes and relationships are not consistent with the philosophical orientation of this approach. Instead, research questions or objectives are used.

      DIF: Cognitive Level: Comprehension REF: Page 266

2. In contrast to quantitative research study participants who are selected to be as representative of a population as possible, qualitative research participants are selected because they

   1. Are philosophically attuned to the use of narratives and narrative analysis as the best means to convey their experience to the researcher and to others

   2. Meet the requirements for involvement in the study that the researcher specified at the outset of the study’s implementation

   3. Also are representative of the population

   4. Have experienced the phenomenon of interest

      ANS: D

      The criterion for selecting participants for a qualitative study is that they have experienced the phenomenon of interest. The participants’ view of the value of narrative research and analysis is not the reason that study participants in a qualitative study are selected. In qualitative methodology, the method of sampling may differ as the study progresses, since the researcher may be led to interview a broader range of subjects than originally intended by what early participants relate. Although representativeness of the sample, especially through random sampling, is important to external validity (that is, the extent to which the sample’s findings can be applied to the population) for quantitative methods, it is not a characteristic of qualitative research.

      DIF: Cognitive Level: Comprehension REF: Page 267

3. All of the following statements related to sample size are true characteristics of qualitative methodology except for which of the following?

   1. The criterion of theoretical sufficiency is used to determine when the sample size is adequate.

   2. Samples used in qualitative research are typically much smaller than in quantitative research.

   3. The criterion of data saturation is used to determine when the sample size is adequate.

   4. When asked to indicate in an institutional review board (IRB) proposal how large the sample will be, the qualitative researcher should indicate between 25 and 50 subjects to capture an adequate sample.

      ANS: D

      The text authors recommended including a projected sample size of 12 to 25 participants when submitting a study for IRB approval. The criterion of theoretical sufficiency has been proposed as a means for determining when the sample size is adequate. This refers to the process where data are collected until the research question can be adequately addressed. It contrasts with the more established term data saturation as a criterion to determine when the sample size is adequate, and is preferred by some researchers who believe that it is more appropriate because one can never completely know (or be saturated with) all there is to know about a topic. Samples for qualitative research studies are notably smaller than samples used in quantitative studies. Data saturation, or gathering data to the point where one is no longer learning new information about the phenomenon, is a term used to determine when the sample size is adequate.

      DIF: Cognitive Level: Analysis REF: Page 268

4. The qualitative researcher’s awareness of personal biases and past experiences that might influence his or her responses to participants or their data so that the data can be honestly and intellectually analyzed is termed

   1. An etic view

   2. Reflexivity

   3. A co-constructive process

   4. An emic view

      ANS: B

      Reflexivity is the term used to describe the researcher’s awareness of personal biases and past experiences that might influence how he or she responds to the participants and analyzes data in an intellectually honest way. An etic view is one that reflects the outsider’s perspective and tends to occur when the qualitative interviewer is not careful about establishing a relationship characterized by openness and trust. As a result, the view of the phenomenon obtained by the interviewer is an outsider’s perspective. The co-constructive process is a term used to describe the mutual influence the qualitative researcher and the study participant have on one another in generating findings. An emic view is the perspective of the participant. Qualitative interviewers should interact with the participants in a way that is open, fosters trust, and encourages the emic (or participant’s) view to emerge.

      DIF: Cognitive Level: Comprehension REF: Page 268

5. Probing is a strategy used in interviews to

   1. Make it clear that the interviewer is in charge.

   2. Limit the range of responses.

   3. Elicit more information in a specific area.

   4. Ensure a variety of interpretations of the question by different subjects.

      ANS: C

      In probing, the interviewer asks participants to elaborate further on a topic through the use of non-threatening but thought-provoking questions. Although the questions are controlled by the researcher, the interviewer needs to establish a permissive atmosphere where the participant is encouraged to respond fully and honestly to the questions asked. Verbally or non-verbally asserting that the interviewer is in charge hinders this process. Structured questions may limit the range of responses given by participants, but this is not the purpose of probing. Ensuring a variety of interpretations of the question by different subjects is not the purpose of probing.

      Interview questions should be designed so that each subject’s interpretation of the question is as consistent as possible while still encouraging the respondent to answer fully and honestly.

      DIF: Cognitive Level: Comprehension REF: Page 272

6. A clinical nurse at a large urban hospital has decided to conduct a descriptive qualitative study related to staff nurses’ perceptions of the causes of various types of violence against nurses in their facility. As part of his research design, he hosts a series of focus groups with staff nurses during each of three shifts. What is considered the main advantage of using a focus group strategy as opposed to one-on-one interviews for data collection?

   1. Individuals who are alike on some characteristic are more likely to feel safer or less anxious expressing their views, especially with difficult experiences, when participating in a focus group rather than in a one-on-one interview.

   2. Focus groups allow the researcher to gather a lot of information in a short time.

   3. Focus groups require less planning than one-on-one interviews do, because interviewers should talk little and listen more.

   4. It is more efficient and less expensive to transcribe one interview with several participants rather than to transcribe several individual interviews.

      ANS: A

      The assumption underlying focus groups is that in settings that are permissive and non- threatening, participants are more likely to express and to clarify their views than they would be in individual interviews, especially for sensitive topics. This allows for richer data collection. Focus groups often generate a great deal of information from the participants’ perspectives and do so in a short period of time, but this is not the primary advantage of using this data collection strategy. Conducting a focus group involves a great deal of advance planning to ensure that the interviewer asks relevant questions in a way that is non-intrusive, non-threatening, and safe. Both one-on-one and focus group interviews require careful planning. Transcribing tapes from both individual and group interviews can be time- consuming and challenging. This, however, is not the primary reason to conduct a focus group about the phenomena of interest instead of a one-on-one interview.

      DIF: Cognitive Level: Application REF: Page 269

7. What is the typical size and duration of a focus group interview?

   1. 4 to 12 participants; 3 1/2 hours

   2. 3 participants; 30 minutes

   3. At least 12 participants; 3 hours

   4. 4 to 12 participants; 45 to 90 minutes

      ANS: D

      Involving 4 to 12 participants in a discussion that lasts 45 to 90 minutes is typical for focus groups. Four to 12 participants is considered an appropriate size for a focus group, although 3 1/2 hours is longer than the typical focus group runs. Three participants is smaller than the typical number of participants, and a half-hour is less time than is needed to generate a rich discussion of the phenomenon of interest. Involving more than 12 participants in a focus group may limit hearing the perspective of less vocal members of the group and can be unwieldy. In addition, 3 hours is longer than typical focus groups last.

      DIF: Cognitive Level: Knowledge REF: Page 278

8. If a researcher decides to transcribe a recorded one-hour interview or focus group in order to better understand her data, she might need to spend up to how much time creating a verbatim transcript?

   1. 1 hour

   2. 2 hours

   3. 4 hours

   4. 6 hours

      ANS: D

      Verbatim transcription of a 1-hour interview or focus group may require up to 6 hours.

      DIF: Cognitive Level: Application REF: Page 278

9. The role of the facilitator involves all of the following except to

   1. Encourage group members to go beyond the current discussion or debate to encourage sharing of perspectives.

   2. Instruct participants that all points of view are valid and helpful and to not ask speakers to defend their positions.

   3. Prepare for the facilitation experience by developing a few preconceived ideas about the topic in order to direct the discussion most effectively.

   4. Reflect on inconsistencies among the views of participants and with their own thinking.

      ANS: C

      Facilitators should prepare themselves to be effective moderators of the discussion, but to not develop preconceived ideas about the topic as this may hinder their ability to hear the perspectives of the group members. Encouraging group members to stretch their thinking and to share their perspectives is the role of an effective facilitator. It is important to instruct group members at the outset of the meeting that all views are valid and helpful to the researcher in understanding the topic. Once rapport is established with the group, one of the facilitator’s roles is to reflect on inconsistencies among the participants and in their own thinking to challenge ideas and increase group interaction.

      DIF: Cognitive Level: Synthesis REF: Page 275

10. A researcher is interested in studying the experiences of gay (G), lesbian (L), and transgender

    (T) youth in the middle school setting. With parental consent and the students’ assent to participate, she provided a group of 12 students with disposable digital cameras and had them each take 15 photos that illustrate their experiences, both positive and negative, as a GLT adolescent. The researcher then developed the photos and asked participants to discuss what they documented. This is an example of what type of qualitative data collection technique?

    1. Thick description

    2. Photovoice or photo novella

    3. Participatory research

    4. Data immersion

    ANS: B

    Photovoice (or photo novella) is a technique for gathering data from participants that reflect their individual perspectives of a phenomenon. This strategy involves asking individuals to record their experiences and perceptions with photos that are then analyzed for meaning with input from participants. Thick description is a term used to describe a richness and depth of information gathered from effective qualitative interviews. Involving study participants in collecting data via taking digital photographs would be a participatory strategy but is not specific term for this technique. Data immersion is a term commonly used to describe the researcher’s experience of being immersed and fully invested in reading and thinking about the data.

    DIF: Cognitive Level: Analysis REF: Page 277

11. The primary disadvantage to the use of Internet-based data collection is that

1. It can be difficult to obtain consent.

2. It limits the sample to those who can read and write, use computers, and have Internet access.

3. It can only be used with quantitative research methods.

4. The subject pool tends to be limited.

   ANS: B

   The main disadvantage of Internet-based data collection has to do with sampling those who are able to read and write, are computer-literate, and who have Internet access. Thus, the poorly educated, elderly, disabled, or disadvantaged may be underrepresented. Researchers who conduct Internet-based research are often able to obtain consent by noting a statement like “Completion and submission of the survey implies consent.” Data can be effectively collected for a qualitative study using the Internet. Although there are some sampling limitations in terms of certain populations, the subject pool in general tends to be very large given the extensiveness of the online community not limited by geographic space.

   DIF: Cognitive Level: Analysis REF: Page 277

• In addition to sample bias and ethical issues (e.g., securing consent, assuring anonymity, and protecting site security), a third concern about factors that may affect the credibility of Internet-mediated study findings is

  1. The interviewer’s ability to establish rapport with study participants

  2. The fact that use of a pseudonym might cause participants to make up information about the phenomenon

  3. The researcher’s ability to transcribe the data gathered through online interviews

  4. Reliability and validity of data, although terms most often applied to quantitative research, might be an issue since the researcher can’t verify whether or not participants meet inclusion criteria for the study

ANS: D

Not being able to ensure that participants meet inclusion criteria and being unable to control distractions during data collection are the biggest threats to the validity and reliability of the research findings gathered by Internet-mediated data collection. A skilled and personable interviewer may be able to establish good rapport and to effectively conduct online interviews with study participants. Use of a pseudonym, as well as site controls, helps ensure that participants’ identities are not made public. Plans to carefully capture interviews digitally, note-taking, and careful data transcription minimize problems with transcription of data.

DIF: Cognitive Level: Analysis REF: Page 278

MULTIPLE RESPONSE

1. Which of the following statements are true statements about qualitative research methodology? (Select all that apply.)

   1. Qualitative researchers develop questions and then determine which philosophical approach to use to answer the question.

   2. Qualitative analyses involve using words rather than numbers as the basis of analysis.

   3. Because the methods used for sampling, data gathering, and analysis are more flexible for qualitative research than for quantitative research, qualitative research is considered a less rigorous approach to nursing research.

   4. As with quantitative research, qualitative researchers are not able to modify sampling and data gathering processes once the study begins, since this leads to problems with internal validity.

      ANS: A, B

      Qualitative researchers typically first do a literature search and develop their research question and then determine which philosophical approach (e.g., ethnography, phenomenology) needs to be used to address the research question. Note that some qualitative researchers will defer the review of literature until after data collection to avoid biasing their analysis and data interpretation. In qualitative research, narratives (transcriptions of respondents’ stories about their experiences) and written observations are analyzed for themes and patterns. Although strict positivists would argue that qualitative methodology is less rigorous than quantitative approaches to research, most nursing researchers believe that qualitative research employs the same careful skills in analytical reasoning and is as rigorous in seeking knowledge about human experience. Internal validity is not a criteria applied to qualitative research. In qualitative approaches, data analysis begins as data are gathered and insights may suggest the need to modify the original methodology. Such changes, however, need to be supported with a clear rationale.

      DIF: Cognitive Level: Synthesis REF: Page 264

2. Which of the following are true statements regarding data analysis in qualitative research? (Select all that apply.)

   1. Qualitative data analysis involves examining and interpreting data in order to elicit meaning, gain understanding, and develop empirical knowledge.

   2. Although qualitative data analysis may identify additional data that may need to be collected, once the data collection period is over, the researcher is discouraged from going back to participants to gather additional information.

   3. Data analysis in qualitative research occurs concurrently with data collection.

   4. Researchers are encouraged to “dwell with the data” by immersing themselves in transcripts, tapes, and interview notes to make sense not only of what participants have said but also of meanings underlying expressions, emphasis, and nonverbal communications.

      ANS: A, C, D

      The purpose of qualitative data analysis is to examine and interpret data to elicit meaning and understanding to add to the profession’s body of knowledge. Data analysis occurs concurrently with data collection. Researchers must immerse themselves with the data to obtain the deepest understanding possible of the phenomenon being investigated. As long as the qualitative researcher has additional questions, he or she has not reached data saturation; going back to participants to gather additional information to clarify meanings is expected.

      DIF: Cognitive Level: Synthesis REF: Page 266

3. Which of the following are accurate statements about the interview process used by qualitative researchers? (Select all that apply.)

   1. It is sufficient to develop interviewing skills once the interviewing of study participants begins since the qualitative research process involves co-construction of data; learning to interview is part of the process the researcher is expected to experience once data collection begins so that the interviewer enters the study without bias or preconceived ideas.

   2. When participants appear to begin speaking about a subject that seems unrelated to the focus of the study, an effective strategy is to ask obtain the respondent’s perspective by asking how the new subject is related to his/her previous comments.

   3. The interviewer should dress in either business attire or a nursing uniform when

      conducing interviews or focus groups.

   4. When a study participant appears to be fatigued or in pain from illness or treatments, the interviewer should offer to stop the interview, to take a break, or to reschedule for another day.

ANS: B, D

When the interviewer does not understand how a topic might be related to the topic being discussed, it is an effective strategy to obtain the participant’s perspective; then, if there still appears to be no link, the interviewer can redirect the interview. The interviewer must not inflict unnecessary harm upon participants. Even though interviews are not generally considered invasive, they may be invasive to the psyche. Researchers who have less experience with interviewing should work to develop interview skills before they start interviewing study participants, since interviewing is a skill that directly affects the quality of the data produced. It is generally not a good idea for the interviewer to dress for an interview in business attire or a nursing uniform since this may emphasize power differences in the relationship. Interviewers should consider how the participant is likely to be dressed and select their own clothing accordingly.

DIF: Cognitive Level: Synthesis REF: Page 268

Chapter 13: Outcomes Research Test Bank

MULTIPLE CHOICE

1. Sampling in outcomes studies differs from that in traditional quantitative research in several ways. Which of the following is true?

   1. A heterogeneous sample is preferred.

   2. A random sample is required.

   3. A small, focused sample is artificially assembled.

   4. The sample is selected before an intervention occurs.

      ANS: A

      The preferred methods of obtaining samples are different in outcomes studies; random sampling is not considered desirable and is seldom used. Heterogeneous, rather than homogeneous, samples are obtained. Rather than using sampling criteria that restrict subjects included in the study to decrease possible biases and that reduce the variance and increase the possibility of identifying a statistically significant difference, outcomes researchers seek large heterogeneous samples that reflect, as much as possible, all patients who would be receiving care in the real world.

      DIF: Cognitive Level: Comprehension REF: Page 306

2. A preference for type I error, as compared with type II error, in outcomes research means that

   1. The outcomes researcher is not particularly concerned with drawing incorrect conclusions.

   2. The outcomes researcher would rather identify a possible connection that doesn’t end up being true than miss something.

   3. The outcomes researcher would rather establish definite causation than an indefinite connection.

   4. Patients usually don’t recognize what quality of care really is.

      ANS: B

      Donabedian (1987) identified the following problem-solving styles: (1) routine approaches to care versus flexibility, (2) parsimony versus redundancy, (3) variations in degree of tolerance of uncertainty, (4) propensity to take risks, and (5) preference for type I errors versus type II errors. In a type I error, the null hypothesis is rejected when it is true; this means that a promising glimmer that may affect outcomes is not noted.

      DIF: Cognitive Level: Synthesis REF: Page 294

3. A researcher is studying the likely occurrence rate of secondary cancers after a new schedule of chemotherapy for childhood leukemia, using a biochemical marker obtained by blood draw six months after the initiation of chemotherapy. What is the rationale for using this marker as a proximate outcome, rather than counting the actual rate of secondary cancers?

   1. Research on recurrent cancers in children labels them as vulnerable, causing psychological harm.

   2. The final endpoint is not obtainable over a reasonable span of time, since secondary cancers can occur at any age.

   3. Most proximate endpoints are unreliable variables and should not be used unless there are no final endpoints.

   4. The researcher is not interested in whether children suffer a secondary malignancy; the researcher is merely interested in the marker value.

      ANS: B

      At the outset of a research project, there may be as yet little scientific basis for judging the precise relationship between factors and outcome. Many of the influencing factors may be outside the jurisdiction or influence of the healthcare system or of the providers within it, occurring much later in time, when subjects have been lost to follow-up. One solution to this problem of identifying relevant outcomes is to define a set of proximate outcomes specific to the condition for which care is being provided. Critical pathways and care maps may help the researcher to define at least proximate outcomes.

      DIF: Cognitive Level: Analysis REF: Page 296

4. Which of the following is a prospective cohort study?

   1. All of the children in Toledo, Ohio, are weighed and measured to obtain an accurate statistic for malnutrition occurrence.

   2. A physician’s records are analyzed to identify how many of his patients have remained in his care for more than 20 years.

   3. The citizens of a city experiencing a nuclear accident are tracked for cancer occurrence.

   4. A database is accessed to identify mortality rate in patients with sepsis.

      ANS: C

      A prospective study is an epidemiological study in which the researcher identifies a group of people who are at risk for experiencing a particular event. Sample sizes for these studies often must be very large, particularly if only a small portion of the at-risk group will experience the event. The entire group is followed over time to determine the point at which the event occurs, variables associated with the event, and outcomes for those who experienced the event compared with those who did not.

      DIF: Cognitive Level: Comprehension REF: Page 309

5. A hospital has recently converted to an “80% BSN staff” policy.” In service of this goal, all newly hired nurses are expected to hold at least a bachelor’s degree in nursing. Within the area of outcomes research, the variable “educational preparation of nurses” is what kind of a variable?

   1. Practice profile

   2. Structure of care

   3. Process of care

   4. Outcome of care

      ANS: B

      Structures of care are the elements of organization and administration, as well as provider and patient characteristics, which guide the processes of care. The first step in evaluating structure is to identify and describe the elements of the structure. Various administration and management theories could be used to identify the elements of structure. These elements might be leadership, tolerance of innovativeness, organizational hierarchy, decision-making processes, distribution of power, financial management, and administrative decision-making processes.

      DIF: Cognitive Level: Application REF: Page 298

6. A study examines the careers of hospital nurses who opt for retirement before the age of 55, examining their education, work shift, and final work area, and the religion in which they were raised. This is an example of which type of study?

   1. Prospective cohort

   2. Retrospective cohort

   3. Population-based

   4. Cost-effectiveness analysis

      ANS: B

      A retrospective cohort study is an epidemiological study in which the researcher identifies a group of people who have experienced a particular event. A prospective cohort study is an epidemiological study in which a group of people are identified who are at risk for experiencing a particular event. In a population-based study, all cases of a condition occurring in the defined population are included, rather than only patients treated at a particular facility, because the latter could introduce a selection bias. Conditions must be studied in the context of the patient’s community rather than of the medical system. With this method, all cases of a condition occurring in the defined population are included, rather than only patients treated at a particular health care facility, because the latter could introduce a selection bias. Cost- effectiveness analyses compare different ways of accomplishing a clinical goal, such as diagnosing a condition, treating an illness, or providing a service.

      DIF: Cognitive Level: Application REF: Page 310

7. A nurse manager designs a research study to examine nurse workload stress, work shift, number of years in the nursing profession, number of medication errors, patient falls, and after-shift overtime, as the relate to one another. What is the most likely method the manager will use to study this?

   1. Analysis of change

   2. Analysis of improvement

   3. Analysis of variance

   4. Multilevel analysis

ANS: D

Multilevel analysis is a statistical technique that is useful when data exist at several different levels; for example, if data are nested or if a study has several different units of analysis. It has been used in epidemiology to study how environmental factors (aggregate-level characteristics) and individual attributes and behaviors (individual-level characteristics) interact to influence individual-level health behaviors and disease risks. Variance analysis is used to track individual and group variance from a specific critical pathway. In analysis of improvement, in addition to reporting the mean improvement score for all patients treated, it is important to report what percentage of patients improved. Do all patients improve slightly, or is there a divergence among patients, with some improving greatly and others not improving at all? With the focus on outcomes studies has come a renewed interest in methods of analyzing change—this refers to change of any sort, and it is a global term.

DIF: Cognitive Level: Application REF: Page 317

MULTIPLE RESPONSE

1. Outcomes research has several practical applications. To which of these can outcomes research be logically applied? (Select all that apply.)

   1. Individual nursing practice

   2. Testing a new product to measure its outcomes

   3. Fiscal responsibility in healthcare

   4. Improvement in healthcare delivery

   5. Development of policy specific to specialty areas

      ANS: A, C, D, E

      Outcomes research focuses on the end results of patient care. The momentum propelling outcomes research comes primarily from policymakers, insurers, and the public. There is a growing demand for data from providers that justify interventions, costs, and systems of care that demonstrate improved patient outcomes. By linking the care people receive to the outcomes they experience, outcomes research has become the key to developing better ways to monitor and improve the quality of care.

      DIF: Cognitive Level: Application REF: Page 294

2. Outcomes research differs from traditional quantitative research in which of the following ways? (Select all that apply.)

   1. Outcomes research measures the effects of interventions; quantitative research measures the theory underlying the effects of interventions.

   2. Quantitative research identifies variables before the study onset. Outcomes research may or may not identify variables before the study onset.

   3. Quantitative research may use a number of appropriate theoretical frameworks; outcomes research’s theoretical and philosophical bases are all nested within Donabedian’s paradigm.

   4. Outcomes research focuses on medical practice; quantitative research focuses on nursing practice.

   5. At the outset, the researcher selects a traditional quantitative research sample

      according to strict inclusion and exclusion criteria. Outcomes research initially uses all available data and then focuses on specifics.

      ANS: B, C, E

      Quality is the overriding construct of the theory; however, Donabedian never defined this concept himself. Outcomes research may focus on any potential input to quality of care, regardless of which discipline “owns” it. Research strategies for outcomes studies have emerged from a variety of disciplines, and innovative new strategies continue to appear in the literature. One source of samples for outcomes studies is large databases. Strategies for outcomes studies tend to employ fewer controls than traditional research designs and cannot be as easily categorized. The research strategies described in this section are only a sampling from the outcomes research literature and include: consensus knowledge building, practice pattern profiling, prospective cohort studies, retrospective cohort studies, population-based studies, geographical analyses, economic studies, and ethical studies.

      DIF: Cognitive Level: Synthesis REF: Page 294

3. Why would outcomes research use an entire database, rather than merely selecting a sample? (Select all that apply.)

   1. Use of the whole database provides an analysis that addresses the entire patient population.

   2. Permission to use an entire data base implies that the entire data base must be studied.

   3. Small effect sizes and multiple variables demand huge samples, if statistical significance is to be achieved.

   4. Accurate determination of risk throughout the system is the focus of outcomes research.

   5. Cost is not an issue.

      ANS: A, C, D

      Outcome design strategies tend to have less control than traditional research designs and, except for the clinical trial, seldom use random samples; rather, they use large representative samples. Rather than using sampling criteria that restrict subjects included in the study to decrease possible biases and that reduce the variance and increase the possibility of identifying a statistically significant difference, outcomes researchers seek large heterogeneous samples that reflect, as much as possible, all patients who would be receiving care in the real world. One source of samples used for outcomes studies is large databases.

      Two broad categories of databases emerge from patient care encounters: clinical databases and administrative. A prospective cohort study is an epidemiological study in which the researcher identifies a group of people who are at risk for experiencing a particular event; they are optimally identified and followed through use of a database.

      DIF: Cognitive Level: Synthesis REF: Page 306

4. From what common sources does outcomes research draw its data? (Select all that apply.)

   1. Journals kept by clients undergoing treatment for a chronic ailment

   2. Nurses’ electronic charting within a single hospital

   3. A multi-hospital system’s morbidity and mortality reports

   4. A health insurance company’s records

   5. A state disability agency’s records

      ANS: B, C, D, E

      One source of samples used for outcomes studies is large databases. Two broad categories of databases emerge from patient care encounters: clinical databases and administrative databases. Clinical databases are created by providers such as hospitals, HMOs, and healthcare professionals.

      DIF: Cognitive Level: Application REF: Page 306

5. Outcomes research in a hospital could address interactions among which of the following general groups of variables? (Select all that apply.)

   1. Those that existed prior to treatment, such as narrative health histories

   2. Those that reflect surroundings, such as the size of family waiting rooms

   3. Those that reflect perceived outcome, such as quality of life

   4. Those that pertain to staff, such as levels of education and training

   5. Those that reflect physical outcome, such as patient survival

      ANS: B, C, D, E

      Outcomes research focuses on the end results of patient care. For such research, items in the hospital database would be logical variables. Donabedian (1987) identified three objects to evaluate when appraising quality: structure, process, and outcome. Individual health histories are difficult to retrieve from a database and not in a form in which they can be analyzed. Size of waiting room, and staff levels of education and training, are structural variables. Quality of life and patient survival are outcome variables.

      DIF: Cognitive Level: Synthesis REF: Page 296

6. In an outcomes study of nurse satisfaction in the workplace, which of the following would be reasonable outcome measures?

   1. Lunch relief staffing

   2. Formal complaints filed by nurses

   3. Nurse satisfaction surveys

   4. Manager style

   5. Patient survival

   6. Length of employment

   7. Sick calls

      ANS: B, C, F, G

      Outcomes research focuses on end results. If nurse satisfaction is conceptualized as an outcome variable, the items that are markers of nurse satisfaction are formal complaints the nurse files, surveys of satisfaction, how long a nurse remains in that particular workplace, and sick calls.

      DIF: Cognitive Level: Analysis REF: Page 294

7. Which of the following are processes of care within a hospital that are likely to be scrutinized in research focusing on nursing-sensitive patient outcomes?

   1. Cost of hospital insurance

   2. The ways nurses perform a certain task of patient care

   3. Whether there are policies governing a procedure

   4. Educational preparation of nurses

   5. Staffing ratios

   6. Number of hospital beds

      ANS: B, C, D, E

      A nursing-sensitive patient outcome is “sensitive” because it is influenced by nursing care decisions and actions. It may not be caused by nursing, but is associated with nursing. In various situations, “nursing” might be the individual nurse, nurses as a working group, the approach to nursing practice, the nursing unit, the institution that determines numbers of nurses, salaries, educational levels of nurses, assignments of nurses, workload of nurses, management of nurses, and policies related to nurses and nursing practice. It might even include the architecture of the nursing unit. In whatever form, nursing actions have a role in the outcome, even though acts of other professionals, organizational acts, and patient characteristics and behaviors often are involved in the outcome.

      DIF: Cognitive Level: Application REF: Page 303

8. How do practice pattern profiling and nursing-sensitive patient outcomes research relate to one another?

   1. The identification of nursing-sensitive patient outcomes is a type of practice pattern profiling. The purpose of both is to identify the outlier, so as to improve patient outcomes.

   2. Practice pattern profiling scrutinizes an individual in comparison with a group; nursing-sensitive patient outcomes research addresses nurses as a group, rather than as individuals.

   3. Both can identify variables that affect patient outcome.

   4. Both pose risk to the person who delivers care.

   5. Neither can be undertaken without signed consent from the participants.

   6. Both are types of outcomes research.

      ANS: B, C, F

      A nursing-sensitive patient outcome is “sensitive” because it is influenced by nursing care decisions and actions. It may not be caused by nursing, but is associated with nursing. Practice pattern profiling is an epidemiological technique that focuses on patterns of care rather than individual occurrences of care. Researchers use large database analysis to identify a provider’s pattern of practice and compare it with that of similar providers or with an accepted standard of practice. The technique has been used to determine overutilization and underutilization of services, to examine costs associated with a particular provider’s care, to uncover problems related to efficiency and quality of care, and to assess provider performance. Both use existent databases as data sources, a majority of the time.

      DIF: Cognitive Level: Comprehension REF: Page 308

9. An advertisement maintains that zip code affects length of life. If outcomes research were designed to explore this geographic difference, what variables would be most useful in understanding the outcome of length of life? (Select all that apply.)

   1. Other outcome variables, such as quality of life and consumer perceptions

   2. Structural variables, such as the availability of parking near clinics

   3. Structural variables, such as the time it actually takes in both areas to transport a patient to an emergency room

   4. Structural variables, such as the prevalence of ethnically associated health problems

   5. Process variables, such as physicians’ clinical judgment

   6. Process variables, such as the presence of standard nursing care plans in the hospitals

   7. Structural variables, such as the number of specialist physicians per 1000 population in each area

   8. Structural variables, such as the number of primary care physicians per 1000 population in each area

      ANS: C, D, E, G, H

      Geographical analyses examine variations in health status, health services, patterns of care, or patterns of use by geographical area and are sometimes referred to as small area analyses.

      Variations may be associated with sociodemographic, economic, medical, cultural, or behavioral characteristics. Locality-specific factors of a healthcare system, such as capacity, access, and convenience, may play a role in explaining variations. The social setting, environment, living conditions, and community may also be important factors. The interactions between the characteristics of a locality and of its inhabitants are complex. The characteristics of the total community may transcend the characteristics of individuals within the community and may influence subgroup behavior. High educational levels in the community are commonly associated with greater access to information and receptiveness to ideas from outside the community.

      DIF: Cognitive Level: Comprehension REF: Page 311

10. What are the differences between a cost-effectiveness analysis and a cost-benefit analysis? (Select all that apply.)

    1. Cost-effective analysis is prospective, and cost-benefit analysis is retrospective.

    2. Cost-effectiveness analysis in outcomes research focuses on health outcomes, whereas cost-benefit analysis may or may not focus on health outcomes.

    3. Cost-benefit analysis addresses cost as the opposite of benefit, whereas cost- effectiveness analysis treats cost as a limited resource.

    4. Cost-benefit analysis does not consider anything except financial cost, whereas cost-effectiveness analysis considers intangible costs as well.

    5. Cost-effectiveness analysis always considers financial cost as one of its variables, whereas cost-benefit analysis may or may not do so.

       ANS: B, C, E

       The economist’s definition of efficiency is the least expensive method of achieving a desired end while obtaining the maximum benefit from available resources. Cost-effectiveness analyses compare different ways of accomplishing a clinical goal, such as diagnosing a condition, treating an illness, or providing a service. The purpose is to identify the strategy that provides the most value for the money. Cost-benefit analysis compares expenditures and rewards, often both from an economic point of view. Cost effectiveness analysis, rather than cost-benefit analysis, was identified as the appropriate tool for economic analysis for the purpose of public health uses because of its focus on health rather than economic outcomes. Both can be used either retrospectively or prospectively.

       DIF: Cognitive Level: Application REF: Page 312

11. A complete appraisal of quality of care in an institution is undertaken. It could justifiably be linked with which of the following? (Select all that apply.)

    1. The types of insurance the hospital accepts

    2. The general safety of the hospital grounds for visitors and family

    3. Advertisements for health care in the area

    4. Numbers of complaints the hospital administrator receives

    5. Nurse: patient staffing ratios

    6. National research funding for healthcare

    7. Measures of physiologic function, twelve weeks after surgery

       ANS: B, D, E, G

       Donabedian identified three objects to evaluate when appraising quality: structure, process, and outcome. A complete quality assessment program requires the simultaneous use of all three concepts and an examination of the relationships among the three. Only structures and processes can be logically linked with outcomes.

       DIF: Cognitive Level: Analysis REF: Page 294

12. What happens when outcomes are not clearly linked to structure and process? (Select all that apply.)

    1. There is no clear justification for mandating changes to either structure or process.

    2. Structure will not change without evidence as to outcomes.

    3. Processes will be altered according to whim and guesswork.

    4. Without evidence of clear links, general “bundle” or “package” changes are enacted, and these are less likely to gain staff support than are single changes.

    5. Outcomes may be assumed to be reflective of structures and processes that actually are associated with different outcomes.

ANS: A, C, D, E

Donabedian proposed a theory of quality health care and the process of evaluating it.

Its three dimensions are health, subjects of care, and providers of care, and its three objects of evaluation in appraising quality are structure, process, and outcome. Donabedian’s theory requires that identified outcomes be clearly linked with the process that caused the outcome.

DIF: Cognitive Level: Analysis REF: Page 294

Chapter 14: Intervention-Based Research Test Bank

MULTIPLE CHOICE

1. Intervention research shifts the focus from causal connection to causal explanation. What does this mean?

   1. It allows correlational research determining connection to stand in the place of causal explanation.

   2. It provides theoretical explanations of why an independent variable produces an effect, rather than merely reporting findings.

   3. It may use studies that establish causal connection as impetus points, but it proceeds on to descriptive research whenever possible, to explain.

   4. It utilizes experimental research, whenever possible, to establish cause definitively.

      ANS: B

      Intervention research is a methodology that holds great promise as a more effective way of testing interventions. It shifts the focus from causal connection to causal explanation. In causal connection, the focus of a study is to provide evidence that the intervention contributes to the outcome. In causal explanation, in addition to demonstrating that the intervention causes the outcome, the researcher must provide scientific evidence to explain why the intervention contributes to changes in outcomes and how it does so. Causal explanation is theory based. Thus, research focused on causal explanation is guided by theory, and the findings are expressed theoretically (see Chapter 7). Researchers employ a broad base of methodologies, including qualitative studies, to examine the effectiveness of an intervention. Qualitative approaches offer substantial value to the development, feasibility, and validation of nursing interventions.

      DIF: Cognitive Level: Synthesis REF: Page 326

2. Why may intervention research involve the efforts of an entire project team?

   1. A multidisciplinary team provides the grounding, objectivity, and world wisdom to judge whether an intervention really has clinical merit.

   2. Each member of the team carries out a separate research project at a different site, so that the results can be multi-site and more readily generalizable.

   3. Institutional review boards will not approve intervention projects unless they are backed by an entire team, including representatives from both nursing and medicine.

   4. It is rare for one person to be imaginative, clinically current, expert at marketing, skilled in statistics, and adept at both quantitative and qualitative research.

      ANS: D

      Because of the nature of intervention research, one may need to gather a multidisciplinary project team to facilitate distribution of the work and a broader generation of ideas. If both quantitative and qualitative data will be gathered during the research project, the team should include members experienced in various qualitative and quantitative data collection and analysis approaches. Including a team member with marketing expertise will be beneficial, because the final step of the project will be to market the intervention.

      DIF: Cognitive Level: Application REF: Page 338

3. The presence of drop-down oxygen masks on airplanes represents the process of intervention research. During their development, a prototype was designed and refined. What was the final stage of the testing process for drop-down oxygen masks?

   1. Testing of oxygen masks was initiated on several actual consumer airline flights.

   2. An analysis was made of all notes made by the intervention team during meetings.

   3. Oxygen masks already in use on commercial airlines were revised, according to the original protocol specifications.

   4. Oxygen masks were tested in labs on human volunteers.

      ANS: A

      Advanced testing of the intervention occurs after sufficient evidence is available that the intervention is effective in achieving the desired outcomes. The model proposed by Forbes (2009) places this type of testing in phases III and IV, where the intervention is compared to standard of care interventions followed by replication studies with long-term follow-up of the intervention’s effectiveness. Stage III of intervention testing might involve a single, well- designed study that indicates a satisfactory ES for an intervention, but often an intervention requires modification through additional studies. Replication studies ensure that an intervention is refined to create the desired effect in practice.

      DIF: Cognitive Level: Evaluation REF: Page 344

4. Why is treatment fidelity such a major concern in intervention research?

   1. If treatment fidelity is not maintained, it has a direct influence on statistical conclusion validity and power analysis, especially when samples are large.

   2. The project team may differ about how an intervention is applied, and these varying ways of application must be discussed before marketing can occur.

   3. Intervention research can take place over many months. It is important for internal validity that the intervention be applied in the same way every time.

   4. Interventions, especially those involving products that are centered in the health care realm, must reflect the ethical standards of the profession.

      ANS: C

      Treatment fidelity has to do with the accuracy, consistency, and thoroughness in how an intervention is delivered according to the specified protocol, treatment program, or intervention model. Strict adherence to treatment specifications must be evaluated on an ongoing basis during the course of a study. Intervention fidelity is “defined as the adherent and competent delivery of an intervention by the interventionist as set forth in the research plan,” and this fidelity is of utmost importance to the inference of the study’s internal validity in intervention-based research. Treatment fidelity is important in the conduct of all intervention-based research, but it is especially critical for complex interventions such as those involving information dissemination, social support, counseling, and other interventions intended to bring about changes in health behaviors and psychosocial outcomes.

      DIF: Cognitive Level: Analysis REF: Page 332

5. In the process of interventional research on the efficacy of omega 3 fish oil in decreasing blood sugar in diabetic adults, which event would appear just before widespread dissemination?

   1. A randomized clinical trial testing the effects of omega 3 fish oil on blood sugar in 300 ambulatory diabetic adults

   2. Proof of the safety of the prescribed dose of omega 3 fish oil

   3. Several replication studies of the effects of omega 3 fish oil on blood sugar in hundreds of ambulatory diabetic adults

   4. Efficacy studies to establish outcome effects of omega 3 fish oil and optimal treatment regimens in adults

      ANS: C

      Theory-based intervention research can begin with a concept analysis of the problem or the intervention intended to address it. By dissecting the components of problems and plausible solutions, investigators can gain clarity of the issues at hand. After pre-clinical work, proof of the safety of an intervention and estimates of effect occur; following that are efficacy studies to establish outcome effects and optimal treatment conditions. Then a randomized controlled trial is conducted. This is followed by replication and/or long-term follow-up.

      DIF: Cognitive Level: Analysis REF: Page 339

6. A research project shows that a new intervention involving hypnosis decreases PTSD dramatically in servicemen returning from the Middle East. Thirty-three percent of men and women so treated are functional in daily living and free from symptoms three weeks after treatment. Twenty percent of men and women treated remain free from symptoms at one year. Calculate the numbers needed to treat (NNT), both at three weeks and at a year.

   1. The NNT at three weeks is 0.33; the NNT at one year is 0.20.

   2. The NNT at three weeks is 1; the NNT at one year is 1.

   3. The NNT at three weeks is 33; the NNT at one year is 20.

   4. The NNT at three weeks is 3; the NNT at one year is 5.

      ANS: D

      Numbers needed to treat (NNT) is a metric that is defined as the number of patients who would need to be treated with the new intervention to avoid one event that might have occurred with standard treatment. It is necessary that NNT be estimated in the context of those deriving a benefit or those who might be harmed by the intervention (Day, 2007). Intuitively, it is an easy concept to grasp as it is expressed in a numeric value. For example, if the NNT is 4 for a benefit from an intervention, then a prescriber of intervention could expect that 1 out of 4 patients treated with the intervention would derive a positive outcome. The NNT is determined by an analysis of the data following the completion of an adequately powered study (e.g., the sample size is adequate) to detect treatment differences. The researcher establishes criteria for the primary outcome measure for the study that is indicative of a positive or undesirable response, and the NNT is expressed in terms of either outcome.

      Researchers are often required to calculate the NNT for clinical trials prior to submitting a manuscript for publication to influential research journals. NNT are often pooled and analyzed in meta-analyses and systematic reviews of studies. Moreover, it is a meaningful parameter for practice, as clinicians can be informed of the overall effectiveness of the intervention, as well as the expected response when prescribing an intervention. When interpreting NNT, it is important to determine if the NNT value is for a single administration of the intervention, at a single time point, or overall across multiple time points.

      DIF: Cognitive Level: Evaluation REF: Page 333

7. Blinding to treatment involves not letting the patient know which intervention is being delivered. If the research subject who exercises daily because he is in the treatment group knows which treatment is being delivered, but the researcher and the research staff do not know, what type of condition exists?

   1. Single blinding

   2. Double blinding

   3. Triple blinding

   4. Unilateral unblinding

ANS: A

With single-blinded studies, there are two variations. In one variation, study participants are not aware of their treatment assignment but investigators and research staff may have knowledge of who is in what group. The reverse may be used when participants have knowledge of their treatment group assignment but this information is not available to the investigators and research staff. For example, children involved in research comparing the calming effects of music alone compared to music with mother’s voice delivered by audiotaped recordings would recognize the contents of the tape if they were alert. Researchers and data collectors may not be told of participant group assignment. Double-blinded studies keep knowledge of study conditions from study participants, investigators, and research staff. When a study is triple-blinded, the participants, researchers, and those involved in data management are unaware of group assignment.

DIF: Cognitive Level: Application REF: Page 331

MULTIPLE RESPONSE

1. The project team in intervention research failed to operationally define the study variables correctly. Which subsequent actions of the team were affected? (Select all that apply.)

   1. The research question posed failed to address the problem accurately.

   2. Results were not meaningful to clinicians.

   3. The methods used to study the problem were inappropriate for intervention research.

   4. The results could not be discussed effectively, in terms of the hypotheses.

   5. A type III error was not avoided.

      ANS: A, B, D, E

      The initial focus of the team is to clarify the problem or issue of interest. The project team must be alert to the risk of making a “type III error.” A type III error involves asking the wrong question—a question that does not address the problem of concern. This error is most likely to occur when the researchers do not thoroughly analyze the problem and, as a result, have a fuzzy or inaccurate understanding of the issue of concern. The solution, then, does not fit the problem. A study conducted on the basis of a type III error provides the right answer to the wrong question, leading to the incorrect conclusion that the newly designed intervention will resolve the problem.

      DIF: Cognitive Level: Synthesis REF: Page 338

2. Why is pilot testing especially important in nursing intervention research? (Select all that apply.)

   1. It represents the first trial of the intervention and might enable direct application without further testing.

   2. It is an opportunity to discover whether the intervention works as expected to work in a real-life scenario.

   3. It poses risk to fewer individuals, so it decreases the number of actual lawsuits that will result if harm ensues.

   4. It provides a good estimate of the number of subjects the actual project will require in order to demonstrate statistical significance.

   5. It gives the team a chance to refine instructions and details of intervention application and to examine its methods of data collection.

      ANS: B, D, E

      For multiple reasons, pilot or field testing of an intervention is recommended. Pilot testing is helpful for the following reasons: (1) to assess the feasibility and acceptability of the intervention, (2) to determine the feasibility and acceptability of the design and procedures, and (3) to facilitate the determination of treatment ES to use in power analysis calculations of sample size. In general, pilot studies are very useful for determining whether the intervention as a prototype will work and if it is feasible. It also is an opportunity to test and refine instructions, manuals, or training programs to ensure that study procedures are understandable and the preparation of study staff is adequate.

      DIF: Cognitive Level: Synthesis REF: Page 343

3. A nurse is developing a prototype for a new product that allows a very close approximation of blood sugar, based on 2 ml of filtered saliva. Which of the following persons should be included in the project team? (Select all that apply.)

   1. A biostatistician who will perform the calculations that will convert saliva glucose values to blood glucose equivalents

   2. An endocrinologist who will order the insulin based on the reported values

   3. Working nurses who will be collecting the saliva samples

   4. Lab technicians who will not be analyzing blood glucose values any longer after the new method is in place

   5. Patients who will have their saliva tested

   6. The nurse who is developing the prototype

      ANS: A, B, C, F

      Because an intervention research project often involves a study extended over a period of time, sometimes years, nurse researchers are advised to give careful thought to the composition of their research teams. Researchers need to determine (1) who will be included on the project team, (2) what level of expertise is required for team members, (3) how team members will function together, and (4) the roles team members will assume. Because of the nature of intervention research, a multidisciplinary project team will facilitate distribution of the work and a broader generation of ideas. If both quantitative and qualitative data will be gathered during the research project, your team should include members experienced in various qualitative and quantitative data collection and analysis approaches.

      DIF: Cognitive Level: Application REF: Page 338

4. Why is the process of revision of BLS standards from “Airway-Breathing-Circulation” to Circulation-Airway-Breathing considered intervention research? (Select all that apply.)

   1. It is grounded in theory.

   2. It started qualitatively with ideas and observations about the reasons patients code.

   3. It was field-tested and then researched using randomized clinical trials.

   4. The findings were replicated in multiple settings.

   5. It was initiated by a nurse.

   6. It emanates from previous research on CPR and its outcomes.

ANS: A, B, C, D, F

Project team tasks include gathering initial information, developing an intervention theory, designing the intervention, field-testing the intervention, analyzing results, testing the intervention, using a randomized controlled trial, collecting and analyzing data, replicating the results, and disseminating the intervention. Qualitative research may be used if researchers are in the initial phase of developing a model or prototype for an intervention.

DIF: Cognitive Level: Evaluation REF: Page Chapter 15: Sampling Test Bank

MULTIPLE CHOICE

1. A researcher is studying sleep habits of household cats that belong to families with small children. The families live in urban areas. In this study, what are the elements?

   1. Small children

   2. Household cats

   3. Families

   4. Sleep

      ANS: B

      The individual units of the population and sample are called elements. The elements are the things the researcher studies. An element can be a person, event, behavior, or any other single unit of study. In this case, the researcher is studying cats—not children, not families, and not sleep.

      DIF: Cognitive Level: Analysis REF: Page 352

2. A researcher wants to increase the generalizability of a planned experimental study’s results. What can the researcher do, relative to sampling, that will achieve that goal?

   1. Select a sample larger than that recommended by power analysis.

   2. Purposively select a sample that is extremely heterogeneous.

   3. Use random assignment.

   4. Use random sampling.

      ANS: D

      Random sampling increases the extent to which the sample is representative of the target population. Good representativeness enhances generalizability of the results. Selecting a sample larger than the size recommended by power analysis results only is a larger sample, not a more representative one. Purposive selection of a more heterogeneous sample does not increase the sample’s representativeness. Use of random assignment has no effect on representativeness of the sample, since it is selected before assignment occurs.

      DIF: Cognitive Level: Analysis REF: Page 357

3. A researcher studies spending habits of teenagers in strip malls. From what kind of population has the researcher selected her sample?

   1. The accessible population

   2. The entire population

   3. The target population

   4. The target sample

      ANS: A

      An accessible population is the portion of the target population to which the researcher has reasonable access. The sample is obtained from the accessible population by a particular sampling method. The target population is the entire set of individuals or elements who meet the sampling criteria. The sample is selected from the accessible population within the target population, since this is the population from which the researcher can actually select subjects. The sample here is a subset of the accessible population that actually checks into shelters, not the target population of all homeless persons. The entire population is a particular group of people who share one or more characteristics that are the focus of the research.

      DIF: Cognitive Level: Application REF: Page 351

4. A researcher selects his sample in this way. He paints numbers on 100 ping-pong balls, and he paints half of them blue and half of them green. He puts the blue half onto a large tray, and the green half of them onto another large tray. Then he mixes each group and trains his dog to bring 10 balls from each tray to him, gently and systematically, one at a time. What type of sample is this?

   1. Snowball

   2. Random

   3. Stratified random

   4. Systematic

      ANS: C

      Stratified random sampling is used when the researcher knows some of the variables in the population that are critical to achieving representativeness. Variables commonly used for stratification are age, gender, ethnicity, socioeconomic status, diagnosis, geographical region, type of institution, type of care, care provider, and site of care. The dog has no agenda, and the balls are mixed. The dog chooses 10 balls from each stratum. The sample is stratified random.

      DIF: Cognitive Level: Application REF: Page 359

5. “Good morning. You have been selected randomly by our marketing department because of your recent purchase of McCarthy’s Natural Yogurt, several organic raw vegetables, and two types of tofu. As a woman with interest in safe and healthy products, we are asking you to participate in a brief telephone survey.” The discerning student will detect an error in the above statement. What kind of a sampling is this?

   1. Random sampling

   2. Convenience sampling

   3. Purposive sampling

   4. Systematic sampling

      ANS: C

      Marketing research now uses product profiling to identify what consumers buy which products. A sample based on profiling is a purposive sample: people are contacted because they possess a certain pattern of purchasing. This is also referred to as judgmental or selective sampling. If a sample is purposive, it is not random, convenience, or systematic.

      DIF: Cognitive Level: Application REF: Page 362

6. A graduate student has a close friend who is recovering from colon cancer and has a permanent colostomy. For her master’s thesis, the student decides to conduct qualitative research on adjustment to living with a permanent colostomy after colon cancer resection. She asks her friend if she has any idea of how to recruit participants for the research. Her friend tells her about a colon cancer support group to which she belongs and volunteers to bring a printout of the research study’s purpose and general description to the next support group meeting. If the researcher acquires all of her participants in this way, what is the method of sampling used?

   1. Snowball sampling

   2. Cluster sampling

   3. Purposive sampling

   4. Simple random sampling

      ANS: A

      Network sampling, sometimes referred to as snowballing, holds promise for locating samples difficult or impossible to obtain in other ways or who had not been previously identified for study. Network sampling takes advantage of social networks and the fact that friends tend to have characteristics in common. When the researcher has found a few subjects with the necessary criteria, he or she asks their assistance in getting in touch with others with similar characteristics. The first few subjects are often obtained through a convenience sampling method, and the sample size is expanded using network sampling. In cluster sampling, the researcher develops a sampling frame that includes a list of all the states, cities, institutions, or organizations with which elements of the identified population would be linked. States, cities, institutions, or organizations are selected randomly as units from which to obtain elements for the sample. In purposive sampling, sometimes referred to as purposeful, judgmental, or selective sampling, the researcher consciously selects certain participants, elements, events, or incidents to include in the study.

      DIF: Cognitive Level: Application REF: Page 366

7. A researcher has already written a study proposal and performed a power analysis, which indicates that the sample size will have to be at least 36 if a type II error is to be avoided. The researcher then decides to set the level of significance at p <.01 rather than p <.05 but wants to maintain power at 0.8. What will the researcher have to do in order to maintain sufficient power?

   1. Increase the effect size.

   2. Set beta at 0.60.

   3. Use a different statistical test.

   4. Increase the sample size.

      ANS: D

      You determine the sample size needed to obtain sufficient power by performing a power analysis. Power analysis includes the standard power (usually 80%), level of significance (usually set at 0.05 in nursing studies), effect size, and sample size. In order to demonstrate statistical significance at a more stringent level (a decreased alpha), the sample size must be increased. The effect size is determined by the magnitude of effect that the intervention produces and, consequently, cannot be adjusted.

      DIF: Cognitive Level: Application REF: Page 367

8. A researcher studying depression in relation to five predictor variables decides to include five more variables in the study because the literature reveals that they may also be involved in depression. Consequently, the researcher will do which of the following?

   1. Use a larger sample size.

   2. Set beta at a lower level.

   3. Perform additional reliability and validity tests.

   4. Change the design of the research from correlational to descriptive.

      ANS: A

      As the number of variables under study grows, the needed sample size increases. Adding variables such as age, gender, ethnicity, and education to the analysis plan can increase the sample size by a factor of 5 to 10 if the selected variables are uncorrelated with the dependent variable. Setting beta lower, performing additional reliability and validity tests, and changing the design from correlational to descriptive will not solve the problem of the altered power of the study, due to addition of five variables. Only increasing the sample size will be a practical solution.

      DIF: Cognitive Level: Application REF: Page 370

9. How does effect size relate to instrument sensitivity?

   1. If an instrument is sensitive, it will have a large effect size.

   2. If an instrument is not very sensitive, it will take a large effect size for the instrument to detect a difference.

   3. As an instrument is better calibrated and becomes more sensitive, it increases effect size.

   4. If an instrument is extremely sensitive, it will detect a difference even when none exists; because of this effect sizes must be large.

      ANS: B

      Well-developed instruments measure phenomena with precision. The more sensitive the measurement methods used in a study, the better they will detect even a small effect size. A sensitive instrument does not produce an effect—it measures it. Effect size is not altered by calibration of instruments; again, sensitivity does not increase effect size. A legitimate instrument detects a difference when one exists, and only when one exists.

      DIF: Cognitive Level: Analysis REF: Page 370

10. A teacher is supposed to be randomly assigning her students to experimental and control groups, for participation in a learning project mandated by the school district. She has a master list of the alphabetized students, numbered 1 through 30. Which of the following is the most logical way to randomly assign the students to groups?

    1. Put numbers 1 to 30 in a hat, draw them out one by one, and put them into alternating groups.

    2. Place the first 15 subjects in one group and the last 15 in the other group.

    3. Ignore numbers and let the students choose their groups.

    4. Put numbers 1 to 30 in a hat, draw one, placing it in the experimental group. Then find a student with similar gender, attributes, and abilities, and put that one into the control group. Then go back to the hat for the next experimental subject.

       ANS: A

       Random assignment is similar to random selection in that elements are selected at random from the sampling frame. To achieve simple random sampling, elements are selected at random from the sampling frame. This goal can be accomplished in a variety of ways, limited only by the imagination of the researcher. If the sampling frame is small, the researcher can write names on slips of paper, place the names in a container, mix well, and then draw out one at a time until the desired sample size has been reached. Another technique is to assign a number to each name in the sampling frame. The traditional “hat draw” is a random method for selection and for assigning. Placing the students into groups by the alphabet is arbitrary, not random. Allowing students to choose their groups turns the study into a quasi- experimental one. Randomly drawing only the experimental subjects one by one and then finding ones with similar attributes to go into the control group is a kind of matching, not random assignment.

       DIF: Cognitive Level: Application REF: Page 356

11. Which of the following types of sampling is least common in qualitative research?

    1. Convenience

    2. Purposive

    3. Snowball

    4. Random

       ANS: D

       Nonrandom sampling prevails in qualitative research. Of the five methods in the text, purposive sampling, network sampling, and theoretical sampling are more commonly applied in qualitative studies than in quantitative studies. Convenience and quota sampling may also be used, but they are less common.

       DIF: Cognitive Level: Application REF: Page 362

12. A pollster wants to obtain a large sample of voters with the least amount of trouble. Each subject is asked to complete a pencil-paper questionnaire containing seven multiple-choice questions. Each person completing the survey receives a $1-off coupon for a population coffee chain. The pollster decides to stand outside twenty different supermarkets for four hours each and ask patrons to participate in the research. Which method of sampling is this?

    1. Network or snowball sampling

    2. Purposive sampling

    3. Convenience sampling

    4. Cluster sampling

       ANS: C

       Convenience sampling involves the nonrandom selection of subjects who meet criteria and are available and willing to be in the study, or basically subjects who are in the right place at the right time. Thus, this is the easiest, most economic method to obtain a large sample. In purposive sampling, sometimes referred to as purposeful, judgmental, or selective sampling, the researcher consciously selects certain participants, elements, events, or incidents to include in the study. In purposive sampling, qualitative researchers select information-rich cases, or those cases that can teach them a great deal about the central focus or purpose of the study.

       This is almost exclusively a qualitative sampling strategy. Network or snowball sampling takes advantage of social networks to recruit subjects and is almost exclusively a qualitative sampling strategy. Cluster sampling is a type of random sampling.

       DIF: Cognitive Level: Application REF: Page 358

13. A researcher contacts seven large hospitals and makes arrangements to recruit 55 patients from each of their emergency rooms. If this is cluster sampling, how were the seven large hospitals chosen?

    1. By size

    2. By random selection

    3. By availability

    4. By researcher familiarity

       ANS: B

       In cluster sampling, a sampling frame is developed that includes a list of all the states, cities, institutions, or organizations with which elements of the identified population would be linked. States, cities, institutions, or organizations are selected randomly as units from which to obtain elements for the sample. In some cases, random selection continues through several stages and is then referred to as multistage cluster sampling.

       DIF: Cognitive Level: Application REF: Page 361

14. “To be considered eligible for the study, subjects had to be older than 21 years of age, hold a valid state driver’s license, and be able to fire a shotgun.” This is an example of which of the following?

    1. Inclusion plan

    2. Population element

    3. Sampling criteria

    4. Representativeness

       ANS: C

       Sampling criteria, also referred to as eligibility criteria or inclusion criteria, include a list of characteristics essential for membership or eligibility in the target population. The criteria are developed from the research problem, the purpose, a review of literature, the conceptual and operational definitions of the study variables, and the design. The sampling criteria determine the target population, and the sample is selected from the accessible population within the target population

       DIF: Cognitive Level: Application REF: Page 363

15. Five hundred persons were chosen to participate, 270 women and 230 men, representative of the population of Portland, Oregon, treated for congestive heart failure at one of its four main hospitals. Patients were selected using a table of random numbers, from a master list of all patients who had been treated for CHF in the previous three months. This is an example of what type of sampling strategy?

    1. Simple random sampling

    2. Convenience sampling

    3. Purposive sampling

    4. Stratified random sampling

       ANS: D

       Stratified random sampling is used when the researcher knows some of the variables in the population that are critical to achieving representativeness. Variables commonly used for stratification are age, gender, ethnicity, socioeconomic status, diagnosis, geographical region, type of institution, type of care, care provider, and site of care. The variable or variables chosen for stratification need to be correlated with the dependent variables being examined in the study. Subjects within each stratum are expected to be more alike (homogeneous) in relation to the study variables than they are to be like subjects in other strata or the total sample. In stratified random sampling, the subjects are randomly selected on the basis of their classification into the selected strata.

       DIF: Cognitive Level: Application REF: Page 359

16. A research study examined the partying styles of students in fraternities, in sororities, living in dorms, and living in private residences. Ten students from each group were included in the research. This is an example of which type of sampling strategy?

    1. Quota sampling

    2. Cluster sampling

    3. Purposive sampling

    4. Stratified random sampling

       ANS: A

       Quota sampling uses a convenience sampling technique with an added feature, a strategy to ensure the inclusion of subject types or strata in a population that are likely to be underrepresented in the convenience sample, such as women, minority groups, the elderly, the poor, the rich, and the undereducated. This method may also be used to mimic the known characteristics of the target population or to ensure adequate numbers of subjects in each stratum for the planned statistical analyses. The technique is similar to that used in stratified random sampling but the initial sample is not random.

       DIF: Cognitive Level: Application REF: Page 364

17. A sample is chosen for a study on average heights and weights of adult males in a major city. The researcher uses a convenience sampling method, enacting this by going door-to-door in a neighborhood in St. Paul, Minnesota. Unbeknownst to the researcher, this neighborhood is very rich in persons of Norwegian descent, who coincidentally are the tallest Caucasians on the planet. The sampling error that occurs is a result of which of the following?

    1. Random variance

    2. Refusal rate

    3. Systematic bias

    4. Type II error

       ANS: C

       Systematic variation, or systematic bias, is a consequence of selecting subjects whose measurement values are different, or vary, in some specific way from the population. Because the subjects have something in common, their values tend to be similar to those of others in the sample but different in some way from those of the population as a whole. These values do not vary randomly around the population mean. Most of the variation from the mean is in the same direction; it is systematic. All the values in the sample may tend to be higher or lower than the population’s mean. Random variation is the expected difference in values that occurs when one examines different subjects from the same sample. If the mean is used to describe the sample, the values of individuals in that sample will not all be exactly the same as the sample mean. Individual subjects’ values vary from the value of the sample mean. The difference is random because the value of each subject is likely to vary in a different direction.

       DIF: Cognitive Level: Application REF: Page 354

18. Which of the following is the nonprobability sampling method?

    1. Cluster

    2. Quota

    3. Stratified random

    4. Systematic

       ANS: B

       Four sampling designs have been developed to achieve probability sampling: simple random sampling, stratified random sampling, cluster sampling, and systematic sampling.

       DIF: Cognitive Level: Comprehension REF: Page 358

19. Convenience sampling + stratification = what?

    1. Stratified random sampling

    2. Quota sampling

    3. Purposive sampling

    4. Cluster sampling

       ANS: B

       Quota sampling uses a convenience sampling technique with an added feature, a strategy to ensure the inclusion of subject types or strata in a population that are likely to be underrepresented in the convenience sample, such as women, minority groups, the elderly, the poor, the rich, and the undereducated. This method may also be used to mimic the known characteristics of the target population or to ensure adequate numbers of subjects in each stratum for the planned statistical analyses.

       DIF: Cognitive Level: Synthesis REF: Page 364

20. A researcher consented 75 subjects, but 15 dropped out of the study while it was still in progress. What was the sample attrition rate?

    1. 15

    2. 15%

    3. 20%

    4. 75%

       ANS: C

       Sample attrition rate formula = number subjects withdrawing ÷ sample size  100%.

       For example, if a study had a sample size of 160 and 40 people withdrew from the study, the attrition rate would be 25%.

       DIF: Cognitive Level: Application REF: Page 356

21. A researcher consented 400 subjects, but 12 dropped out of the study before it was completed. The rest finished the study. What was the sample retention rate?

    1. 388

    2. 38.8%

    3. 3%

    4. 97%

       ANS: D

       Sample retention rate formula = number subjects completing study ÷ sample size  100%.

       DIF: Cognitive Level: Application REF: Page 356

22. A researcher attempted to recruit all 150 of the patients seen in the emergency department in a three-month period for diverticulitis, but only 120 consented to participate. What is the sample size?

    1. 150

    2. 120

    3. 30

    4. 80%

       ANS: B

       A refusal rate is the number and percentage of subjects who declined to participate in the study. Patients who refuse to participate are not part of the sample, since they were only potential subjects, not actually included in the sample. The refusal rate is calculated by dividing the number of potential subjects refusing to participate by the number of potential subjects meeting sampling criteria and multiplying the results by 100%.

       DIF: Cognitive Level: Application REF: Page 355

23. A researcher attempted to recruit all 150 of the patients seen in the emergency department in a three-month period for diverticulitis, but only 120 consented to participate. What is the refusal rate?

    1. 100%

    2. 80%

    3. 20%

    4. 0%

       ANS: C

       A refusal rate is the number and percentage of subjects who declined to participate in the study. High refusal rates to participate in a study have been linked to individuals with serious physical and emotional illnesses, low socioeconomic status, and weak social networks. The higher the refusal rate, the less the sample is representative of the target population. The refusal rate is calculated by dividing the number of potential subjects refusing to participate by the number of potential subjects meeting sampling criteria and multiplying the results by 100%.

       DIF: Cognitive Level: Application REF: Page 355

24. Using a table of random numbers, the sample of 400 subjects was selected from the list of the license numbers of all registered nurses in the state of Michigan. Each nurse was sent a letter requesting completion of an online survey on workplace bullying. This is an example of what type of sampling method?

    1. Simple random sampling

    2. Quota sampling

    3. Convenience sampling

    4. Purposive sampling

       ANS: A

       To achieve simple random sampling, elements are selected at random from the sampling frame. This goal can be accomplished in a variety of ways, limited only by the imagination of the researcher. A random number table is effective in selecting numbered elements from a master list. Simple random sampling ensures that each element of the population has an equal and independent chance of being chosen.

       DIF: Cognitive Level: Application REF: Page 358

25. When grounded theory researchers recruit subjects who can provide relevant information to explain a cluster of interlocking ideas that is unclear to the researchers, what kind of sampling is used?

    1. Theoretical sampling

    2. Convenience sampling

    3. Quota sampling

    4. Network

       ANS: A

       Theoretical sampling is usually applied in grounded theory research to advance the development of a selected theory throughout the research process. The researcher gathers data from any individual or group that can provide relevant data for theory generation. The data are considered relevant if they include information that generates, delimits, and saturates the theoretical codes in the study needed for theory generation.

       DIF: Cognitive Level: Synthesis REF: Page 366

26. Which is the sampling design that is an example of a probability sampling method?

    1. Purposive

    2. Snowball

    3. Stratified random

    4. Quota

ANS: D

There are several types of nonprobability (nonrandom) sampling designs. Each addresses a different research need. The five nonprobability sampling designs described in this textbook are (1) convenience sampling, (2) quota sampling, (3) purposive or purposeful sampling, (4) network or snowball sampling, and (5) theoretical sampling. These sampling methods are applied in both quantitative and qualitative research. However, convenience sampling and quota sampling are applied more often in quantitative, outcomes, and intervention research than in qualitative studies and are discussed in this section.

DIF: Cognitive Level: Comprehension REF: Page 362

MULTIPLE RESPONSE

1. If the population is E, and assuming the researcher selects part of the population as a sample, what could be the sample? (Select all that apply.)

   a. A

   b. B

   c. C

   d. D

   e. E

   ANS: A, B, C, D

   Sampling involves selecting a group of people, events, behaviors, or other elements with which to conduct a study. A sample denotes the selected group of people or elements included in a study sample; it is a subset of the population. Every element of the sample is located within the population. In the diagram, A, B, C, and D are totally contained within E. The sampling criteria determine the target population, and the sample is selected from the accessible population within the target population.

   DIF: Cognitive Level: Application REF: Page 351

2. A researcher e-mails an online survey about multi-tasking and overcommitedness both on and off the job, as they relate to quality of life, to a random selection of 20,000 RNs in all 50 states; this represents about 1% of the population of RNs. The return rate on the tool is 5%. The goal of this sampling method is to obtain a representative sample. Which of the following are correct statements relative to the sample’s representativeness? (Select all that apply.)

   1. Since the topic has to do with having too many things going at once, it is likely that the results will be skewed, since RNs who are vastly overcommitted will not complete the survey.

   2. The sample is automatically representative if randomly selected names were used for the survey e-mailing.

   3. If the e-mailed subset of the population was randomly selected and the return meets the number required by power analysis, the return is representative.

   4. Subjects whose perceived quality of life is either very high or very low may be more inclined to participate, since they have an interest in finding more out about this relationship.

   5. If the 1,000 subjects who return the survey constitute an insufficient number to demonstrate statistical significance, this means that the sample was not truly representative.

   6. The sample is so huge, it would certainly be representative of the entire population.

      ANS: A, D

      For a sample to be representative, it must be like the target population in as many ways as possible. It is especially important that the sample be representative in relation to the variables being studied and to other factors that may influence the study variables. Random sampling increases the extent to which the sample is representative of the target population. Even if the original sample is random, persons who volunteer or consent to participate in a study may differ in important ways from those who are not willing to participate.

      DIF: Cognitive Level: Synthesis REF: Page 353

3. What would represent a hypothetical population? (Select all that apply.)

   1. The average population of New Jersey

   2. Babies born in taxicabs in New York City in the coming year

   3. The forty-five subjects whose performance supported the study hypothesis

   4. The percentage of the subjects who score higher than 81 on the Test of Motor Capability

   5. All of the high school students at Bountiful High School who will earn their Eagle Scout rank in the academic year 2018–2019

      ANS: B, E

      A hypothetical population assumes the presence of a population that cannot be defined according to sampling theory rules, which require a list of all members of the population. For example, individuals who successfully lose weight would be a hypothetical population. The number of individuals in the population, who they are, how much weight they have lost, how long they have kept it off, or how they achieved the weight loss is unknown. Some populations are elusive and constantly changing. For example, listing all women in active labor in the United States, all people grieving the loss of a loved one, or all people coming into an emergency department would be impossible to identify.

      DIF: Cognitive Level: Application REF: Page 352

4. If all of the tickets purchased in this week’s state lottery is considered the population, the five winning tickets drawn on Saturday constitute the sample. If the lottery is not “fixed,” why is this a probability sample? (Select all that apply.)

   1. Because according to the laws of probability, the group of five people who won is exactly representative of all of the persons who purchased tickets

   2. Because each ticket purchased has a chance of being included in the sample

   3. Because the tickets drawn have a high probability of being representative of all tickets purchased

   4. Because use of random sampling increases the probability that those persons whose tickets win will play the lottery again

   5. Because each ticket probably has an equal chance of being included in the winning group, whether or not random sampling is used

      ANS: B, C

      Probability sampling methods have been developed to ensure some degree of precision in estimations of the population parameters. Thus, probability samples reduce sampling error. The term probability sample refers to the fact that every member (element) of the population has a probability higher than zero of being selected for the sample. Since all tickets have a greater than zero chance of winning, and since the tickets drawn have a very good probability of being representative of all tickets purchased, this is a probability sample.

      DIF: Cognitive Level: Synthesis REF: Page 357

5. Why are broad sampling criteria preferable for descriptive nursing studies? (Select all that apply.)

   1. The accessible population is often limited in size.

   2. They include the sample that is the most representative of the population at that site.

   3. Broad sampling criteria are preferable for studies conducted in natural settings.

   4. Broad sampling criteria eliminate more extraneous variables than do narrow sampling criteria.

   5. Generalization is improved with broad sampling criteria.

      ANS: A, B, C, E

      Broad sampling criteria ensure a large target population of heterogeneous or diverse potential subjects. A heterogeneous sample increases one’s ability to generalize the findings to a larger target population. In descriptive or correlational studies, the sampling criteria may be defined to ensure a heterogeneous population with a broad range of values for the variables being studied. Descriptive studies are usually conducted with minimal control of the study design, because subjects are examined as they exist in their natural setting, such as home, work, or school.

      DIF: Cognitive Level: Synthesis REF: Page 352

6. The population parameter for firefighters on Long Island is 79% male. The sample statistic for three fire stations is 73% male. Why wasn’t the sample statistic the same as the population parameter?

   1. Sampling error was present.

   2. Random variation might have occurred.

   3. Systematic variation might have occurred.

   4. The sample was fairly small.

   5. The sample was not perfectly representative.

   6. The population parameter is inaccurate.

      ANS: A, B, C, D, E

      The difference between a sample statistic and a population parameter is called the sampling error. A large sampling error means that the sample is not providing a precise picture of the population; it is not representative. Sampling error is usually larger with small samples and decreases as the sample size increases. Sampling error reduces the power of a study, or the ability of the statistical analyses conducted to detect differences between groups or to describe the relationships among variables. Sampling error occurs as a result of random variation and systematic variation.

      DIF: Cognitive Level: Application REF: Page 354

7. What are the true statements about inclusion and exclusion criteria? (Select all that apply.)

   1. Inclusion and exclusion criteria determine the demographics of the sample.

   2. Inclusion and exclusion criteria are the opposites of one another.

   3. Inclusion and exclusion criteria must be mutually exhaustive.

   4. Inclusion and exclusion criteria must be mutually exclusive.

   5. Inclusion and exclusion criteria must address the study purpose.

      ANS: A, E

      A study might have inclusion or exclusion sampling criteria (or both). Inclusion sampling criteria are those characteristics that a subject or element must possess to be part of the target population. Exclusion sampling criteria are those characteristics that can cause a person or element to be excluded from the target population. For age, for instance, “excluded if under the age of 18” and “included if over the age of 18” are not acceptable exclusion/inclusion criteria because they are not mutually exhaustive: what should the researcher do with someone 18—include, or exclude? Similarly, “excluded if 65 or younger” and “included if 65 or older” are not mutually exclusive—again, what does the researcher do with the 65-year-old?

      DIF: Cognitive Level: Analysis REF: Page 353

8. Large sample sizes are desirable in which types of research? (Select all that apply.)

   1. Correlational, using an existent database

   2. Grounded theory

   3. Phenomenology

   4. Pilot interventional research

   5. Multisite randomized clinical trials

   6. Survey research

   7. Model testing

   8. Case study research

      ANS: A, E, F, G

      Descriptive case studies tend to use small samples. Groups are not compared, and problems related to sampling error and generalization have little relevance for such studies. A small sample size may better serve the researcher who is interested in examining a situation in depth from various perspectives. Other descriptive studies, particularly those using survey questionnaires, and correlational studies often require large samples. In the past, quasi- experimental and experimental studies often used smaller samples than descriptive and correlational studies. The sample size increases in proportion to the number of variables included in data analysis. In quantitative research, the sample size must be large enough to identify relationships among variables or to determine differences between groups. However, in qualitative research, the focus is on the quality of information obtained from the person, situation, or event sampled versus the size of the sample. The intent is an in-depth understanding of a purposefully selected sample and not the generalization of the findings from a randomly selected sample to a target population, as in quantitative research. The number of participants in a qualitative study is adequate when saturation of information is achieved in the study area. Grounded theory and phenomenology are types of qualitative research. A pilot study is a smaller version of a proposed study conducted to develop and refine the methodology or intervention hence it uses a smaller sample size.

      DIF: Cognitive Level: Synthesis REF: Page 369

9. A hospital-based nurse researcher at Hospital A conducts experimental research on a rotating bed and its effect on prevention of pressure ulcers in hip fracture patients over 80 years of age with cognitive functional impairment. Because there are so few patients over 80 with fractured hips and cognitive functional impairment, and because the researcher anticipates problems with obtaining consent, a convenience sample is utilized and every patient who meets the criteria and consents is used in the study. The bed, although expensive, is found to be much more effective in preventing pressure ulcers in this population than is turning alone. The study is published. What are the implications of applying these findings, considering the researcher’s use of a convenience sample? (Select all that apply.)

   1. The findings can be applied to similar patients who come to Hospital A, with the understanding that data collection will continue and represent a second study, since the research is unreplicated.

   2. The findings may be applicable to similar patients who come to Hospital B, but without replication, this use cannot be mandated in the research report.

   3. The rotating bed should not be used outside of Hospital A at all until a replication study is conducted.

   4. The study findings probably represent a type I error. It is doubtful that use of a rotating bed could produce significant findings with a convenience sample.

   5. The widespread use of the rotating bed has not been supported.

   6. Generalization is appropriate only extremely cautiously and in the same site in which the study was conducted, with tracking of subsequent data.

      ANS: A, B, E, F

      In convenience sampling, any patients who meet the inclusion criteria are recruited for the study. Convenience sampling is considered a weak approach to sampling because it provides little opportunity to control for biases. Multiple biases may exist in convenience sampling; these biases range from minimal to serious. Additional studies with large convenience samples that have similar results would indicate the effectiveness of this intervention for practice.

      Studies with small convenience samples should be replicated to determine the accuracy of the findings and to increase the representation of the population studied. If findings are consistent over replications, then generalization to a larger group is possible.

      DIF: Cognitive Level: Analysis REF: Page 363

10. Why are convenience samples used so frequently in nursing research? (Select all that apply.)

    1. More subjects consent if they can understand the sampling method.

    2. Obtaining a true random sample may be impossible.

    3. There is low risk of sampling bias.

    4. There are limited subjects available.

    5. Nonrandom sampling affects only generalizability, not study integrity.

       ANS: A, D, E

       The majority of nursing studies use nonprobability sampling, especially convenience sampling, to select study samples. In conducting studies in nursing and other health disciplines, there are limited subjects available and often a random sample is not possible to obtain. Researchers often include any subjects willing to participate who meet the eligibility criteria. Nonrandom sampling affects only generalizability, not any other type of validity.

       DIF: Cognitive Level: Analysis REF: Page 362

11. If researchers are attempting to recruit subjects who are members of a group is not mainstream and may be disdained, why is snowball sampling often used?

    1. It is less time-consuming than other methods, for hard-to-access populations.

    2. It produces a sample that is more representative.

    3. It increases recruitment success.

    4. It produces a more diverse sample.

    5. It increases generalizability.

       ANS: A, C

       Network sampling, which also is referred to as snowball or chain sampling, holds promise for locating samples difficult or impossible to obtain in other ways or who had not been previously identified for study. Network sampling takes advantage of social networks and the fact that friends tend to have characteristics in common.

       DIF: Cognitive Level: Evaluation REF: Page 353

12. Why would a researcher use an elimination criterion like “Must not have baseline liver function tests that are outside the normal range”? (Select all that apply.)

    1. Impaired liver function may have been identified by the researcher as an extraneous variable.

    2. The intervention planned by the researcher could have an adverse effect on individuals with impaired liver function.

    3. Liver function tests are possibly being measured in order to detect the independent variable’s effect on the dependent variable.

    4. The researcher is attempting to eliminate persons with all lab tests that are outside normal range.

    5. The dependent variable may be abnormally elevated in persons who do not have normal liver function.

       ANS: A, B, C, E

       Exclusion sampling criteria are those characteristics that can cause a person or element to be excluded from the target population. The usual reasons for exclusion criteria are that they are extraneous variables and, if present, they could affect the value of the dependent variable.

       Other reasons might include increased risk for some groups.

       DIF: Cognitive Level: Synthesis REF: Page 353

13. Performing a power analysis allows the researcher to calculate adequate sample size. Why is this preferable to accomplish in the design phase of a quantitative study? (Select all that apply.)

    1. A sample of sufficient size maximizes the chance of detecting statistical significance.

    2. Performing a power analysis increases the research’s potential for publication.

    3. Conducting a power analysis decreases the chance of a type I error.

    4. Conducting a power analysis increases effect size.

    5. The institutional review paperwork must include a maximum sample size.

       ANS: A, E

       The deciding factor in determining an adequate sample size for correlational, quasi- experimental, and experimental studies is power. Power is the capacity of the study to detect differences or relationships that actually exist in the population. Expressed another way, power is the capacity to correctly reject a null hypothesis. Often the minimum acceptable power for a study is 0.80. If a researcher does not have sufficient power to detect differences or relationships that exist in the population, one might question the advisability of conducting the study. Therefore, it is advisable to conduct the power analysis in the design phase so as to ensure an adequate sample size is obtained. One of the items required by the Institutional Review Board is a description of the subjects the researcher plans to use in the study. This includes the maximum number of subjects anticipated.

       DIF: Cognitive Level: Evaluation REF: Page 367

14. The researcher conducts a qualitative study that explores the feelings of nurses who care for victims of intentional burning. What sampling methods are most appropriate for this study? (Select all that apply.)

    1. Quota sampling

    2. Purposive sampling

    3. Cluster sampling

    4. Stratified random sampling

    5. Systematic sampling

    6. Snowball sampling

    7. Theoretical sampling

       ANS: B, F, G

       Purposive sampling, network sampling, and theoretical sampling are used more frequently in qualitative studies than in quantitative studies. In purposive sampling, sometimes referred to as purposeful, judgmental, or selective sampling, the researcher consciously selects certain participants, elements, events, or incidents to include in the study. In purposive sampling, qualitative researchers select information-rich cases, or those cases that can teach them a great deal about the central focus or purpose of the study. Network sampling, sometimes referred to as snowball or chain sampling, holds promise for locating samples who are difficult or impossible to obtain in other ways or who had not been previously identified for study.

       Network sampling takes advantage of social networks and the fact that friends tend to have characteristics in common. Theoretical sampling is usually applied in grounded theory research to advance the development of a selected theory throughout the research process (Munhall, 2012). The researcher gathers data from any individual or group that can provide relevant data for theory generation.

       DIF: Cognitive Level: Application REF: Page 362

15. Why are convenience samples used so frequently in nursing research, when a random sample would allow for greater generalizability? (Select all that apply.)

    1. Convenience sampling allows researchers to select not only subsets but qualities associated with them.

    2. Key informants are desired.

    3. Random sampling is really not an issue, since little nursing research is replicated.

    4. Subjects are difficult to recruit when they are ill.

    5. Nurses are limited to the populations they serve; many populations are small and difficult to access.

       ANS: D, E

       Thus, nonprobability sampling methods increase the likelihood of obtaining samples that are not representative of their target populations. However, the majority of nursing studies use nonprobability sampling, especially convenience sampling, to select study samples. In conducting studies in nursing and other health disciplines, there are limited subjects available and often a random sample is not possible to obtain. Researchers often include any subjects willing to participate who meet the eligibility criteria.

       DIF: Cognitive Level: Synthesis REF: Page 362

16. A study has a power level of .75. What does that mean? (Select all that apply.)

    1. Study interventions will be statistically significant 75% of the time.

    2. The study has a 75% chance of detecting differences if they exist.

    3. The study’s sample has a 25% attrition rate, at worst.

    4. There is a 25% chance of detecting a type I error.

    5. There is a 25% chance that the study will fail to reveal differences that actually exist.

       ANS: B, E

       Power is the capacity of the study to detect differences or relationships that actually exist in the population. Expressed another way, power is the capacity to correctly reject a null hypothesis. The minimum acceptable power for a study is commonly recommended to be 0.80 (80%). However, the researcher can set this lower, if the researcher is willing to risk a larger likelihood of a type II error.

       DIF: Cognitive Level: Application REF: Page 367

17. Which of the following are true statements related to determination of minimum sample size? (Select all that apply.)

    1. In inferential quantitative research, power analysis drives sample size.

    2. In pilot research, ability to address the purpose for the pilot drives sample size.

    3. In descriptive research, availability of subjects drives sample size.

    4. In both quantitative and qualitative research, available funding drives sample size.

    5. In qualitative research, theoretical saturation drives sample size.

       ANS: A, B, C, E

       Currently, the deciding factor in determining an adequate sample size for correlational, quasi- experimental, and experimental studies is power. Power is the capacity of the study to detect differences or relationships that actually exist in the population. Determining the sample size needed to obtain sufficient power is made by performing a power analysis. In descriptive or descriptive correlational research conducted in a natural setting, it is usual to include all available subjects.Sample size in both quantitative and qualitative research should be determined by the researcher’s available funding. The number of participants in a qualitative study is adequate when saturation of information is achieved in the study area, which occurs when additional sampling provides no new information, only redundancy of previously collected data. A pilot study’s sample size is very small—just enough to address the reason the pilot was conducted. For instance, a small pilot study can be performed to measure the effect size, so that the researchers can perform an informed power analysis for the subsequent quantitative study, estimating its required sample size appropriately.

       DIF: Cognitive Level: Synthesis REF: Page 367

18. Why is a large refusal rate a barrier to widespread generalization? (Select all that apply.)

1. If a study has a refusal rate higher than thirty percent, it is no longer considered research.

2. If researchers cannot recruit subjects into their research studies, their credibility and ethics are under serious scrutiny.

3. The actual sample is not representative of the population. It is representative only of the elements of the population that chose to participate.

4. If many persons refuse to participate, they might refuse to participate in interventions that the study recommends.

   ANS: A, B, C

   Sampling theory was developed to determine mathematically the most effective way to acquire a sample that would accurately reflect the population under study. For a sample to be representative, it must be like the target population in as many ways as possible. It is especially important that the sample be representative in relation to the variables being studied and to other factors that may influence the study variables. A sample must be representative of the demographic characteristics, such as age, gender, ethnicity, income, and education, which often influence study variables. The accessible population must be representative of the target population. If the accessible population is limited to a particular setting or type of setting, the individuals seeking care at that setting may be different from those who would seek care for the same problem in other settings or from those who choose to use self-care to manage their problems. Representativeness is usually evaluated through comparison of the numerical values of the sample (a statistic such as the mean) with the same values from the target population.

   DIF: Cognitive Level: Synthesis REF: Page 353

• Why is survey research subject selection considered nonrandom? (Select all that apply.)

  1. If monetary reward is offered as an inducement, subjects may participate only to get the reward. The sample may include fewer people who are well off financially.

  2. There is no direct contact with the subjects.

  3. Follow-up reminders make recruitment long and drawn-out.

  4. Inducements are essentially manipulative; potential subjects who resent manipulation refuse to return surveys.

  5. Refusal rates average 50% or more, and this makes the sample nonrepresentative.

     ANS: A, D, E

     In conducting a survey study, the researcher may never have personal contact with the subjects. To recruit such subjects, one must rely on the use of attention-getting techniques, persuasively written material, and strategies for following up on individuals who do not respond to the initial written or e-mail communication. Because of the serious problems of low response rates in survey studies, using strategies to raise the response rate is critical. In some cases, small amounts of money ($1 to $5 dollars) are enclosed with the letter. This may produce a feeling of obligation on the part of the potential participant. Survey research return rate varies from 5% through about 50% for most studies. Interestingly, the accuracy of responses in survey research is slightly better with a lower return!

     DIF: Cognitive Level: Comprehension REF: Page 376

• Inclusion criteria differ from sample characteristics. Which of the following are sample characteristics from a study conducted in a neurosurgical critical care unit of a major hospital? (Select all that apply.)

  1. Mean age 62, with range from 37 through 87

  2. Diagnosed with neurologic impairment due to trauma or disease

  3. Glasgow Coma Scale range 4 to 15

  4. Twenty-one male, nineteen female

  5. Able to speak English or Spanish

     ANS: A, C, D

     Inclusion criteria are those characteristics that a subject or element must possess to be part of the target population. Sample characteristics are a description of the subjects who participated in the study; in a nursing study, these often contain information about age, gender, diagnosis, and medical condition.

     DIF: Cognitive Level: Synthesis REF: Page 351

• Inclusion criteria differ from sample characteristics. Which of the following are inclusion criteria for a study conducted on an acute care ward of a major hospital? (Select all that apply.)

  1. Mean age 62, with range from 37 through 87

  2. Twenty-four male, twelve female

  3. Glasgow Coma Scale of at least 14

  4. Twenty-one post hip replacement, fifteen post knee replacement

  5. Able to read and write English

ANS: C, E

Inclusion criteria are those characteristics that a subject or element must possess to be part of the target population. They are like a list of what you are fishing for when you go out in a boat. Sample characteristics are a description of the subjects who participated in the study; in a nursing study, these often contain information about age, gender, diagnosis, and medical condition. They are like a list of what fish you caught on the fishing trip.

DIF: Cognitive Level: Synthesis REF: Page 351

Chapter 16: Measurement Concepts Test Bank

MULTIPLE CHOICE

1. A shepherd in the wilds of eastern Nevada is counting his sheep at the end of a work day. What is another term for what he is doing?

   1. Estimating random error

   2. Measuring

   3. Using an interval level of measurement

   4. Calculating risk ratios

      ANS: B

      Measurement is the process of assigning numbers to objects, events, or situations in accord with some rule. The numbers assigned can indicate numerical values or categories for the objects being measured for research or practice.

      DIF: Cognitive Level: Application REF: Page 382

2. What kind of reliability testing is used extensively in qualitative research?

   1. Equivalence reliability

   2. Stability reliability

   3. External consistency

   4. Internal consistency

      ANS: A

      Equivalence reliability compares two versions of the same paper-and-pencil instrument or two observers measuring the same event. Determining interrater reliability is a concern when studies include observational measurement, which is common in qualitative research.

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

      DIF: Cognitive Level: Analysis REF: Page 390

3. Why would interrater reliability be measured in a quantitative research project?

   1. A verbal quantitative questionnaire is filled out.

   2. Behavior is observed and classified.

   3. Phenomenology is the research method.

   4. Distances are measured.

      ANS: B

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

      DIF: Cognitive Level: Analysis REF: Page 390

4. What is the purpose of determining an instrument’s internal consistency?

   1. It establishes face validity.

   2. It demonstrates that the instrument is measuring exactly what the researcher thinks it is measuring.

   3. It decreases measurement error.

   4. It is a way of establishing test-retest reliability.

      ANS: D

      Tests of instrument internal consistency or homogeneity, used primarily with paper-and-pencil tests or scales, address the correlation of various items within the instrument. The original approach to determining internal consistency was split-half reliability. This strategy was a way of obtaining test-retest reliability without administering the test twice.

      DIF: Cognitive Level: Application REF: Page 391

5. A new tool and very short tool is developed. It is to be used instead of a previously validated tool that is very long to administer. What kind of validity concept will be used for testing this new tool?

   1. Divergent validity

   2. Convergent validity

   3. Discriminant analysis

   4. Content validity

      ANS: B

      In examining the validity of the new instrument, it is important to determine how closely the existing instruments measure the same construct as the newly developed instrument (convergent validity). Divergent validity would measure the differences in measurement, between an existing instrument and a newly-developed one. Discriminant analysis measures the difference between two related but not identical concepts. Content validity is the extent to which a measurement represents the concept being measured.

      DIF: Cognitive Level: Application REF: Page 400

6. Which one of the following instructions to the research subject will provide the highest possible level of measurement?

   1. Indicate whether your income is above $20,000 a year or not.

   2. What was your income last year: $0–$20,000; $20,000–$60,000; $60,000–

      $100,000; or more than $100,000?

   3. What was your total income last year, before taxes? Enter amount:

   4. Did you earn money last year?

      ANS: C

      An important rule of measurement is that one should use the highest level of measurement possible. For example, you can collect data on age (measured) in a variety of ways: (1) you can obtain the actual age of each subject (ratio level of measurement); (2) you can ask subjects to indicate their age by selecting from a group of categories, such as 20–29, 30–39, and so on (ordinal level of measurement); or (3) you can sort subjects into two categories of under 65 years of age and 65 years of age and older (nominal level of measurement).

      DIF: Cognitive Level: Application REF: Page 387

7. A band is in on a multi-city tour, and souvenir shirts are ordered from a factory. They are shipped without the size labels. The vendor must then sort them into sizes—apparently they are small, medium, large, extra-large, and extra-extra-large. What level of measurement is this?

   1. Nominal

   2. Ordinal

   3. Interval

   4. Ratio

      ANS: B

      Data that can be measured at the ordinal level can be assigned to categories of an attribute that can be ranked. Nominal level of measurement is the lowest of the four measurement levels or categories. It is used when data can be organized into categories of a defined property but the categories cannot be ordered. It merely names. In interval level of measurement, distances between intervals of the scale are numerically equal. Interval scales are assumed to be a continuum of values. They are almost exclusively manmade scales, measures, inventories, and so forth. Ratio level of measurement is the highest form of measure and meets all the rules of the lower forms of measures. It uses the real number scale, on which zero means none of the variable being measured.

      DIF: Cognitive Level: Application REF: Page 386

8. A secretary in a veterinarian’s office keeps track of how many animals come in for care in a week’s time and what types of animals they are: cat, dog, horse, gerbil, duck, snake, and so forth. What level of measurement is this?

   1. Nominal

   2. Ordinal

   3. Interval

   4. Ratio

      ANS: A

      Nominal level of measurement is the lowest of the four measurement levels or categories. It is used when data can be organized into categories of a defined property but the categories cannot be ordered. It merely names. Data that can be measured at the ordinal level can be assigned to categories of an attribute that can be ranked. In interval level of measurement, distances between intervals of the scale are numerically equal. Interval scales are assumed to be a continuum of values. They are almost exclusively manmade scales, measures, inventories, and so forth. Ratio level of measurement is the highest form of measure and meets all the rules of the lower forms of measures. It uses the real number scale, on which zero means none of the variable being measured.

      DIF: Cognitive Level: Application REF: Page 386

9. Mark is in third grade and has just learned how to use a ruler to measure. He has become a measuring fool. He measures everything in the house, writing down all the measurements, and gaily announcing to his mom, “Hey, Mom. Guess what? The salt shaker is four and a quarter inches tall.” What level of measurement is this?

   1. Nominal

   2. Ordinal

   3. Interval

   4. Ratio

      ANS: D

      Ratio level of measurement is the highest form of measure and meets all the rules of the lower forms of measures. It uses the real number scale, on which zero means none of the variable being measured. Nominal level of measurement is the lowest of the four measurement levels or categories. It is used when data can be organized into categories of a defined property but the categories cannot be ordered. It merely names. Data that can be measured at the ordinal level can be assigned to categories of an attribute that can be ranked. In interval level of measurement, distances between intervals of the scale are numerically equal. Interval scales are assumed to be a continuum of values. They are almost exclusively manmade scales, measures, inventories, and so forth.

      DIF: Cognitive Level: Application REF: Page 387

10. Depression is measured by the Beck Depression Inventory, which adds up scores from 21 items to provide a total value ranging from 0 to 63. What level of measurement is this?

    1. Nominal

    2. Ordinal

    3. Interval

    4. Ratio

       ANS: C

       In interval level of measurement, distances between intervals of the scale are numerically equal. Interval scales are assumed to be a continuum of values. They are almost exclusively manmade scales, measures, inventories, and so forth. Nominal level of measurement is the lowest of the four measurement levels or categories. It is used when data can be organized into categories of a defined property but the categories cannot be ordered. It merely names. Data that can be measured at the ordinal level can be assigned to categories of an attribute that can be ranked. Ratio level of measurement is the highest form of measure and meets all the rules of the lower forms of measures. It uses the real number scale, on which zero means none of the variable being measured.

       DIF: Cognitive Level: Application REF: Page 387

11. Inclusion criteria and exclusion criteria in sample selection are mutually exclusive and mutually exhaustive. A researcher has a list of all of the study’s inclusion and exclusion criteria. These then must be sorted into an inclusion list and an exclusion list. The method of sorting may be considered

    1. Nominal

    2. Categorical

    3. Interval

    4. Ratio

       ANS: A

       Nominal level of measurement is the lowest of the four measurement levels or categories. It is used when data can be organized into categories of a defined property but the categories cannot be ordered. A study might have inclusion or exclusion sampling criteria (or both).

       Inclusion sampling criteria are those characteristics that a subject or element must possess to be part of the target population. Exclusion sampling criteria are those characteristics that can cause a person or element to be excluded from the target population. For age, for instance, “excluded if under the age of 18” and “included if over the age of 18” are not acceptable exclusion/inclusion criteria because they are not mutually exhaustive: what should the researcher do with someone 18—include, or exclude? Similarly, “excluded if 65 or younger” and “included if 65 or older” are not mutually exclusive—again, what does the researcher do with the 65-year-old?

       DIF: Cognitive Level: Evaluation REF: Page 386

12. A student finds a tool that measures adaptability that she wants to use for her master’s thesis. It has 25 items, and they are all of the ordinal level, scaled 0 through 5. The level of measurement of the tool is said by its authors, pragmatics all, to be which of the following?

    1. Ratio level

    2. Interval level

    3. Ordinal level

    4. Nominal level

       ANS: D

       Pragmatists often treat ordinal data from multiple item scales as interval data, using statistical methods to analyze them such as the Pearson’s Product-Moment Correlation Coefficient, t- test, and analysis of variance (ANOVA), which are traditionally reserved for interval or ratio level data. Fundamentalists insist that the analysis of ordinal data be limited to statistical procedures designed for ordinal data, such as nonparametric procedures.

       DIF: Cognitive Level: Analysis REF: Page 388

13. Interval scales of measurement (IQ tests, anxiety inventories, mental status exams) are products of man’s invention how frequently?

    1. Never

    2. Sometimes

    3. Frequently

    4. Always

       ANS: D

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

       DIF: Cognitive Level: Analysis REF: Page 387

14. Tests of stability reliability, such as test-retest, can reveal random measurement error. Why is systematic measurement error not revealed when stability reliability determinations are made?

    1. Actually, reliability testing does not reveal the type of error: differences on test- retest can indicate problems with both random and systematic measurement error.

    2. Tests of stability reliability are not powerful enough to pick up systematic measurement error because of its subtlety.

    3. If an instrument systematically measures all blood pressures 10 points high, it will do so both at baseline and on retesting.

    4. The direction of the systematic measurement error is reversed on retesting, so it is not visible in the statistical analysis.

       ANS: C

       Stability reliability is concerned with the consistency of repeated measures of the same attribute with the use of the same scale or instrument over time. It is usually referred to as test- retest reliability. This measure of reliability is generally used with physical measures, technological measures, and paper-and-pencil scales. The technique requires an assumption that the factor to be measured remains the same at the two testing times and that any change in the value or score is a consequence of random error.

       DIF: Cognitive Level: Analysis REF: Page 389

15. Specificity of an instrument used for diagnosis refers to what?

    1. Its ability to detect error

    2. Its ability to detect the presence of a condition or illness

    3. Its ability to detect the absence of a condition or illness

    4. Its true positives minus its false negatives

ANS: C

Specificity of a screening or diagnostic test is the proportion of patients without the disease who have a negative test result or true negative. A test with high specificity is very good at identifying the patient without any disease.

DIF: Cognitive Level: Comprehension REF: Page 407

MULTIPLE RESPONSE

1. Which of the following must be measured indirectly? (Select all that apply.)

   1. Number of miles from San Francisco to Disneyland

   2. Level of consciousness

   3. Height

   4. Hope

   5. Liver function

      ANS: A, D, E

      An abstract concept is not measured directly; instead, indicators or attributes of the concept are used to represent the abstraction. This is referred to as indirect measurement. In addition, hard-to-access physiologic and behavioral variables and huge quantities may be measured indirectly.

      DIF: Cognitive Level: Application REF: Page 383

2. Which of the statements is true, relative to error? (Select all that apply.)

   1. True score plus error score equals observed score.

   2. Random error of measurement increases the mean.

   3. The mean of the true measurements is equal to the mean of the observed measurements when there is no systematic error.

   4. No measurement of anything is ever correct.

   5. Measurement error always exists, if a straightforward measurement like counting is made often enough and by enough people.

      ANS: A, C, E

      Observed score = true score + random error. Random error does not influence the mean to be higher or lower but, rather, increases the amount of unexplained variance around the mean. Measurement error is the difference between what exists in reality and what is measured by an instrument.

      DIF: Cognitive Level: Analysis REF: Page 383

3. Which of the statements is true relative to systematic error? (Select all that apply.)

   1. If the amount of the systematic error is known, true scores can be retrieved.

   2. Systematic error may be decreased by proper instrument calibration.

   3. Systematic error results in values that vary in one direction from the true scores.

   4. Systematic error results from researcher fatigue or inattention.

   5. Systematic error changes the mean but not the relative magnitude of the variance.

      ANS: A, B, C, E

      Observed score = true score + systematic error. Measurement error that is not random is referred to as systematic error. For example, a scale that weighed subjects three pounds more than their true weights demonstrates systematic error. All of the body weights would be higher, and, as a result, the mean would be higher than it should be. Systematic error results in error in one direction. Consequently, the mean is either higher or lower, but the relative magnitude of the variance should remain the same. Systematic error occurs because something else is being measured in addition to the concept.

      DIF: Cognitive Level: Analysis REF: Page 383

4. What is the true statement, related to stability reliability? (Select all that apply.)

   1. It is useful for establishing the validity of a physiologic measure.

   2. It establishes the consistency of repeated measures of the same attribute with the use of the same scale or instrument over time.

   3. It reveals random error but not systematic error.

   4. It is sometimes referred to as test-retest reliability.

   5. It may be difficult to interpret whether a measurement has unacceptable stability reliability or whether maturation has affected subjects’ responses.

      ANS: B, C, D, E

      Stability reliability is concerned with the consistency of repeated measures of the same attribute with the use of the same scale or instrument over time. It is usually referred to as test- retest reliability. Because it measures the same variable in the same manner, it reveals only random error, not systematic error. Test-retest reliability requires the assumption that the factor being measured has not changed between the measurement points. Many of the phenomena studied in nursing, such as hope, coping, pain, and anxiety, do change over short intervals. Thus, it is difficult to determine whether change represents measurement error or valid change.

      DIF: Cognitive Level: Analysis REF: Page 389

5. For a multimethod measure, a researcher measures anxiety using a 0- to 10-point verbal scale, the Spielberger State-Trait Anxiety Inventory (0 to 40 points), and systolic blood pressure readings (80 to 300 points). What are logical strategies for using these three pieces of information gathered from each subject? (Select all that apply.)

   1. Add up all three numbers for a total score.

   2. Rank all three measures as 1-high, 2-medium, and 3-low, and sum the result.

   3. Determine the most accurate measurement and give it more weight than the others in a ranking.

   4. Determine the most accurate measurement in the first few subjects and then use it exclusively.

   5. Report the numbers individually without summing them.

      ANS: B, D, E

      Another effective means of diminishing systematic error is to use more than one measure of an attribute or a concept and to compare the measures. To make this comparison, researchers use a variety of data collection methods, such as scale, interview, and observation. Campbell and Fiske developed a technique of using more than one method to measure a concept, referred to as the multimethod-multitrait technique. Multimethod measurement strategies decrease systematic error by combining the values in some way to give a single observed score of anxiety for each subject. Sometimes, however, it may be difficult logically to justify combining scores from various measures.

      DIF: Cognitive Level: Application REF: Page 384

6. A researcher administers a test of hopelessness to 50 teen mothers in a continuation high school, in order to norm it for a study planned for the subsequent semester. This norming process is part of the approved research protocol. Retesting in two weeks reveals different values for many of the subjects’ paired tests. What should the researcher do now, and why? (Select all that apply.)

   1. Administer the test a third time and see whether there is a trend. The subjects may be becoming more/less hopeless because of an external factor or a Hawthorne effect.

   2. Calculate statistical tests to determine whether there are about the same amounts of positive change and negative change for the pooled sample, and whether the means are very similar for the two measurements. If so, this represents normal fluctuation of mood.

   3. After obtaining IRB approval for study revision, ask several of the 50 subjects with large changes about their recent experiences and discover whether there is an underlying reason for the change.

   4. Use the second value, not the first, for all data analysis. The subjects have evidently re-examined their feelings and discovered new insights.

   5. Consider the multitrait-multimethod technique for this complex concept. A single measurement doesn’t seem to be capturing the concept very well.

      ANS: A, B, C, E

      Stability reliability is concerned with the consistency of repeated measures of the same attribute with the use of the same scale or instrument over time. It is usually referred to as test- retest reliability. Test-retest may include an additional retest, especially when an unanticipated event has occurred. A third measurement may capture the Hawthorne effect. To capture a complex concept, researchers use the multimethod-multitrait technique, or even a mixed methods design, employing a variety of data collection methods, such as scale, interview, and observation. These techniques allow researchers to measure more dimensions of abstract concepts, and the effect of the systematic error on the composite observed score decreases.

      Subjects’ knowledge of a study could influence their behavior and possibly alter the research outcomes. This threatens the validity or accuracy of the measurements. This change could be due to normal random measurement error. If so, the sum of the error (the measured change) for all subjects should be zero, and the means on the two days should be the same. Random error does not influence the mean to be higher or lower but, rather, increases the amount of unexplained variance around the mean.

      On the other hand, test-retest reliability requires the assumption that the factor being measured has not changed between the measurement points. Many of the phenomena studied in nursing, such as hope, coping, pain, and anxiety, do change over short intervals. Perhaps true change has occurred.

      DIF: Cognitive Level: Analysis REF: Page 389

7. A researcher administers a 40-item instrument that measures anxiety of 30 mothers of 9- month-old triplets, repeating it in two weeks. Over half of the scores are higher. Why? (Select all that apply.)

   1. The mothers are more anxious. The babies are becoming more mobile, and the mothers’ anxiety is well founded.

   2. There may have been random error of measurement. The researcher should compare the group means; if they are the same, it is only random error.

   3. This may represent systematic error of measurement.

   4. This may have poor validity for this population and concept.

   5. This test may have poor reliability for this population and concept.

      ANS: A, B, E

      Stability reliability is concerned with the consistency of repeated measures of the same attribute with the use of the same scale or instrument over time. It is usually referred to as test- retest reliability. It reveals random error of measurement. This change in scores could be due to normal random measurement error. If so, the sum of the error (the measured change) for all subjects should be zero, and the means on the two days should be the same. Random error does not influence the mean to be higher or lower but, rather, increases the amount of unexplained variance around the mean. Systematic error is not revealed on test-retest. Test- retest does not measure validity but reliability. On the other hand, test-retest reliability requires the assumption that the factor being measured has not changed between the measurement points. Many of the phenomena studied in nursing, such as hope, coping, pain, and anxiety, do change over short intervals.

      DIF: Cognitive Level: Analysis REF: Page 389

8. A lab scientist is attempting to develop a screening tool that will detect leukemia before children show any symptoms of the disease, because it is most curable in its early stages. The scientist wants a test that will detect all children, whether or not it produces some false positives. What does the researcher want in terms of that new screening tool? (Select all that apply.)

   1. Maximum specificity

   2. A high LR–

   3. Maximum sensitivity

   4. A high LR+

   5. High interrater reliability

ANS: A, D

Sensitivity is the ability of a test or diagnostic tool to detect patients with the disease. This is referred to as a true positive. Specificity is the ability of a test or diagnostic tool to detect patients without the disease. This is referred to as a true negative. A test with high sensitivity is very good at identifying the diseased patient. A high positive Likelihood Ratio makes a positive diagnosis almost certain. A high negative Likelihood Ratio makes a negative diagnosis almost certain.

DIF: Cognitive Level: Analysis REF: Page 406

Chapter 17: Measurement Methods Used in Developing Evidence-Based Practice Test Bank

MULTIPLE CHOICE

1. In a study of teasing among third-graders, after an intervention on peer interactions, behavioral observers collect the data, rating six behaviors on a 0- to 4-point scale. The observers are not trained by the same person, and there is no measure of interrater reliability. What is likely to happen?

   1. The variable of teasing will not be measured accurately.

   2. Peer interactions will not be able to be rated.

   3. The data will have to be scored independently by the researcher.

   4. Comparison with norms is unlikely.

      ANS: A

      Every variable must be measured in the same way, every time, or the results of the measurement will not be accurate. Measuring physiological variables using observation requires a quality tool for data collection and consistent use of this tool by data collectors. Thus, if the observations in a study are being conducted using multiple data collectors, it is essential that the consistency or interrater reliability of the data collectors be determined.

      DIF: Cognitive Level: Application REF: Page 413

2. A researcher plans to conduct interviews with the first four participants in a qualitative study, and then the researcher plans to have an assistant conduct several interviews for the remainder of the interviews. The first thing the researcher does with the research participants is to perform a pilot interview on one participant and to have the assistant conduct a pilot interview on a different participant, and then they compare notes, discussing the process. Why is this a good idea?

   1. This establishes interrater reliability.

   2. Their styles may differ, and this way they can imitate one another’s styles.

   3. Pretesting of the interview protocol is essential.

   4. They can begin the process of data analysis at once.

      ANS: C

      Interviews involve verbal communication between the researcher and the study participant, during which the researcher acquires information. Interviewers must be trained in the skills of interviewing, and the interview protocol must be pretested.

      DIF: Cognitive Level: Application REF: Page 422

3. A researcher is interested in discovering whether the topics of written family complaints are shared by the majority of patients’ families in a major university hospital, or whether merely a minority of the patients’ families are disgruntled. The researcher goes throughout the hospital each day and hands family members a printed form and pencil and asks them to answer the ten questions, all of which have three to five responses, in return for a “$3 off” coupon to be used in the hospital cafeteria. What is this printed form called?

   1. A questionnaire

   2. A Likert scale

   3. A semantic differential scale

   4. An interview

      ANS: A

      Questionnaires are printed self-report forms designed to elicit information that can be obtained from a subject’s written responses. Likert scales determine opinion or attitude and contain a number of declarative statements with a scale after each statement. Semantic differential scales consist of two opposite adjectives with a seven-point scale between them. The subject is to select one point on the scale that best describes his or her view of the concept being examined. Interviews involve verbal communication during which the subject provides information to the researcher.

      DIF: Cognitive Level: Application REF: Page 422

4. An outpatient being treated in the infusion center for thalassemia is asked to fill out a form about satisfaction with the center, while he waits for his appointment. The form consists of five questions, each a statement, with six possibilities after it: Strongly Agree, Agree, Slightly Agree, Slightly Disagree, Disagree, and Strongly Disagree. This is an example of which of the following?

   1. A semantic differential scale

   2. A Likert scale

   3. A questionnaire

   4. A paper interview

      ANS: B

      A Likert scale determines the opinion or attitude of a subject and contains a number of declarative statements with a scale after each statement. The Likert scale is the most commonly used of the scaling techniques in nursing and health care studies. Response choices in a Likert scale most commonly address agreement, evaluation, or frequency. Agreement options may include statements such as strongly agree, agree, uncertain, disagree, and strongly disagree.

      DIF: Cognitive Level: Application REF: Page 430

5. A researcher constructs a semantic differential scale that will measure a topic about which people express extreme responses. He pilots it and, at the same time, asks a psychometrician to give his opinion on the scale. The psychometrician suggests that the researcher edit the scale, so that it has some questions for which a 1 or 2 would be a positive finding, and some questions for which a 1 or 2 would be a negative finding. The researcher edits the scale and finds that subjects’ responses are not quite as extreme as they were originally. What should the researcher’s response be?

   1. Resentment. The new scale is giving weaker results, and its analysis will not be able to show statistical significance unless the projected sample size is increased.

   2. Bewilderment. The scale is exactly the same; the items were merely rearranged. There is nothing that explains this change.

   3. Gratitude. The new scale measures the concept better because the subjects are thinking about the individual items instead of marking extremes automatically.

   4. Annoyance. The researcher has probably inadvertently reworded some of his original items, accounting for the less extreme values.

      ANS: C

      A semantic differential scale consists of two opposite adjectives with a seven-point scale between them. The subject is to select one point on the scale that best describes his or her view of the concept being examined. The scale is designed to measure the connotative meaning of the concept to the subject. Although the adjectives may not seem to be particularly related to the concept being examined, the technique can be used to distinguish varying degrees of positive and negative attitudes toward a concept. In a semantic differential scale, values from 1 to 7 are assigned to each of the spaces, with 1 being the most negative response and 7 the most positive. Placement of negative responses to the left or right of the scale should be randomly varied to avoid global responses (in which the subject places checks in the same column of each scale).

      DIF: Cognitive Level: Analysis REF: Page 431

6. A nurse believes that patient acuity is a poor measure of patient fragility. Consequently, he and another nurse construct an instrument that measures patient fragility. In what order should the various steps of scale testing, conceptual definition, scale construction, instrument validation, and qualitative exploration occur?

   1. Scale testing, qualitative exploration, scale construction, conceptual definition, instrument validation

   2. Conceptual definition, qualitative exploration, scale construction, scale testing, instrument validation

   3. Scale construction, conceptual definition, instrument validation, scale testing, qualitative exploration

   4. Instrument validation, qualitative exploration, scale construction, conceptual definition, scale testing

   5. Qualitative exploration, scale testing, scale construction, conceptual definition, instrument validation

   6. Conceptual definition, instrument validation, scale construction, scale testing, qualitative exploration

      ANS: B

      In classic test theory, the following process is used to construct a scale: conceptual definition, scale design, item review, preliminary item tryouts, field testing, item analyses, selection of items to retain, conduct validity studies, reliability estimations, compiling of norms. Other methods vary. However, the essential thing is to identify the concept and then proceed with design, either by quantitative or qualitative methods, following with construction, some form of testing for feasibility, and then reliability and validity determination.

      DIF: Cognitive Level: Application REF: Pages 442-443

7. A university that is publicly funded is located in a state that is experiencing serious budget shortfall, and the budget has been halved. The university’s 32 departments are asked to list each of their programs on an index card, resulting in 90 cards. A panel comprised of the president, provost, and five deans each independently arranges the cards into categories of 3 essential, 7 highly desirable, 15 very desirable, 40 mainstream, 15 expendable, 7 immediately expendable, and 3 targeted elimination. This is an example of which methodology?

   1. Delphi technique

   2. Semantic differential scale

   3. Likert scaling

   4. Q-sort method

      ANS: D

      Q-sort methodology is a technique of comparative rating that preserves the subjective point of view of the individual. Cards are used to categorize the importance placed on various words or phrases in relation to the other words or phrases in the list. Each phrase is placed on a separate card. The number of cards should range from 40 to 100. The subject is instructed to sort the cards into a designated number of piles, usually 7 to 10 piles ranging from the most to the least important. The subject is limited in the number of cards that may be placed in each pile, with few at the ends and many in the center, mimicking the normal curve.

      DIF: Cognitive Level: Application REF: Page 434

8. How would a rating scale item be worded?

   1. “I can be alone for hours and not feel lonely”: Strongly Agree, Agree, Undecided, Disagree, Strongly Disagree.

   2. When I walk one block, I feel: (a) healthy and invigorated, (b) no different from the way I ordinarily feel, (c) pleasantly tired, (d) exhausted and out of breath.

   3. Place a vertical line intersecting this line to show what your anxiety is; the scale’s ends are 0 for “No Anxiety at All,” and 10 for “The Worst Anxiety I Have Ever Experienced.”

   4. Rank your boss from 1 to 7 on the following quality: sensitivity–callousness.

      ANS: B

      The Likert scale determines the opinion or attitude of a subject and contains a number of declarative statements with a scale after each statement. A rating scale lists an ordered series of categories of a variable that are assumed to be based on an underlying continuum.

      The Visual Analog Scale (VAS) is frequently used in health care research since it is easy to construct, administer, and score. VASs can be administered using a drawn, printed, or computer-generated 100-mm line. The research participant is asked to place a mark through the line to indicate the intensity of the sensation or stimulus. A semantic differential scale consists of two opposite adjectives with a seven-point scale between them.

      DIF: Cognitive Level: Application REF: Page 430

9. A Canadian researcher has had a tool published in English. The tool examines the embedded meanings of life in a country that has colonial roots but still maintains allegiance to the mother country. There is a demand for use of the tool in French-speaking Canadian cities. Which is the type of translation that is most appropriate for this tool?

   1. Pragmatic translation

   2. Aesthetic-poetic translation

   3. Ethnographic translation

   4. Linguistic translation

ANS: C

Four types of translations can be performed: pragmatic translations, aesthetic-poetic translations, ethnographic translations, and linguistic translations. Pragmatic translations communicate the content from the source language accurately in the target language. The primary concern is the information conveyed. An example of this type of translation is the use of translated instructions for assembling a computer. Aesthetic-poetic translations evoke moods, feelings, and affect in the target language that are identical to those evoked by the original material. In ethnographic translations, the purpose is to maintain meaning and cultural content. In this case, translators must be familiar with both languages and cultures. Linguistic translations strive to present grammatical forms with equivalent meanings. Translating a scale is generally done in the ethnographic mode.

DIF: Cognitive Level: Application REF: Page 445

MULTIPLE RESPONSE

1. Which of the following are physiological measures? (Select all that apply.)

   1. A subject’s report of episodes of tachycardia per day

   2. Score on the Mini Mental Status Exam

   3. Pulse rate as displayed on an ICU’s monitor

   4. Serum sodium

   5. Use of a tuning fork to measure bone conduction hearing loss

      ANS: A, C, D, E

      Physiological measures include two categories, biophysical and biochemical measures. For example, biophysical measures might include the use of the stethoscope and sphygmomanometer to measure blood pressure and a biochemical measure might include the laboratory value for total cholesterol. Self-report has been used effectively to obtain physiological information and may be particularly useful when the subjects are not in closely monitored settings such as hospitals, clinics, or research facilities. For some variables, self- report may be the only means of obtaining the information. Such may be the case when study participants experience a physiological phenomenon that cannot be observed or measured by others.

      DIF: Cognitive Level: Analysis REF: Page 412

2. Which of the following would be non-physiologic measures that could be used in nursing research? (Select all that apply.)

   1. Surveys that determine the percentage of counseling appointments that have

      decreased psychological pain in the 72 hours following each appointment

   2. Photographs of chimpanzee chromosomes

   3. Observation ratings of the depth of a pressure ulcer

   4. Surgical interventions intended to ablate pain

   5. Opinion surveys of what patients want to have included in their discharge teaching after outpatient surgery

      ANS: A, E

      Physiological measures include two categories: biophysical and biochemical measures. For example, biophysical measures might include the use of the stethoscope and sphygmomanometer to measure blood pressure and a biochemical measure might include the laboratory value for total cholesterol. Self-report has been used effectively to obtain physiological information and may be particularly useful when the subjects are not in closely monitored settings such as hospitals, clinics, or research facilities. For some variables, self- report may be the only means of obtaining the information. Such may be the case when study participants experience a physiological phenomenon that cannot be observed or measured by others.

      DIF: Cognitive Level: Application REF: Page 412

3. Which of the following are direct measures? (Select all that apply.)

   1. The patient’s radial pulse rate

   2. The dimensions in centimeters of a decubitus ulcer

   3. The nurse’s observations of an infant’s apparent pain

   4. The physician’s measure of the patient’s deep tendon reflexes

   5. The patient’s estimate as to whether his lithium level is within therapeutic range

   6. The mother’s report of her toddler’s anxiety level before a blood draw

   7. The patient’s serum serotonin levels

      ANS: A, B, D, G

      Direct measures are more accurate because there is an objective measurement of the study variable. For example, patients might be asked to report any irregular heartbeats during waking hours over a 24-hour period, which is an indirect measurement of heart rhythm, and each patient’s heart could be monitored with a Holter monitor over the same 24-hour timeframe, which is a direct measurement. Whenever possible, researchers usually select direct measures of their study variables due to the accuracy and precision of these measurement methods. However, if a direct measurement method does not exist, an indirect measurement method could be used in the initial investigation of a physiological variable.

      DIF: Cognitive Level: Application REF: Pages 413-414

4. In an observational study of manifestations of various categories of sundowning behavior in hospitalized super-elders, which of the following are true? (Select all that apply.)

   1. Checklists based on a rating scale would be helpful ways to record behaviors.

   2. Rating scales of 1-absent, 2-slight, 3-moderate, and 4-severe could be used.

   3. A category system should be developed before the study begins.

   4. The patient’s assessment of whether or not he is sundowning is valuable.

   5. There should be no overlap of the categories “confused, placid” and “confused, agitated.”

   6. Research assistants observing the patients should be given similar training.

   7. Observations should be made under similar circumstances.

      ANS: A, B, C, E, F, G

      The first step in a structured observation is to define carefully what specific behaviors or events are to be inspected or observed in a study. From that point, researchers determine how the observations are to be made, recorded, and coded. In most cases, the research team will develop an observational checklist or category system to direct the collecting, organizing, and sorting of the specific behaviors or events being observed. The observational categories should be mutually exclusive. A numerical value is assigned to each category; and the fineness of the distinctions between categories varies with the scale, making this one of the crudest forms of scaling technique. If the observations in a study are being conducted using multiple data collectors, it is essential that the consistency or interrater reliability of the data collectors be determined.

      DIF: Cognitive Level: Application REF: Page 421

5. An outpatient’s daughter has been using a diary to track the appearance of her mother’s decubitus ulcer when the daughter performs the daily dressing change. The patient has been newly consented for participation in the trial of a new product presumed to accelerate healing and prevent infection. The researcher instructs the daughter in use of the new product and the use of a scale for tracking the ulcer’s healing. Scale items are change in total area (width times depth), drainage color, surrounding tissue integrity, pain, and smell. What are the advantages of using a scale instead of a diary? (Select all that apply.)

   1. It reduces all items to a Likert scale.

   2. It makes wound care easier.

   3. It forces a level of precision that may or may not be present in a diary.

   4. It produces numerical data that the researcher can easily analyze in order to provide evidence of difference between the new method and the old method.

   5. It makes sure that subjects all will have daily recordings of the variables the researcher intends to measure.

      ANS: C, D, E

      A rating scale allows the observer to rate the behavior or event on a scale. Scales, a form of self-report, are a more precise means of measuring phenomena than are questionnaires. The majority of scales have been developed to measure psychosocial variables. However, self- reports can be obtained on physiological variables such as pain, nausea, or functional capacity by using scaling techniques as discussed earlier in this chapter. This method provides more information for analysis than does the use of dichotomous data, which indicate only that the behavior either occurred or did not occur. Scales, another form of self-reporting, are more precise in measuring phenomena than are questionnaires and have been developed to measure psychosocial and physiological variables. The types of scales include the rating scale, Likert scale, semantic differential scale, and the visual analog scale.

      DIF: Cognitive Level: Analysis REF: Page 422

6. Which of the following are true statements regarding the disadvantages of observational methods? (Select all that apply.)

   1. They may increase subject reactivity.

   2. When a single interrater is used and observations are opposite, there is no way to resolve the conflict, since each is equally correct.

   3. They may be used for both quantitative and qualitative research.

   4. They are more subjective than other types of measurements.

   5. They allow real-time capture of data.

   6. They are invariably subject to skepticism unless verified in some manner.

      ANS: A, D, F

      Observational measurement is the use of unstructured and structured inspection to gauge a study variable. Although measurement by observation is most common in qualitative research, it is used to some extent in all types of studies. The researcher must be clear on what is to be observed. The researcher must ensure that each variable is observed in a similar manner in each instance, so much attention must be given to training data collectors, especially when the observations are complex and examined over time. Pilot-testing and assurance of interrater reliability are essential. Observational measurement tends to be more subjective than other types of measurement and is thus often seen as less credible, but in many cases it is the only possible way to obtain important evidence for practice.

      DIF: Cognitive Level: Analysis REF: Page 421

7. The principal disadvantages of administering open-ended questions are which of the following? (Select all that apply.)

   1. They are difficult to construct.

   2. They are time-consuming to analyze.

   3. They are impractical for use with large samples.

   4. They cannot produce exhaustive, exclusive answers.

   5. They force answers.

   6. They can be difficult to interpret.

      ANS: B, C, F

      Data from open-ended questions are often difficult to interpret, and content analysis may be used to extract meaning. Open-ended questionnaire items are not advised if data are being obtained from large samples.

      DIF: Cognitive Level: Analysis REF: Page 425

8. The principal disadvantages of using a subject’s diary either instead of interview data or to supplement interview data would be which of the following? (Select all that apply.)

   1. Subjective perception at the time of the event is retrievable.

   2. Private and clandestine topics that have previously been accessible may be obtained through diaries.

   3. Diaries contain more truthful information than do other sources.

   4. No contact with the subject is necessary.

   5. Diaries may be used without consent.

   6. Information obtained from a diary is thought to be more accurate than that obtained from pure recall.

      ANS: A, B, F

      A diary is a recording of events over time by an individual to document experiences, feelings, or behavior patterns. Diaries are also called logs or journals and have been used since the 1950s to collect data for research from a variety of populations including children, the acute and chronically ill, pregnant women, and the elderly. A diary, which allows recording shortly after an event, is thought to be more accurate than obtaining the information through recall during an interview. In addition, the reporting level of incidents is higher, and one tends to capture the participant’s immediate perception of situations. The diary technique gives nurse researchers a means to obtain data on topics of particular interest within nursing that have not been accessible by other means.

      DIF: Cognitive Level: Analysis REF: Page 437

9. Pre-existent databases used in nursing research for secondary analysis contain data of different sorts. What are these? (Select all that apply.)

   1. Data collected internally by a health care institution for quality assurance or other review of its processes

   2. Data collected by unknown people for unknown reasons

   3. Data collected by governmental and private agencies, such as insurance companies, external to a health care institution

   4. Records locked by the courts

   5. Data collected by another researcher for a previous study

      ANS: A, C, E

      Nurse researchers are expanding their use of data from existing databases to answer their research questions and test their research hypotheses. Health data is usually categorized into secondary data and administrative data. Secondary data are those data collected during a previous research study. Administrative data are collected within clinical agencies; obtained by national, state, and local professional organizations; and collected by federal, state, and local agencies.

      DIF: Cognitive Level: Analysis REF: Page 439

10. A researcher isn’t sure whether 60-year-old women, the target population of her research, will understand the wording of a questionnaire’s 50 items assessing knowledge of symptoms of myocardial infarction in women. Consequently, the researcher might logically decide to do which of the following? (Select all that apply.)

    1. Provide a small glossary defining some of the more technical terms on the questionnaire.

    2. Conduct a pilot of the questionnaire.

    3. Use a Q-sort methodology to prioritize the essential questions and decrease the questionnaire down to 20 items.

    4. Ask a content expert to evaluate the readability of the questionnaire.

    5. Arrange for several radio and TV public-service announcements, informing the public of the symptoms of myocardial infarction in women.

       ANS: B, D

       Once the research team has satisfactorily developed the interview protocol, they must pretest or pilot-test it, using subjects similar to those who will be included in their study. Pilot-testing will allow them to identify problems in the design of questions, sequencing of questions, or procedure for recording responses.The readability level of an instrument is a critical factor when selecting an instrument for a study. Regardless of how valid and reliable the instrument is, it cannot be used effectively if study participants do not understand the items. Calculating readability is relatively easy and can be performed in a few minutes. Many word processing programs and computerized grammar checkers will report the readability level of written material. Provision of a glossary is counter to the intent of the questionnaire, which is to assess knowledge of symptoms. Arranging for several radio and TV announcements will also undermine the purpose of the intent of the questionnaire. Q-sort methodology is a technique of comparative rating that preserves the subjective point of view of the individual. Using a Q- sort to decrease the number of questions will address length, not readability.

       DIF: Cognitive Level: Analysis REF: Page 433

11. Which of the following constructs would be inappropriate to measure with a visual analogue scale? (Select all that apply.)

    1. Dichotomous variables

    2. Blood pressure

    3. Visual acuity

    4. Anxiety

    5. Playfulness

       ANS: A, B, C

       In an effort to resolve this problem, the visual analog scale was developed to measure magnitude, strength, and intensity of the individual’s sensations or feelings. The visual analog, sometimes spelled analogue, scale (VAS) is referred to as magnitude scaling. This technique seems to provide interval-level data, and some researchers argue that it provides ratio-level data. It is particularly useful in scaling stimuli. This scaling technique has been used to measure pain, mood, anxiety, alertness, craving for cigarettes, quality of sleep, attitudes toward environmental conditions, functional abilities, and severity of clinical symptoms. The stimuli must be defined in a way that the subject clearly understands. Only one major cue should appear for each scale. The scale is a line 100 mm in length with right-angle stops at each end. Bipolar anchors are placed beyond each end of the line.

       DIF: Cognitive Level: Application REF: Page 433

12. Why is the visual analogue scale (VAS) used so frequently in health care research? (Select all that apply.)

    1. Validity is the same, regardless of how the visual analogue scale is used.

    2. It elicits nominal-level data.

    3. It is easy for clients to understand.

    4. It is more sensitive to small changes than are numerical and rating scales.

    5. It requires a minimum of translation to be used in languages other than English.

    6. It is easy to administer and score.

       ANS: C, D, E, F

       The visual analog scale (VAS) is a magnitude scale particularly useful in scaling stimuli. Measured stimuli must be defined in a way that the subject clearly understands. Only one major cue should appear for each scale. The scale is a line 100 mm in length with right-angle stops at each end. Bipolar anchors are placed beyond each end of the line. The VAS is frequently used in health care research since it is easy to construct, administer, and score. The VAS is more sensitive to small changes than numerical and rating scales are and can discriminate between two dimensions of pain. Validity of the VAS has most commonly been determined by comparing the VAS scores with other measures of a concept. For example, Winkelman, Norma, Maloney, and Kless (2008) compared VAS scores with dermatome assessment in measuring pain during labor. The following study excerpt describes the agreement between these two measures of pain in laboring women who received an epidural analgesia.

       DIF: Cognitive Level: Analysis REF: Page 434

13. Why might a researcher use a structured interview rather than an unstructured one? (Select all that apply.)

    1. The desired data for this interview is quantitative.

    2. Interview time is limited.

    3. The researcher is collecting only demographic data for the study.

    4. The research subjects are confused and garrulous.

    5. Other data were gathered previously, using an unstructured interview.

       ANS: A, C, E

       Structured interviews are verbal interactions with subjects that allow the researcher to exercise increasing amounts of control over the content of the interview to obtain essential data for a study. The researcher designs the questions before data collection begins, and the order of the questions is specified. In some cases, the interviewer is allowed to further explain the meaning of the question or modify the way in which the question is asked so that the subject can better understand it. In more structured interviews, the interviewer is required to ask the question precisely as it has been designed. If the subject does not understand the question, the interviewer can only repeat it. The subject may be limited to a range of responses previously developed by the researcher, similar to those in a questionnaire. If the possible responses are lengthy or complex, they may be printed on a card so study participants can review them visually before selecting a response. Qualitative research almost invariably uses interviews that are unstructured or semi-structured. Unstructured interviews consist of one or two global open-ended questions developed to gain quality, in-depth data from a limited number of subjects. They are completely controlled by the subject.

       DIF: Cognitive Level: Synthesis REF: Page 422

14. Which of the following are examples of items that could be included in a visual analogue scale? (Select all that apply.)

    1. Stronger than Hercules, weak as a kitten

    2. Passive, nonassertive

    3. Strongly agree, uncertain

    4. Stunningly beautiful, repulsively ugly

    5. Perfect, wrong in all respects

       ANS: A, B, E

       The visual analog scaling technique has been used to measure pain, mood, anxiety, alertness, craving for cigarettes, quality of sleep, attitudes toward environmental conditions, functional abilities, and severity of clinical symptoms. The stimuli must be defined in a way that the subject clearly understands. The scale is a line 100 mm in length with right-angle stops at each end. Bipolar anchors are placed beyond each end of the line. These should be opposite and extreme.

       DIF: Cognitive Level: Application REF: Page 433

15. A researcher plans to administer a valid research tool in another language. What must be done in order to establish its validity in the second language? (Select all that apply.)

    1. Reliability testing

    2. Testing and then back-translating with different translators

    3. Analysis of values obtained with both scales

    4. Testing in both languages with bilingual subjects

    5. Concept analysis

ANS: B, C, D

Translating an instrument from the original language to a target language is a complex process. One strategy for translating scales is to translate from the original language to the target language and then back-translate from the target language to the original language by using translators not involved in the original translation. Discrepancies are identified, and the procedure is repeated until troublesome problems are resolved. After this procedure, the two versions are administered to bilingual subjects and scored by standard procedures. The resulting sets of scores are examined to determine the extent to which the two versions yield similar information from the subjects. This procedure assumes that the subjects are equally skilled in both languages.

DIF: Cognitive Level: Application REF: Page 445

Chapter 19: Evidence Synthesis and Strategies for Evidence-Based Practice Test Bank

MULTIPLE CHOICE

1. Which is the most accurate statement about translational research?

   1. Translational research focuses on providing literal and readable translations of research in one of the primary 15 languages in which research is read.

   2. Translational research is essentially evidence-based practice.

   3. Translational research attempts to discover something useful in basic scientific discoveries.

   4. Translational research is applied research based on basic research knowledge.

      ANS: D

      Translational research is an evolving concept that is defined by the NIH as the translation of basic scientific discoveries into practical applications. Basic research discoveries from the laboratory setting need to be tested in studies with humans. In addition, the outcomes from human clinical trials need to be adopted and maintained in clinical practice. Translational research is being encouraged by both medicine and nursing to increase the implementation of evidence-based interventions in practice and to determine if these interventions are effective in producing the outcomes desired in clinical practice.

      DIF: Cognitive Level: Analysis REF: Page 503

2. Nursing is said to be a science and an art. If best research evidence represents the science of nursing, what represents the art?

   1. Clinical expertise

   2. Patient values and needs

   3. Synthesis of best research evidence

   4. Eye-hand coordination

      ANS: A

      Evidence-based practice (EBP) is the conscientious integration of best research evidence with clinical expertise and patient values and needs in the delivery of quality, cost-effective health care. Best research evidence is largely fact-based and is intended to produce consistent interventions, usually of a technical nature. Patient values and needs emanate from the patient. Clinical expertise provides the art of nursing practice.

      DIF: Cognitive Level: Comprehension REF: Page 468

3. How is best research evidence produced?

   1. By the conduct and synthesis of numerous high-quality studies in a health-related area

   2. By the imaginations of creative health care workers, who design qualitative research that illuminates our understanding

   3. By dissemination of important results at conferences

   4. By publications that detail the newest advances in health care

      ANS: A

      Best research evidence is produced by the conduct and synthesis of numerous high-quality studies in a health-related area.

      DIF: Cognitive Level: Comprehension REF: Page 468

4. How are evidence-based practice and best research evidence related?

   1. With best research evidence publications, there is no evidence-based practice.

   2. Both evidence-based practice and best research evidence are generated by research.

   3. Best research evidence is the evidence on which practice is based.

   4. Best research evidence includes five basic items, one of which is evidence-based practice.

      ANS: C

      Evidence-based practice is the conscientious integration of best research evidence with clinical expertise and patient values and needs in the delivery of quality, cost-effective health care. Best research evidence is produced by the conduct and synthesis of a number of high- quality studies in a selected health-related area.

      DIF: Cognitive Level: Analysis REF: Page 468

5. If a “trigger” is defined as a condition of actual or potential harm to the patient, the nurses, or the institution, the Iowa model becomes a reactive problem-prioritization and problem-solving process. What is its tie-in with evidence-based practice?

   1. The Iowa model addresses utilization of research findings at an individual level.

   2. Individual nurses enact an Iowa decision tree when they examine risk-management data.

   3. Available published evidence drives the process, as scholars review the literature and bring it forward for committee focus.

   4. When evidence is available, it is used for problem-solving.

      ANS: D

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

      DIF: Cognitive Level: Synthesis REF: Page 493

6. In the Iowa model, what is the focus of intervention?

1. The patient level

2. The family level

3. The institutional level

4. The conceptual level

   ANS: C

   The Iowa Model of Evidence-Based Practice provides direction for the development of EBP in a clinical agency. In a health care agency, triggers initiate the need for change, and the focus should always be to make changes based on best research evidence. These triggers can be problem-focused and evolve from risk management data, process improvement data, benchmarking data, financial data, and clinical problems. The triggers can also be knowledge- focused, such as new research findings, changes in national agencies or organizational standards and guidelines, an expanded philosophy of care, or questions from the institutional standards committee. The triggers are evaluated and prioritized based on the needs of the clinical agency. If a trigger is considered an agency priority, a group is formed to search for the best evidence to manage the clinical concern.

   DIF: Cognitive Level: Analysis REF: Page 493

• A researcher locates twelve research studies that all examine the effect of a different cognitive-behavioral strategy for decreasing pain—hypnosis, distraction, focusing, music therapy, and so forth. Why would these twelve studies make a poor meta-analysis?

  1. Cognitive-behavioral interventions are not a suitable focus for all patients, and consequently should not be studied.

  2. Twelve studies would be too many for synthesis of any kind.

  3. Secondary analyses of pooled data are not used for meta-analysis on pain, because of interindividual differences in perception.

  4. The result, if statistically significant, will produce a general recommendation, “If in pain, do something cognitive-behavioral,” which is meaningless.

ANS: D

A meta-analysis is conducted to statistically pool the results from previous studies into a single quantitative analysis that provides one of the highest levels of evidence about an intervention’s effectiveness. This approach has objectivity, since it includes analysis techniques to determine the effect of an intervention while examining the influences of variations in the studies selected for the meta-analysis. The studies to be included in the analysis need to be examined for variations or heterogeneity in such areas as sample characteristics, sample size, design, types of intervention, and outcomes variables and measurement methods. Heterogeneity in the studies included in a meta-analysis produces broad and meaningless results.

DIF: Cognitive Level: Analysis REF: Page 482

MULTIPLE RESPONSE

1. The Magnet Program represents a credentialing process, whereby organizations of quality are recognized. What does the Magnet Recognition Program require, relative to research and evidence-based practice? (Select all that apply.)

   1. Nurses will participate in the institutional review process.

   2. Nursing research will be a budget line item.

   3. Only nurse researchers will conduct clinical research.

   4. The institution will keep track of nursing research projects in progress and recently completed.

   5. Care applied to patients will be, in a large part, supported by research.

      ANS: A, B, D

      Approval for Magnet status is obtained through the American Nurses Credentialing Center (ANCC). The Magnet Recognition Program® recognizes evidence-based practice as a way to improve the quality of patient care and revitalize the nursing environment. Selection criteria for Magnet status that require health care agencies to promote the conduct of research and the use of research evidence in practice follow. Some of its point items are availability of current literature, dissemination of current literature, application of current literature to practice, nurse involvement in the institutional review process, research consultants actively involved in mentorship, budget line items for nursing research, tracking of all nursing research activities in progress, and education that has changed practice.

      DIF: Cognitive Level: Analysis REF: Page 469

2. Evidence-based practice is based on three things. On what would a nurse base practice in a new area of nursing if there is yet no research evidence? (Select all that apply.)

   1. Nursing theory

   2. The nurse’s own clinical expertise

   3. Client values and needs

   4. Evidence in parallel, related fields

   5. Past documentation in the medical record

      ANS: B, C, D

      Evidence-based practice is the conscientious integration of best research evidence with clinical expertise and patient values and needs in the delivery of quality, cost-effective health care. Best research evidence is produced by the conduct and synthesis of a number of high- quality studies in a selected health-related area.

      DIF: Cognitive Level: Analysis REF: Page 468

3. Which of the following statements about the Stetler model of research utilization are true? (Select all that apply.)

   1. Its goal is to assure that research it utilized.

   2. It is a framework.

   3. It facilitates synthesis of research knowledge.

   4. It is used to update hospital policies.

   5. In its validation phase, scientific soundness is assessed.

   6. It provides a step-by-step way to assess and evaluate research findings.

      ANS: B, C, D, E, F

      The Stetler (2001) model provides a comprehensive framework to enhance the use of research findings by nurses to facilitate an evidence-based practice. The use of research findings can be at the institutional or individual level. The five stages of the Stetler model are preparation, validation, comparative evaluation/decision making, translation/application, and evaluation. It is used to synthesize research knowledge, but it does this in a step-by-step way, evaluating each study on its own merits. Ultimately, its use is practice-based.

      DIF: Cognitive Level: Analysis REF: Page 493

4. What are the basic problems with meta-syntheses of qualitative research? (Select all that apply.)

   1. Qualitative research itself is a subjective interpretation; a meta-synthesis of qualitative research is a compiling of information generated subjectively.

   2. If individual studies have different methods, it may be difficult to find common ground and to devise a meaningful interpretation of the results.

   3. Qualitative research has no implications for practice, so performing a meta- synthesis is unjustifiable.

   4. In qualitative research, multiple valid interpretations may occur if different researchers examine the text.

   5. The recommendation for practice that results from meta-synthesis of qualitative research lacks statistics.

   6. The raw data are not available to the qualitative meta-synthesizer.

      ANS: A, B, D, F

      Meta-synthesis is defined as the systematic compiling and integration of qualitative study results to expand understanding and develop a unique interpretation of study findings in a selected area. The focus is on interpretation rather than the combining of study results as with quantitative research synthesis. Meta-synthesis involves the breaking down of findings from different studies to discover essential features, and then the combining of these ideas into a unique, transformed whole. Meta-summary is a step in conducting meta-synthesis. A process for conducting a meta-synthesis is described in the following section. The process of interpretation occurs in the mind of the reader. Corbin and Strauss describe interpretation as translating the words and actions of participants into meanings that readers and consumers can understand. The virtual text grows in size and complexity as the researcher reads and rereads the transcripts. Throughout the process of analysis, the virtual text develops and evolves.

      Although multiple valid interpretations may occur if different researchers examine the text, all findings must remain trustworthy to the data. This trustworthiness applies to the unspoken meanings emerging from the totality of the data, not just the written words of the text.

      DIF: Cognitive Level: Synthesis REF: Page 490

5. Nursing practice has been said to have the potential to be increasingly evidence-based in the next ten years. What are the impediments to enacting EBP? (Select all that apply.)

   1. A misunderstanding of what EBP is has resulted in mandates and policies; bedside nurses sense that their expertise is being overridden.

   2. Only about one-seventh of published nursing research is experimental or quasi- experimental.

   3. Systematic reviews and meta-analyses in nursing are limited.

   4. Most hospitals do not have computer access to practice evidence.

   5. Population-based knowledge may or may not translate to the care of individual patients.

      ANS: A, B, C, E

      Barriers to the EBP movement have been both practical and conceptual. One of the most serious barriers is the lack of research evidence available regarding the effectiveness of many nursing interventions. Between 2000 and 2006, published research in major journals was only 7% experimental and 6% quasi-experimental; interventional studies are required for EBP. The systematic reviews and meta-analyses conducted in nursing have been limited. Another concern of the EBP movement is that the development of evidence-based guidelines has led to a “cookbook” approach to health care. Health professionals are expected to follow these guidelines in their practice as developed. However, the definition of EBP describes it as the conscientious integration of best research evidence with clinical expertise and patient values and needs.

      DIF: Cognitive Level: Evaluation REF: Page 471

6. A systematic review should address the components specified in PICOS. Why is this so? (Select all that apply.)

   1. Interventional research always uses some means of comparison.

   2. “Interventions” that are actually naturally occurring conditions should be noted, since they decrease confirmatory power of the collective evidence.

   3. Study design is essential, since recommendations for change in practice can be based only on some designs.

   4. Desired outcomes, not actual outcomes of the study, are the focus of the review.

   5. The specific population from which a sample was drawn, and its similarity to those of others studies reviewed, affects generalizability.

ANS: A, B, C, E

A systematic review is a structured, comprehensive synthesis of the research literature to determine the best research evidence available to address a health care question. A systematic review involves identifying, locating, appraising, and synthesizing quality research evidence for expert clinicians to use to promote an EBP. Systematic reviews are often conducted by two or more researchers and/or clinicians in a selected area of interest to determine the best research knowledge in that area. Systematic reviews need to be conducted with rigorous research methodology to promote the accuracy of the findings and minimize the reviewers’ bias. A systemic review or meta-analysis is best directed by a relevant clinical question that focuses the review process and promotes the development of a quality synthesis of research evidence. One of the most common formats used to organize a systematic review is the PICO or PICOS format described in the Cochran Handbook. PICOS are (1) population (or sample),

(2) intervention, (3) comparison group or condition, (4) outcomes, and (5) study design. Naturally occurring “interventions” indicate a non-interventional design; the researcher enacts the research intervention.

DIF: Cognitive Level: Synthesis REF: Page 472

Chapter 20: Collecting and Managing Data Test Bank

MULTIPLE CHOICE

1. Planning as a step in the quantitative research process ends when the data collection has begun. Which is the true statement about planning in the qualitative research process?

   1. Since sample size is not usually decided upon ahead of time, there is no practical reward to planning the qualitative research study ahead of time.

   2. There is no planning in the qualitative research process; it all emanates from the data collected.

   3. Everything about a qualitative study is planned ahead of time, except for analysis of the data.

   4. The researcher may adapt strategies for data collection or analysis well into the study.

      ANS: D

      A data collection plan details how the researcher will implement the study. The plan for collecting data is specific to the study being conducted and requires that the researcher consider some of the more common elements of research, mapping out procedures ahead of time. This extensive planning increases the accuracy of the data collected and the validity of the study findings. In qualitative methods, however, the researcher may adapt the data collection or analysis strategies during the study.

      DIF: Cognitive Level: Analysis REF: Page 517

2. What is the general rule about collecting demographic data during an interview?

   1. The mood of the qualitative interview, so crucial to quality data capture, may be intruded upon by demographic data collection.

   2. In quantitative interviews, everything excerpted from medical records must again be verified in face interviews.

   3. In qualitative interviews, routinely asking twenty or thirty demographic questions sets the stage for actual data collection.

   4. If data can be obtained in other ways, leave the valuable interview time for actual interviewing.

      ANS: D

      The researcher should consider the importance of each piece of datum and the subject’s time required to collect it. If the data can be obtained from patient records or any other written sources, the researcher does not need to ask the subject to provide this information. To collect data from a patient’s records, the researcher must make sure to include the intent to do so in the consent form and ensure that the institutional review board has authorized the team to do this. The qualitative researcher has the power to shape the interview agenda. Participants have the power to choose the level of responses they will provide. The researcher might begin the interview by asking a broad question such as “Describe for me your experience with...” or “Tell me about ” Ideally, the participant will respond as though she or he is telling a story.

      The researcher responds nonverbally with a nod or eye contact to convey interest in what is being said, and tries to avoid agreeing or disagreeing with what the participant is saying. The less the researcher says, the better.

      DIF: Cognitive Level: Comprehension REF: Page 517

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

   1. The researcher will go back to the institutional review board and request permission to use a different form.

   2. The researcher will design a new form, with the assumption that the next CPR incident will be just as complex as the last was.

   3. The researcher will continue to use the old form, writing on the back when necessary, and pulling out blank pieces of paper, from time to time, for additional data recording.

   4. The researcher will decrease the amount of data necessary to record by revising the

      old study protocol, so that fewer research questions are asked.

      ANS: B

      Before data collection begins, the researcher develops or adapts forms on which to record data. These forms can be used to record demographic data, information from the patient record, observations, or values from physiological measures. The researcher also might need to collect other data that may be extraneous or confounding variables such as the subject’s physician, stage of illness, length of illness or hospitalization, complications, date of data collection, time of day and day of week of data collection, and any untoward events that occur during the data collection period. Data collection forms must be designed so that the data are easily recorded. If a form isn’t working, design a better form. Data collection forms themselves do not need institutional review board (IRB) approval—the information to be collected is what the IRB approves.

      DIF: Cognitive Level: Application REF: Page 517

4. The quantitative researcher collects many pieces of quantitative data as words, not numbers. Prior to statistical analysis, all of the data pieces must be coded. What does this mean?

   1. The data are transformed into numerals corresponding to words, such as 0—no college degree, 1—bachelor’s degree, 2—master’s degree, 3—PhD or EdD.

   2. The essence of each word is noted; later, these essences emerge as themes.

   3. The data are typed into a computer, and the computer is instructed to transform the words into binary values, using only 0 and 1, by adding up the numbers of each letter in the alphabet.

   4. The data regarding protected data are transformed to code names; a list is made and kept in a secure location.

      ANS: A

      Coding is the process of transforming language data into numerical symbols that can be entered easily into the computer. For example, variables such as race, gender, ethnicity, and diagnoses can be categorized and given numerical labels. For gender, the male category could be identified by a “1” and the female category by a “2.” The coding categories developed for the research must be both mutually exclusive and mutually exhaustive so, with respect to the latter, inclusion of “3”—decline to state and “4”—none of the above might be useful.

      DIF: Cognitive Level: Application REF: Page 517

5. A nurse is conducting her master’s thesis research in the unit in which she works as a staff nurse. The focus of her thesis is burned children’s pain, with versus without a child life specialist assisting the child. She is providing child life specialist presence every other day at the mid-morning dressing change. For obvious reasons, she wants to keep everything else consistent for the four contiguous days of data collection. On the second day of four, with the child life specialist present, one child demonstrates poor pain control. The nurse researcher would ordinarily advocate for more pain medication for this child, but if she does, she will not be able to compare the data with that of the previous day. This is an example of which of the following?

   1. Serendipity

   2. Subject as object

   3. Role conflict

   4. Passive resistance

ANS: C

As a researcher, one is observing and recording events. Nurses who conduct clinical research often experience a conflict between their researcher role and their clinician role during data collection. In some cases, the researcher’s involvement in the event, such as providing physical or emotional care to a patient during data collection, could alter the event and thus bias the results. It would be difficult to generalize the findings to other situations in which the researcher was not present to intervene. However, the needs of patients must take precedence over the needs of the study.

DIF: Cognitive Level: Application REF: Page 528

MULTIPLE RESPONSE

1. A researcher intends to collect data, including patients’ ratings of pain and anxiety, during a procedure. No electrical equipment or photography may be used in the procedure room. In order to record the various pain and anxiety ratings, the researcher may plan to use which of the following? (Select all that apply.)

   1. A plug-in word processor

   2. A form with large margins, or a column for comments, or both

   3. A pencil with an eraser

   4. A form with pre-labeled columns and rows

   5. A cell phone with camera

      ANS: B, C, D

      Before data collection begins, the researcher develops or adapts forms on which to record data. These forms can be used to record demographic data, information from the patient record, observations, or values from physiological measures. The researcher also might need to collect other data that may be extraneous or confounding variables such as the subject’s physician, stage of illness, length of illness or hospitalization, complications, date of data collection, time of day and day of week of data collection, and any untoward events that occur during the data collection period. Data collection forms must be designed so that the data are easily recorded. Pencil and paper are ideal, since they allow for erasure, in case the subject clarifies data.

      DIF: Cognitive Level: Application REF: Page 517

2. Part of a research study entails that research subjects complete a printed form with checkboxes. The researcher decides ahead of time that any item that has more than one response checked will be treated as unanswered. What are logical ways the researcher can maximize properly answered items, without skewing the data? (Select all that apply.)

   1. Make a rule that if there are two checked replies, only the first one will be counted.

   2. When the researcher hands the form to the subjects, the researcher should specify “One answer and one answer only for each these items, please, or I won’t be able to include the double-answered ones in my report.”

   3. Glance at the forms as they are about to be handed in, and if two boxes for an item are checked, ask the subject to address this.

   4. In the printed instructions at the top of the form, be sure to state that if a question has more than one response checked, that item will be treated as unanswered.

   5. Eliminate from the entire study any subject who double-selects an item.

      ANS: B, C, D

      Decision rules for data entry should be finalized during the planning process. The researcher must realize that any decision rule may skew the data. For example, if a subject selects two responses for a single item, will the variable be coded as missing, or does the researcher want to specify that the lowest or highest value should be entered?

      DIF: Cognitive Level: Application REF: Page 523

3. A researcher is studying the way that ICU nurses prioritize the charting responsibilities for their 12-hour shift. The researcher happens to discover that nurses are administering medications as close to the ordered times as possible but consistently charting the times at which medications are ordered, not the time they are actually administered, even though that may be two or three hours later. What could the researcher do with this information? (Select all that apply.)

   1. The researcher makes the nurse manager aware of the finding, after the study data have all been collected, because this is essentially a medication charting error.

   2. Nothing. This is not a focus of the study, and the information must be suppressed.

   3. The researcher takes time to educate individual nurses, so that they understand that what they are doing is not honest.

   4. The researcher includes the findings in the article, stating that this is a time-saving strategy, since the computer allows charting of meds when ordered (instead of when administered) as a block, saving time.

   5. The researcher reports this information under Serendipitous Discoveries in the article that results from the study.

      ANS: A, B, E

      Serendipity is the accidental discovery of something useful or valuable. During the data collection phase of studies, researchers often become aware of elements or relationships that they had not previously identified. These aspects may be closely related to the study being conducted or have little connection with it. They come from increased awareness and close observation of the study situation. Because the researcher is focused on close observation, other elements in the situation can come into clearer focus and take on new meaning.

      Serendipitous findings are important to the development of new insights in nursing theory. They can be important for understanding the totality of the phenomenon being examined. Educating individual nurses is sure to alienate staff. The manager is the logical choice for a person in whom to confide this information. Obviously, this should be communicated as, “Some nurses...” rather than naming names, since the nurses’ privacy would be violated by telling their names.

      DIF: Cognitive Level: Application REF: Page 530

4. How may research data, code-named and stripped of all identifiers, be stored? (Select all that apply.)

   1. Separate from the master list of identifiers and codes

   2. Only in a locked box in a safe

   3. Anywhere the researcher decides to store it that has reasonable security

   4. Only in the original database from which it was derived

   5. Only in a password-protected computer, located in a private office or residence

      ANS: A, D

      In this time of flash drives and thumb drives, it is relatively easy to store data. The original data forms and database must be stored for time frames dictated by the funding source or by the journal publisher. There are several reasons to store data. The data can be used for secondary analyses. For example, researchers participating in a project related to a particular research focus may pool data from various studies for access by all members of the group.

      Data should be available to document the validity of your analyses and the published results of your study. Because of nationally publicized incidents of scientific misconduct in which researchers fabricated data and published multiple manuscripts, you would be wise to preserve documentation that your data were obtained as you claim. Issues that have been raised include how long data should be stored, the need for institutional policy regarding data storage, and whether graduate students who conduct a study should leave a copy of their data at the university. Some researchers store their data for only five years after publication, while others store their data until they retire from a research career. Researchers should check with their funding sponsors and publishers for guidelines on how long to keep the data. Most researchers store data in their office or laboratory; others archive their data in a central location with storage fees or retrieval fees. HIPAA mandates protection of anonymity by removing all 18 identifiers for data; a master list of the code-labeled data and the person to whom it belonged must be kept separate from the main data. The master list must be kept in a locked area.

      DIF: Cognitive Level: Analysis REF: Page 532

5. How may raw research data, with identifiers, obtained from a hospital be stored? (Select all that apply.)

   1. It must be kept only in the hospital’s computer system; at the end of the work day, all excerpted data must be deleted.

   2. In a locked box in a safe

   3. In any e-mail account

   4. On a private website

   5. In a password-protected computer, located in a private office or residence

      ANS: B, E

      In this time of flash drives and thumb drives, it is relatively easy to store data. The original data forms and database must be stored for time frames dictated by the funding source or by the journal publisher. There are several reasons to store data. The data can be used for secondary analyses. For example, researchers participating in a project related to a particular research focus may pool data from various studies for access by all members of the group.

      Data should be available to document the validity of your analyses and the published results of your study. Because of nationally publicized incidents of scientific misconduct in which researchers fabricated data and published multiple manuscripts, you would be wise to preserve documentation that your data were obtained as you claim. Issues that have been raised include how long data should be stored, the need for institutional policy regarding data storage, and whether graduate students who conduct a study should leave a copy of their data at the university. Some researchers store their data for only five years after publication, while others store their data until they retire from a research career. Researchers should check with their funding sponsors and publishers for guidelines on how long to keep the data. Most researchers store data in their office or laboratory; others archive their data in a central location with storage fees or retrieval fees. HIPAA mandates protection of anonymity by removing all 18 identifiers for data; a master list of the code-labeled data and the person to whom it belonged must be kept separate from the main data. The master list must be kept in a locked area.

      DIF: Cognitive Level: Analysis REF: Page 532

6. What are the purposes of completing a pilot study? (Select all that apply.)

   1. It provides nominal and ordinal data with which the researcher can construct better instruments.

   2. It helps identify problems the researcher might encounter while collecting data.

   3. It justifies the existence of a research gap.

   4. It gives the researcher preliminary data to present to the institutional review board in order to obtain permission to conduct research.

   5. It provides an idea of the timelines of the proposed study, including instrument completion and subject recruitment.

      ANS: B, E

      Completing a pilot study may save the researcher difficulty later when the final steps of the research process are implemented. Pilot testing helps to identify problems that might be encountered while collecting data, and helps develop strategies for addressing potential problems. Following approval of the study by your institutional review board (IRB), the study’s approved research plan is used to recruit 3 to 5 pilot subjects who meet the eligibility criteria. The same study data collection methods are utilized, paying special attention to how long it takes to recruit a subject, obtain informed consent, and collect the data. Often, the participant is asked to identify questions or aspects of the process that were unclear or confusing. Based on the pilot study and feedback of the first subjects, data collection forms and methods of data collection may be modified to improve feasibility, validity, and reliability.

      DIF: Cognitive Level: Analysis REF: Page 532

7. What are the four principal tasks of data collection? (Select the four that apply.)

   1. Performing constant comparison for qualitative data

   2. Maintaining research controls as indicated in the study design

   3. Solving problems that threaten to disrupt the study

   4. Cross-checking with the literature review

   5. Collecting data in a consistent way

   6. Staying with institutional review board permission

   7. Selecting subjects

ANS: B, C, E, G

In both quantitative and qualitative research, the investigator performs four tasks during the process of data collection. These tasks are interrelated and occur concurrently rather than in sequence. The tasks are: (1) selecting subjects, (2) collecting data in a consistent way, (3) maintaining research controls as indicated in the study design, and (4) solving problems that threaten to disrupt the study.

DIF: Cognitive Level: Comprehension REF: Page 523

Chapter 21: Introduction to Statistical Analysis Test Bank

MULTIPLE CHOICE

1. A researcher who has conducted experimental research finds that in his 145-person hospital study the patients who are ambulated on the evening of abdominal surgery are less likely than the control group to develop postoperative pneumonia. What does the researcher infer?

   1. The control group resembled the experimental group in all important characteristics.

   2. Early ambulation and pneumonia are strongly related.

   3. Evening-of-surgery ambulation will prevent some cases of postoperative pneumonia in abdominal surgery patients.

   4. Careful support of the abdomen is important for postoperative ambulation in patients who have had abdominal surgery.

      ANS: C

      Statisticians use the term inference or infer in somewhat the same way that a researcher uses the term generalize. Inference requires the use of inductive reasoning. One infers from a specific case to a general truth, from a part to the whole, from the concrete to the abstract, from the known to the unknown. When using inferential reasoning, one can never prove things; one can never be certain. However, the rules that have been established with regard to statistical procedures so as to increase the probability that inferences are accurate. Inferences are made cautiously and with great care. Researchers use inferences to infer from the sample in their study to the larger population.

      DIF: Cognitive Level: Analysis REF: Page 537

2. What is this particular distribution called?

   1. Bimodal

   2. Normal

   3. Camelesque

   4. Negatively skewed

      ANS: A

      Another characteristic of distributions is their modality. Most curves found in practice are unimodal, which means that they have one mode and frequencies progressively decline as they move away from the mode. Symmetrical distributions are usually unimodal. However, curves can also be bimodal or multimodal. accurately reflect the shape of the population from which the sample was taken.

      DIF: Cognitive Level: Application REF: Page 540

3. A researcher reports that the heights of men aged 53 living in Rapid City, South Dakota, are between 5’7” and 6’0” and that the confidence interval is calculated at the p <.05 level. What does this mean?

   1. If the heights of men in Rapid City, South Dakota, do not fall within the confidence interval at least 5% of the time, a type I error has occurred.

   2. If a 53-year-old man in Rapid City, South Dakota, is measured, there is a 95% chance that his height will fall in the 5’7” through 6’0” interval.

   3. Ninety-five percent of the 53-year-old men living in Rapid City, South Dakota, are

      between 5’7” and 6’0”.

   4. The heights of the men in the sample were all between 5’7” and 6’0”, and the sample was representative of 95% of the men in town.

      ANS: B

      When the probability of including the value of the parameter within the interval estimate is known, this is referred to as a confidence interval. Calculating a confidence interval involves the use of two formulas to identify the upper and lower ends of the interval. A confidence interval is actually an estimate.

      DIF: Cognitive Level: Synthesis REF: Page 541

4. There are four data sets:

   A: 1, 1, 1, 1, 1, 10, 10, 10, 10

   B: 2, 2, 2, 2, 4, 8, 8, 8, 9

   C: 3, 4, 4, 5, 5, 5, 6, 6, 7

   D: 1, 2, 3, 4, 5, 6, 7, 8, 9

   What is the mean of the four individual data sets?

   1. 5, 5, 5, 5

   2. 1, 4, 5, 5

   3. 1, 2, 5, 5

   4. 5

      ANS: A

      The measures of central tendency are descriptive statistics. The statistics that represent “measures of central tendency” are the mean, median, and mode. All of these statistics are representations or descriptions of the center or middle of a frequency distribution. The mean is the arithmetic average of all of a variable’s values. The median is the exact middle value (or the average of the middle two values if there is an even number of observations). The mode is the most commonly occurring value in a data set. In a normal curve, the mean, median, and mode will be equal or approximately equal

      DIF: Cognitive Level: Analysis REF: Page 538

5. There are four data sets:

   A: 1, 1, 1, 1, 1, 10, 10, 10, 10

   B: 2, 2, 2, 2, 4, 8, 8, 8, 9

   C: 3, 4, 4, 5, 5, 5, 6, 6, 7

   D: 1, 2, 3, 4, 5, 6, 7, 8, 9

   What is the median of the four individual data sets?

   1. 5, 5, 5, 5

   2. 1, 4, 5, 5

   3. 1, 2, 5, 5

   4. 5

      ANS: B

      The measures of central tendency are descriptive statistics. The statistics that represent “measures of central tendency” are the mean, median, and mode. All of these statistics are representations or descriptions of the center or middle of a frequency distribution. The mean is the arithmetic average of all of a variable’s values. The median is the exact middle value (or the average of the middle two values if there is an even number of observations). The mode is the most commonly occurring value in a data set. In a normal curve, the mean, median, and mode will be equal or approximately equal.

      DIF: Cognitive Level: Analysis REF: Page 538

6. There are four data sets:

   A: 1, 1, 1, 1, 1, 10, 10, 10, 10

   B: 2, 2, 2, 2, 4, 8, 8, 8, 9

   C: 3, 4, 4, 5, 5, 5, 6, 6, 7

   D: 1, 2, 3, 4, 5, 6, 7, 8, 9

   What is the mode of the four individual data sets?

   1. 5, 5, 5, 5

   2. 1, 4, 5, 5

   3. 1, 2, 5, none

   4. 1

      ANS: C

      The measures of central tendency are descriptive statistics. The statistics that represent “measures of central tendency” are the mean, median, and mode. All of these statistics are representations or descriptions of the center or middle of a frequency distribution. The mean is the arithmetic average of all of a variable’s values. The median is the exact middle value (or the average of the middle two values if there is an even number of observations). The mode is the most commonly occurring value in a data set. In a normal curve, the mean, median, and mode will be equal or approximately equal.

      DIF: Cognitive Level: Analysis REF: Page 538

7. Which of the following is the best example of a normally distributed data set?

   1. 1, 1, 1, 1, 1, 10, 10, 10, 10

   2. 2, 2, 2, 2, 4, 8, 8, 8, 9

   3. 3, 4, 4, 5, 5, 5, 6, 6, 7

   4. 1, 2, 3, 4, 5, 6, 7, 8, 9

      ANS: C

      The measures of central tendency are descriptive statistics. The statistics that represent “measures of central tendency” are the mean, median, and mode. All of these statistics are representations or descriptions of the center or middle of a frequency distribution. The mean is the arithmetic average of all of a variable’s values. The median is the exact middle value (or the average of the middle two values if there is an even number of observations). The mode is the most commonly occurring value in a data set. In a normal curve, the mean, median, and mode will be equal or approximately equal.

      DIF: Cognitive Level: Analysis REF: Page 538

8. One hundred students took an exam; the mean of the test was 45%, and the median was 38%; seventy students scored below the mean, but three scored more than 96%. This would represent what type of distribution?

   1. Normal

   2. Positively skewed

   3. Negatively skewed

   4. Leptokurtic

      ANS: B

      Any curve that is not symmetrical is referred to as skewed or asymmetrical. Skewness may be exhibited in the curve in a variety of ways. A curve may be positively skewed, which means that the largest portion of data is below the mean. A curve can also be negatively skewed, which means that the largest portion of data is above the mean. A normal curve is symmetric and has no skew. Few samples will be perfectly symmetrical; however, as the deviation from symmetry increases, the seriousness of the impact on statistical analysis increases. In a positively skewed distribution, the mean is greater than the median, which is greater than the mode. In a negatively skewed distribution, the mean is less than the median, which is less than the mode.

      DIF: Cognitive Level: Analysis REF: Page 540

9. In the following illustration of a negatively skewed curve, which line represents the mode?

   1. First dotted line

   2. Second dotted line

   3. Third dotted line

      ANS: C

      In a skewed distribution, the mean, median, and mode are not equal. In a negatively skewed distribution, the mean will be less than the median, which will be less than the mode.

      DIF: Cognitive Level: Application REF: Page 540

10. Which of the following distribution curves demonstrates the least amount of variation in the scores?

    1. The least amount of variation would be in the first curve.

    2. The least amount of variation would be in the second curve.

    3. The least amount of variation would be in the third curve.

    4. The amount of variation can’t be defined by the curve.

       ANS: A

       Kurtosis explains the degree of peakedness of the distribution curve, which is related to the spread of the variance of scores. An extremely peaked curve is referred to as leptokurtic, an intermediate degree of kurtosis as mesokurtic, and a relatively flat curve as platykurtic. The less peaked the curve, the more variation is present.

       DIF: Cognitive Level: Application REF: Page 541

11. is the symbol for which of the following?

    1. Sample mean

    2. Population mean

    3. Population variance

    4. Sample variance

       ANS: A

       Use of the terms statistic and parameter can be confusing because of the various populations

       referred to in statistical theory. A statistic (such as a mean, ) is a numerical value obtained from a sample. A parameter is a true (but unknown) numerical characteristic of a population. For example, is the population mean or arithmetic average. The mean of the sampling

       distribution (mean of samples’ means) can also be shown to be equal to . Thus, a numerical value that is the mean ( ) of the sample is a statistic; a numerical value that is the mean of the population ( ) is a parameter.

       DIF: Cognitive Level: Comprehension REF: Page 537

12. A researcher conducts a statistical test that reveals that the four groups analyzed differed. The researcher wants to discover which one or ones of the four differed from the others. The researcher must then perform a post hoc analysis. What will this involve?

    1. Design of a second research study, using a new sample

    2. Descriptive statistics about the sample demographics

    3. Qualitative research generating new themes and ideas

    4. A second statistical test using the original data

       ANS: D

       Post hoc analyses are commonly performed in studies with more than two groups when the analysis indicates that the groups are significantly different but does not indicate which groups are different. A post hoc analysis must be performed to determine which of the three groups are significantly different. In other studies, the insights obtained through the planned analyses generate further questions that can be examined with the available data.

       DIF: Cognitive Level: Application REF: Page 545

13. Where would one find approximately 95% of the scores in the following example if scores are normally distributed?

    Scores ranged from 30 to 68, M = 45, SD = 7.

    1. Between 37 and 61

    2. Between 38 and 52

    3. Between 31 and 59

    4. Between 30 and 68

       ANS: C

       The range, standard deviation, and variance are statistics that describe the extent to which the values in the sample vary from one another. The most common of these statistics to be reported in the literature is the standard deviation, because of its direct association with the normal curve. If the frequency distribution of any given variable is approximately normal, knowing the standard deviation of that variable allows us to know what percentages of subjects’ values on that variable fall between +1 and –1 standard deviation. Referring back to the hypothetical frequency distribution of pain in Figure 21-1, when we calculate a standard deviation, we know that 34.13% of the subjects’ pain scores were between the mean pain score and 1 standard deviation above the mean pain score. We also know that 34.13% of the subjects’ pain scores were between the mean pain score and 1 standard deviation below the mean. The middle 95.44% of the subjects’ scores were between –2 standard deviation and +2 standard deviations.

       DIF: Cognitive Level: Evaluation REF: Page 541

14. If a researcher wishes to predict with 97.5% accuracy, the level of significance would be

    1. .05

    2. .01

    3. .25

    4. .025

ANS: D

If one wishes to predict with 95% accuracy, the level of significance (p) is 1 minus 95% = .05. In nursing research, alpha is usually set at 0.05, meaning that the researcher will allow a 5% or lower chance of making a type I error.

DIF: Cognitive Level: Application REF: Page 535

MULTIPLE RESPONSE

1. A researcher states in an article that a new experimental treatment, trialed in the outpatient setting in a tri-physician practice in northern Oregon, produces better outcomes than the control treatment for patients with COPD. The p-value given is p <.05. What does this mean? (Select all that apply.)

   1. There is better than a 95% chance that at the research site mentioned in the article the experimental treatment really DOES produce better outcomes for patients with COPD.

   2. The probability of error is 95%.

   3. There is very little chance that the intervention is effective—less than a 5% chance, in fact.

   4. There is better than a 95% chance that the experimental treatment will produce better outcomes for all COPD patients.

   5. There is less than a 5% chance that the researcher has reached this conclusion in error.

      ANS: A, D, E

      Probability theory addresses statistical analysis as the likelihood of accurately predicting an event or the extent of an effect. In probability theory, the meaning of statistical results is interpreted by the researcher in light of his or her knowledge of the field of study. Probability is expressed as a lowercase p, with values expressed as percentages or as a decimal value ranging from 0 to 1.

      DIF: Cognitive Level: Synthesis REF: Page 535

2. A null hypothesis is stated. The null hypothesis is, “There is no difference between 10 mcg and 20 mcg of vitamin D3 in prevention of osteoporosis.” What are the implications of this statement, concerning that hypothesis and type I error? (Select all that apply.)

   1. Rejecting the null hypothesis when it actually is false means that the researcher has made a type I error in concluding that there is a difference between 10 mcg and 20 mcg of vitamin D3 in preventing osteoporosis.

   2. Making the statement is itself a type I error.

   3. Whether the null hypothesis is true or not makes no difference in terms of type I error.

   4. Whether or not the researcher rejects the null hypothesis makes no difference in terms of type I error.

   5. Rejecting the null hypothesis when it actually is false means that the researcher concludes that there is a difference between 10 mcg and 20 mcg of vitamin D3 in preventing osteoporosis, and there is no error.

   6. Rejecting the null hypothesis when it actually is true means that the researcher concludes that there is no difference between 10 mcg and 20 mcg of vitamin D3 in preventing osteoporosis, but the researcher thinks there is and has made a type I error.

      ANS: E, F

      Type I error is the probability of rejecting the null hypothesis when it is in fact true. It is also called alpha [α]. In nursing studies, this is usually .05, which equals 5%. To test the null hypothesis, the researcher consults a statistics website or book, to discover the decision point or cutoff point, which is the value at which rejecting the null hypothesis would be the wrong decision only 5% of the time. Then the researcher calculates the statistic, based on the data. If the value of the statistic is less than the cutoff point, the null hypothesis stands—it is not rejected. If the value of the statistic is more than the cutoff point, the null hypothesis is rejected. This will be the correct decision 95% of the time.

      DIF: Cognitive Level: Analysis REF: Page 535

3. A null hypothesis is stated. The null hypothesis is, “There is no difference between one baby aspirin every day and no baby aspirin at all in prevention of myocardial infarction.” What are the implications of this statement, concerning that hypothesis and type II error? (Select all that apply.)

   1. Accepting the null hypothesis when it actually is true means that the researcher has made a type II error in concluding that there is no difference between 10 mcg and 20 mcg of vitamin D3 in preventing osteoporosis.

   2. Making the statement is itself a type II error.

   3. Whether the null hypothesis is true or not makes no difference in terms of type II error.

   4. Whether or not the researcher rejects the null hypothesis makes no difference in terms of type II error.

   5. Accepting the null hypothesis when it actually is true means that the researcher concludes that there is no difference between 10 mcg and 20 mcg of vitamin D3 in preventing osteoporosis, and there is no error.

   6. Accepting the null hypothesis when it actually is false means that the researcher concludes that there is no difference between 10 mcg and 20 mcg of vitamin D3 in preventing osteoporosis, when there actually IS a difference. The researcher has therefore made a type II error.

      ANS: E, F

      Type II error is the probability of retaining the null hypothesis when it is in fact false. In nursing research, type II error is usually set at .20. This means that a type II error, failure to detect a difference when it indeed exists, will occur 20% of the time. One minus beta [ß] equals the power of the study. This is the research study’s power to detect a difference when it indeed does exist.

      DIF: Cognitive Level: Analysis REF: Page 535

4. As researcher designs a study to measure the effect on patient satisfaction of the nurse stating to the patient at least once a day, “You’re a good person.” The researcher sets the alpha (type I error) for the study at p <.10 because the intervention is free, it needs next to no time to enact, and it is harmless. If the alpha is set at .10, what is the effect on the beta [β] and on type II error? (Select all that apply.)

   1. Beta [ß] stays the same.

   2. Type II error becomes less likely.

   3. Type II error becomes more likely.

   4. Beta [ß] decreases.

   5. Beta [ß] increases as well.

   6. Type II error stays the same.

      ANS: B, D

      The researcher chooses the probability of making a type I error when setting alpha [α], and if the researcher sets the probability of making a type I error quite low, perhaps only 1%, the probability of making a type II error, [ß], increases. By the same token, if the researcher sets the probability of making a Type I error quite high, perhaps 10%, the probability of making a type II error decreases.

      DIF: Cognitive Level: Analysis REF: Page 536

5. In statistical hypothesis testing, which of the following occur before the data are collected? (Select all that apply.)

   1. The beta (type II error) is set.

   2. A power analysis is conducted.

   3. The null hypothesis is accepted or rejected.

   4. The alpha (type I error) is set.

   5. The primary null hypothesis is stated.

      ANS: A, B, D, E

      The following steps outline each of the components of statistical hypothesis testing. The null hypothesis is stated. The study alpha (type I error) is set. The study beta (type II error) is set. A power analysis is performed. The study is conducted. The statistic is computed, based on the data obtained. The obtained statistic is compared with the critical value for the alpha chosen.

      If the obtained statistic is greater than the critical value, the null hypothesis is rejected; if the obtained statistic is less than the critical value, the null hypothesis is accepted.

      DIF: Cognitive Level: Analysis REF: Page 535

6. If beta, ß, is the probability of making a type II error, what is 1 minus ß? (Select all that apply.)

   1. Alpha [α]

   2. A relationship exists

   3. The power of the study

   4. The likelihood that the null hypothesis is incorrect

   5. The probability of not making a type II error

      ANS: C, E

      Power is the probability that a statistical test will detect an effect when it actually exists. Therefore, power is the inverse of type II error and is calculated as 1 – ß. Recall that type II error is the probability of retaining the null hypothesis when it is in fact false. When the researcher sets type II error at 0.20 prior to conducting a study, this means that the power of the planned statistic has been set to 0.80. In other words, the statistic will have an 80% chance of detecting an effect if it actually exists.

      DIF: Cognitive Level: Analysis REF: Page 536

7. A researcher is concerned about the power of his study. His planned interventional study examines the effect upon depression of instituting twice-yearly trips with a Road Scholar program for widows and widowers who have, 1 to 2 years before, lost a spouse to a long illness. What strategies could make type II error less likely? (Select all that apply.)

   1. Decreasing the effect size

   2. Increasing the alpha from .05 to .10

   3. Increasing the beta from .20 to .30

   4. Decreasing the beta from .20 to .10

   5. Decreasing the alpha from .05 to .025

   6. Increasing the sample size

      ANS: B, D, F

      Power is the probability that a statistical test will detect an effect when it actually exists. Therefore, power is the inverse of type II error and is calculated as 1 – ß. Recall that type II error is the probability of retaining the null hypothesis when it is in fact false. When the researcher sets type II error at 0.20 prior to conducting a study, this means that the power of the planned statistic has been set to 0.80. In other words, the statistic will have an 80% chance of detecting an effect if it actually exists. Often, reported studies failing to reject the null hypothesis (in which power is unlikely to have been examined) will have a low power level to detect an effect if one exists. Until recently, the researcher’s primary interest was in preventing a Type I error. Therefore, great emphasis was placed on the selection of a level of significance but little on power. This point of view is changing. Power analysis involves determining the required sample size needed to conduct the study. Cohen identified four parameters of power: (1) significance level, (2) sample size, (3) effect size, and (4) power. If three of the four are known, the fourth can be calculated by using power analysis formulas.

      Effect size is a constant; it is “the degree to which the phenomenon is present in the population or the degree to which the null hypothesis is false.” Consequently, if the researcher wants to increase a study’s power, the sample size must be increased, or the level of significance must be set at a less stringent level.

      DIF: Cognitive Level: Analysis REF: Page 536

8. Findings can be statistically significant be clinically not significant. Which of the following studies with statistically significant findings exemplify this? (Select all that apply.)

   1. Seventy-five seconds of UV light daily can completely reverse the symptoms of allergic dermatitis.

   2. Eating a cup of salad greens daily increases one’s life expectancy by 2 years.

   3. Petting a cat for five minutes daily increases one’s endorphin levels.

   4. Exercise Program Delta causes weight loss of 6.3 pounds per year in morbidly obese women.

   5. Talking to a crying baby calms the baby more than ignoring it; picking up the baby calms it more than talking to it.

   6. Medication R15B, taken daily from age 13, completely controls cystic acne by age 23.

      ANS: C, D, E, F

      The findings of a study can be statistically significant but may not be clinically important. For example, one group of patients might have a body temperature 0.1° F higher than that of another group. Data analysis might indicate that the two groups are statistically significantly different. However, the findings have little or no clinical importance due to the small difference in temperatures between groups. Persons with dermatitis would find the UV light treatment almost miraculous. Two extra years of life may be clinically important to those with good quality of life. Increasing endorphins is not due only to petting cats, so this study is not particularly significant, clinically. A weight loss of 6.3 pounds per year is not large enough to make a significant difference in the life of a morbidly obese woman. Picking up crying babies is something that even one’s grandmother knows; this is not clinically useful. A medication that controls cystic acne ten years later is of little use to the adolescent who is miserable with acne.

      DIF: Cognitive Level: Analysis REF: Page 537

9. A measured value is within two standard deviations of the mean but not within one standard deviation, and it is greater than the mean. The distribution is very close to a normal distribution. What does this signify? (Select all that apply.)

   1. This particular value is not an outlier.

   2. In the data set, almost 2/3 of the values are closer to the mean than this one is.

   3. The data point falls within the majority of the measured values, in terms of its closeness to the mean.

   4. In the data set, at least 4% of the values are further from the mean than this particular value is.

   5. In this data set, between 65% and 95% of the values are smaller in value than this one is.

      ANS: A, B, D, E

      The range, standard deviation, and variance are statistics that describe the extent to which the values in the sample vary from one another. The most common of these statistics to be reported in the literature is the standard deviation, because of its direct association with the normal curve. If the frequency distribution of any given variable is approximately normal, knowing the standard deviation of that variable allows the reader to know what percentages of subjects’ values on that variable fall between +1 and –1 standard deviation. In a normal distribution, when a standard deviation is calculated, 34.13% of the values are between the mean score and 1 standard deviation above the mean. Similarly, 34.13% of the values are between the mean score and 1 standard deviation below the mean. The middle 95.44% of the subjects’ scores are between +2 standard deviations and –2 standard deviations.

      DIF: Cognitive Level: Synthesis REF: Page 541

10. Which of the following are true about a type II error? (Select all that apply.)

    1. It is more likely to occur when p <.01 rather than when p <.05.

    2. It is extremely likely to occur when p <.001.

    3. It occurs when the null hypothesis is true but rejected.

    4. It is a possibility only when there are statistically nonsignificant results in a study.

    5. It is a possibility only when there are statistically significant results in a study.

       ANS: A, B, D

       The probability of retaining the null hypothesis when it is in fact false is a type II error. In nursing research, beta is frequently set to 0.20, meaning that the researcher will allow for a 20% or lower chance of making a type II error, when the alpha is set at .05. If the alpha decreases (becomes more stringent) (.025, .01, and so forth), decreasing the possibility of type I error, the consequence is that the beta rises, making type II error much more likely. When a statistical test in a research study shows that a result is not statistically significant, the discerning reader will evaluate the sample size and the level of significance, in order to determine the possibility that a type II error occurred. It is not possible to decrease both types of error simultaneously without a corresponding increase in sample size.

       DIF: Cognitive Level: Analysis REF: Page 535

11. A teacher administers an exam. The exam seemed relatively easy for the students, and the majority of the scores are at the high end of the scale, although several students received low scores. In statistical terms this represents what? (Select all that apply.)

    1. Positive skew

    2. Negative skew

    3. Asymmetrical distribution

    4. Symmetrical distribution

    5. A normal curve

    6. A non-normal curve

       ANS: B, C, F

       Any curve that is not symmetrical is referred to as skewed or asymmetrical. Skewness may be exhibited in the curve in a variety of ways. A curve may be positively skewed, which means that the largest portion of data is below the mean. A curve can also be negatively skewed, which means that the largest portion of data is above the mean. A normal curve is symmetric and has no skew.

       DIF: Cognitive Level: Synthesis REF: Page 540

12. A researcher is attempting to decide whether to hire a statistician to assist with the statistical aspects of the study. If the researcher cannot perform which of the following for a quantitative study, a statistician should be contacted? (Select all that apply.)

    1. Provide sample demographics using descriptive statistics.

    2. Perform reliability testing of the study instruments.

    3. Design and perform analyses to answer research questions and test hypotheses.

    4. Design and perform an exploratory analysis of the data.

    5. Hand-compute all statistical calculations.

    6. Prepare the data for analysis.

    7. Perform a power analysis.

    8. Interpret the results obtained by all statistical computations.

       ANS: A, B, C, D, F, G, H

       To perform statistical analysis of data from a quantitative study, one must be able to (1) determine the necessary sample size to adequately power your study, (2) prepare the data for analysis, (3) describe the sample, (4) test the reliability of measures used in the study, (5) perform exploratory analyses of the data, (6) perform analyses guided by the study objectives, questions, or hypotheses, and (7) interpret the results of statistical procedures. If the researcher is not able to do all of these, a statistician is consulted. Descriptions of the sample demographics are made statistically.

       DIF: Cognitive Level: Application REF: Page 534

13. Why might nonparametric statistical methods be used for analysis?

    1. The level of measurement of the variables is nominal.

    2. The researcher prefers to use these statistical tests.

    3. The null hypothesis is absent.

    4. The sample is small or lacks a normal distribution.

       ANS: A, D

       The most commonly used type of statistical analysis is parametric statistics. The analysis is referred to as parametric statistical analysis because the findings are inferred to the parameters of a normally distributed population. These approaches to analysis require meeting the following three assumptions before they can justifiably be used: (1) normal distribution and variance can be calculated, (2) level of measurement at least interval, or ordinal with an approximately normal distribution, and (3) data that can be treated as a random sample.

       Nonparametric statistical analysis, or distribution-free techniques, can be used in studies that do not meet the first two assumptions of normal distribution and at least interval level data.

       DIF: Cognitive Level: Analysis REF: Page 542

14. Which of the following should a reader of a research article be able to do, in order to decide whether the article’s statistics are correctly selected and applied? (Select all that apply.)

    1. Understand the discussion section of the article.

    2. Make a judgment as to whether the author’s interpretations of the data are correct.

    3. Make some judgment about whether the statistical procedures used were the correct ones for the level of measurement used for the study variables.

    4. Make some judgment about whether the statistical procedures used were the correct ones for the research question.

    5. Agree with the study’s stated limitations.

    6. Find the names of the statistical procedures the author used.

       ANS: A, B, C, D, F

       To critically appraise the results section of a quantitative study, the reader needs to be able to

       (1) identify the statistical procedures used, (2) judge whether these statistical procedures were appropriate for the hypotheses, questions, or objectives of the study and for the data available for analysis, (3) comprehend the discussion of data analysis results, (4) judge whether the author’s interpretation of the results is appropriate, and (5) evaluate the clinical importance of the findings.

       DIF: Cognitive Level: Comprehension REF: Page 534

15. Which of the following are true in a skewed distribution? (Select all that apply.)

    1. Mean, mode, and median are not equal.

    2. The curve is asymmetrical.

    3. There is bimodal distribution.

    4. There is no mode.

    5. More than 50% of the values lie to one side of the mean.

       ANS: A, B, E

       Any curve that is not symmetrical is referred to as skewed or asymmetrical. A curve may be positively skewed, which means that the largest portion of data is below the mean. A curve can also be negatively skewed, which means that the largest portion of data is above the mean. In a skewed distribution, the mean, median, and mode are not equal. In a positively skewed distribution, the mean is greater than the median, which is greater than the mode. In a negatively skewed distribution, the mean is less than the median, which is less than the mode.

       DIF: Cognitive Level: Analysis REF: Page 540

16. Why can type I error and type II error not be both present for one given hypothesis?

    1. Power analysis makes one type of error less likely.

    2. One refers to rejecting the null hypothesis when it is true and the other to accepting it when it is false.

    3. As beta rises, alpha falls.

    4. The researcher sets both the alpha level and the beta level.

    5. Qualitative research does not use power analysis.

       ANS: B, C

       The researcher sets the values of two theoretical probabilities: (1) the probability of rejecting the null hypothesis when it is in fact true (alpha [α]; type I error), and (2) the probability of retaining the null hypothesis when it is in fact false (beta [ß]; type II error). In nursing research, alpha is usually set at 0.05, meaning that the researcher will allow a 5% or lower chance of making a type I error. The beta is frequently set to 0.20, meaning that the researcher will allow for a 20% or lower chance of making a type II error. A type II error occurs if the null hypothesis is regarded as true when, in fact, it is false.

       DIF: Cognitive Level: Comprehension REF: Page 535

17. A data set shows that the mean, median, and mode are the same. This means which of the following? (Select all that apply.)

    1. The distribution is bimodal.

    2. The data are normally distributed.

    3. The variables are dichotomous.

    4. All data points are identical.

    5. The kurtosis is symmetrical.

    6. This may describe the normal curve.

ANS: B, D, F

The theoretical normal curve is an expression of statistical theory. It is a theoretical frequency distribution of all possible scores. This theoretical normal curve is symmetrical and unimodal and has continuous values. The mean, median, and mode are equal. The distribution is completely defined by the mean and standard deviation. The data are normally distributed. If all data points are identical, their mean, median, and mode will be the same.

DIF: Cognitive Level: Analysis REF: Page 538 Chapter 22: Using Statistics to Describe Variables Test Bank

MULTIPLE CHOICE

1. The following is the frequency distribution for a set of data. What is the set’s mode?

   X	f
   5	1
   4	0
   3	2
   2	3
   1	1

   a. 5

   b. 4

   c. 3

   d. 1

   ANS: C

   The measures of central tendency are mode, median (MD), and mean ( ). The mode is the numerical value or score that occurs with the greatest frequency in a data set. It does not necessarily indicate the center of the data set.

   DIF: Cognitive Level: Analysis REF: Page 555

2. In the data set below, what is the mean ( )?

   X	f
   5	4
   4	2
   3	1
   2	1
   1	2

   1. 4

   2. 3.5

   3. 3

   4. 2.5

      ANS: B

      The measures of central tendency are mode, median (MD), and mean ( ). The mean is the arithmetic average of all a variable’s values in a study and is the most commonly reported measure of central tendency. The mean is the sum of the scores divided by the number of

      scores being summed. Mean ( ) = ÷ N = 35 ÷ 10 = 3.5.

      DIF: Cognitive Level: Analysis REF: Page 555

3. The median is represented by which score for the following data set?

   Data set: 1, 2, 4, 7, 7, 8, 10, 10, 10, 18

   1. 10

   2. 8

   3. 7.5

   4. 7

      ANS: C

      The median (MD) is the score at the exact center of the ungrouped frequency distribution. It is the 50th percentile. To obtain the MD, sort the values from lowest to highest. If the number of values is an uneven number, exactly 50% of the values are above the MD and 50% are below it. If the number of values is an even number, the MD is the average of the two middle values. The median for this set is 7.5, since the data set contains an even number of values, and the two numbers in the middle are 7 and 8. Their average is 7.5.

      DIF: Cognitive Level: Analysis REF: Page 553

4. Which of the following measures is the most helpful both for providing a quantification of dispersion and for providing a way to interpret how far away from the mean each individual score is?

   1. Standard deviation

   2. Difference scores

   3. Range

   4. Magnitude

      ANS: A

      Measures of dispersion, such as the range, difference scores, variance, and standard deviation, provide important insight into the nature of the data. The standard deviation is an important statistic, both for understanding dispersion within a distribution and for interpreting the relationship of a particular value to the distribution.

      DIF: Cognitive Level: Analysis REF: Page 554

5. Which of the following measures is merely a simple difference score?

   1. Standard deviation = 2.41

   2. Difference scores = –2, –2, –1, +2, and +3

   3. Range = 8

   4. Variance = 5.80

      ANS: A

      The simplest measure of dispersion is the range. In published studies, range is presented in two ways: (1) the range is the lowest and highest scores, or (2) the range is calculated by subtracting the lowest score from the highest score. In this form, the range is a difference score that uses only the two extreme scores for the comparison. The range is generally reported in published studies but is not used in further analyses.

      DIF: Cognitive Level: Analysis REF: Page 554

6. The data set is: 2, 3, 6, 7, 12. A measure of dispersion is calculated, and it is about 3.5. What is this measure of dispersion?

   1. The difference score

   2. The variance

   3. The range

   4. The standard deviation

      ANS: D

      The definition of standard deviation (SD) is the average difference between the mean and each of the scores in the set. Standard deviation (SD) is a measure of dispersion that is the square root of the variance. SD is the most precise analysis technique for examining the distribution of scores. SD includes difference scores in its calculation but does not involve the use of standardized scores.

      DIF: Cognitive Level: Application REF: Page 555

7. The data set is as follows: Ford, Ford, Chevy, Toyota, Ford, Ford, Chevy, Dodge, Dodge, Dodge, Ford, Subaru, Chevy, Toyota, Chevy. What measures of central tendency and dispersion will be used with this set?

   1. Difference scores

   2. Range

   3. Median

   4. Mode

      ANS: D

      The data are not inherently numerical in nature and represent only a nominal level of measurement. None of the listed measures of variability are suitable for nominal-level data. The mode is the only measure of central tendency appropriate for nominal data. The mode is the numerical value or score that occurs with the greatest frequency in a data set.

      DIF: Cognitive Level: Application REF: Page 552

8. Twenty student nurses take the NCLEX examination. If the average of the twenty scores is known, how many degrees of freedom are there in the sample?

1. 18

2. 19

3. 20

4. 21

ANS: B

The concept of degrees of freedom was used originally in reference to computing a confidence interval, but it applies to any statistical computation. Degrees of freedom are the number of independent pieces of information that are free to vary in order to estimate another piece of information. If, for instance, the mean and the total “n” are known, if all of the values except one are known, the last one can be calculated. However, if all except two are known, one has the freedom to vary, and the other one’s value is then set. In calculations, the degrees of freedom (df) are n – 1. This means that there are n – 1 independent observations in the sample of n data points that are free to vary (to be any value).

DIF: Cognitive Level: Application REF: Page 558

MULTIPLE RESPONSE

1. The Stanford Binet Intelligence Quotient is a normed intelligence test, and its IQ measures are quite normally distributed. Its standard deviation is 16. If the test were perfectly normal in its distribution, this would mean which of the following? (Select all that apply.)

   1. There are more people with IQs of 100 than any other number.

   2. For every person with an IQ of 120, there is one with an IQ of 80.

   3. More than 95% of people have IQs between 68 and 132.

   4. If someone’s IQ is measured as 109, and years later it is measured as 112, someone else’s IQ has dropped three points.

   5. About 14% of people have IQs between 117 and 132.

   6. Excluding people with IQs of exactly 100, half of the remainder have IQs lower than 100, and the other half have IQs higher than 100.

      ANS: A, B, C, E, F

      The normal curve is a perfectly symmetrical frequency distribution. The value at the exact center of a normal curve is the mean of the values. When a frequency distribution is shaped like the normal curve, we know that 34.13% of the subjects scored between the mean and 1 standard deviation above the mean and 34.13% of the subjects scored between the mean and 1 standard deviation below the mean. This means that 68.26% of the subjects scored between –1 and +1 standard deviations. Because the normal curve is perfectly symmetrical, it is known that 50% of the subjects scored above the mean, and 50% of the subjects scored below the mean. Furthermore, 95.44% of the subjects scored between –2 and +2 standard deviations.

      DIF: Cognitive Level: Synthesis REF: Page 555

2. Female graduate nurses scored an average of 89% on the first midterm examination. Male graduate nurses also scored an average of 89% on the first midterm examination. What does this mean? (Select all that apply.)

   1. The same number of men and women failed the test.

   2. If the passing score is 75%, fewer students failed in both groups than the number that passed.

   3. The overall combined average on the midterm, for both classes, is 89%.

   4. Both classes have the same range.

   5. Both classes have identical variances and standard deviations.

   6. The median score is the same for both classes.

   7. The mode score is the same for both classes.

      ANS: B, C

      The most commonly used measure of central tendency is the mean. The mean is the sum of the scores divided by the number of scores being summed. Consequently, it provides an average of the scores for each group. Combination of the groups provides the same group mean, since the means are identical. The values for mode and median are not provided, so no conclusions can be drawn about these. Measures of dispersion (standard deviation, range, variance) are not provided, and cannot be assumed to be identical between groups. Since 100% (the highest possible passing score) and 74.9% (the highest possible failing score) average 87.5% and the overall combined mean is higher than this, more students passed than failed in both groups, and this is true, as well, for the combined group.

      DIF: Cognitive Level: Synthesis REF: Page 553

3. Descriptive statistics are found in which of the following? (Select all that apply.)

   1. All quantitative descriptive research reports

   2. Some qualitative research reports

   3. All quantitative inferential research reports

   4. No qualitative research reports

   5. Some quantitative inferential research reports

      ANS: A, B, C

      For some types of studies, descriptive statistics will be the only approach to analysis of the data. For other studies, descriptive statistics are the first step in the data analysis process, to be followed by inferential statistics. Data analysis begins with descriptive statistics in any study in which the data are numerical, including some qualitative studies.

      DIF: Cognitive Level: Application REF: Page 550

4. There is a data set A: 3, 3, 3, 5, 6, 6, 8, 9, 9, 12, 13. The data set B is created.

   It is identical to A, except for its much larger last value. Data set B: 3, 3, 3, 5, 6, 6, 8, 9, 9, 12, 83.

   What is the effect of increasing the largest value upon the descriptive statistics of the data set? (Select all that apply.)

   1. The mean increases.

   2. The median increases.

   3. The mode increases.

   4. The set’s distribution changes from perfectly normal to somewhat skewed.

   5. The standard deviation increases.

   6. The variance increases.

   7. The range increases.

      ANS: A, D, E, F, G

      The mode is the numerical value or score that occurs with the greatest frequency in a data set; unless this is the largest value, the mode will be unaffected. The median (MD) is the score at the exact center of the ungrouped frequency distribution; it is unaffected by a change in the value of the largest value. The mean is the arithmetic average of all a variable’s values in a study and is the most commonly reported measure of central tendency. The mean is sensitive to extreme scores such as outliers, and it will be affected by a large increase in the largest value. Measures of dispersion or variability are measures of individual differences of the members of the population and sample. Since they indicate how different the scores are, they all are affected by an extreme value.

      DIF: Cognitive Level: Evaluation REF: Page 552

5. The confidence interval for five-year survival after Stage I breast cancer in a large sample of women living in Texas is 87.5% to 93.3%, at a p <.05 level of significance. What does this mean? (Select all that apply.)

   1. Texan women in the near future will be likely to have about a 90% chance of living five years after they are newly diagnosed with Stage I breast cancer.

   2. Women in Texas with Stage I breast cancer have a 95% chance of 90% survival, over a five-year period.

   3. Women in Texas with Stage I breast cancer have an 86% chance of five-year

      survival.

   4. In any sample of women in Texas newly diagnosed with Stage I breast cancer, there is about a 95% chance that their collective survival five years from now will be around 90%.

   5. Women in Texas can feel 95% confident that they will survive Stage I breast cancer.

      ANS: A, D

      To determine how closely the sample mean approximates the population mean, the standard error of the mean is used to build a confidence interval. For that matter, a confidence interval can be created for many statistics, such as a mean, proportion, and odds ratio. At the p <.05 level, it merely signifies that there is a window of possibilities, and future samples have a 95% chance of falling within that window.

      DIF: Cognitive Level: Application REF: Page 558

6. A researcher wants to select a way to measure how values in a research study are dispersed around the mean, and how homogeneous or heterogeneous they are, for a ratio-level variable. The researcher might select which of the following? (Select all that apply.)

   1. Mode

   2. Range

   3. Frequency distribution

   4. Mean

   5. Standard deviation

ANS: B, E

Measures of dispersion or variability are measures of individual differences of the members of the population and sample. They indicate how values in a sample are dispersed around the mean. These measures provide information about the data that is not available from measures of central tendency. They indicate how different the scores are—the extent to which individual values deviate from one another. If the individual values are similar, measures of variability are small and the sample is relatively homogeneous in terms of those values. When there are wide variations or differences in the scores, the sample is considered heterogeneous. The heterogeneity of sample scores or values is determined by measures of dispersion or variability. The measures of dispersion most commonly reported in nursing research are range, difference scores, variance, and standard deviation. All are useful for ratio-level data.

DIF: Cognitive Level: Application REF: Page 554 Chapter 23: Using Statistics to Examine Relationships Test Bank

MULTIPLE CHOICE

1. Which of the following correlation coefficients shows the strongest relationship?

   1. .10

   2. –.85

   3. .80

   4. –.42

      ANS: B

      Pearson’s product-moment correlation is represented by the letter r, and the value of the r is always between –1.00 and +1.00. A value of zero indicates no relationship between the two variables. The further the value from zero, the stronger the relationship. The number indicates the strength of the relationship, and the sign connotes whether that relationship is positive or negative (inverse). Consequently, a relationship of –.60 is exactly as strong as a relationship of

      .60, although one is a positive relationship and the other a negative, or inverse, one. Values greater than .50 or less than –.50 indicate strong correlations.

      DIF: Cognitive Level: Analysis REF: Page 561

2. The Pearson product-moment correlation for two variables, fear of embarrassment and anxiety just before making an oral presentation, is r = .78, with a coefficient of determination of 0.6084. This means that what percentage of anxiety just before making an oral presentation can be attributed to fear of embarrassment?

   1. About 0.61%

   2. About 61%

   3. About 0.78

   4. About 78%

      ANS: B

      One can also assess the magnitude of association by obtaining the coefficient of determination for the Pearson correlation. Computing the coefficient of determination simply involves squaring the r value. The r2 (multiplied by 100%) represents the percentage of variance shared between the two variables. In other words, the coefficient of determination explains how much of the change in value of one variable can be attributed to the fluctuation in value of the other variable.

      DIF: Cognitive Level: Analysis REF: Page 564

3. What does the correlational diagram X Y mean?

   1. X obviously precedes Y in time.

   2. X is interchangeable with Y.

   3. There is a relationship between X and Y.

   4. Either X causes Y, or Y causes X.

      ANS: C

      Correlational analyses identify relationships or associations among variables. In the diagram, the arrow points to both variables, further confirming that one doesn’t cause the other: X is merely related to Y and nothing more.

      DIF: Cognitive Level: Comprehension REF: Page 560

4. A researcher develops a new instrument for measuring adjustment to widowhood in dependents whose spouses were killed in armed conflict. The researcher’s initial instrument contains 55 items, and he wants to trim these down to 25 or 30 but doesn’t want to lose any of the main concepts. What method of statistical analysis will the researcher use, in order to pare this tool down to a manageable size without loss of content?

   1. Kendall’s tau

   2. Spearman’s rho

   3. Linear regression analysis

   4. Factor analysis

      ANS: D

      Factor analysis is one of the statistical techniques designed to examine interrelationships among large numbers of variables to reduce them to a smaller set of variables, and to identify clusters of variables that are most closely linked together (factors).

      DIF: Cognitive Level: Application REF: Page 566

5. A study examines the relationship between strength of belief in previous lives (Yes, Not Sure, and No) and percentage of butterfat in milk most commonly purchased (Non-Fat, 1%, 2%, Whole). The data could be analyzed by which of the following statistical tests?

   1. Kendall’s tau

   2. Pearson’s product-moment correlation

   3. Principal components analysis

   4. Bland and Altman plot

      ANS: A

      If one or both of two study variables do not meet the assumptions for a Pearson’s correlation, or if the variables are scaled on an ordinal scale of measurement (rather than interval or ratio), both the Spearman rank order correlation and Kendall’s tau are more appropriate statistics.

      The Spearman rank-order correlation and Kendall’s tau calculations involve converting the data to ranks, thereby discarding any variance or normality issues associated with the original values.

      DIF: Cognitive Level: Analysis REF: Page 560

6. A Pearson’s correlational analysis examines the relationship between variable A, hours of sleep per week, and B, symptom severity, in 43 women with post-polio syndrome. In accessing the table of values, the researcher uses which of the following numbers for degrees of freedom?

   1. 2

   2. 4

   3. 41

   4. 43

ANS: C

Every inferential statistic has is own formula for degrees of freedom (numbers of values that are free to vary). The formula for degrees of freedom (df) for a Pearson r is n – 2. Thus, in this case, the df is 43 – 2 = 41.

DIF: Cognitive Level: Analysis REF: Page 563

MULTIPLE RESPONSE

1. In the results and conclusions sections of a research paper about pre-delinquent behavior, the researcher mentions the strong correlational relationship between the number of incidents of pre-delinquent behavior and the number of hours the mother works outside the home. What does the author imply by stating this? (Select all that apply.)

   1. Some sort of test of correlation was performed and it reached statistical significance.

   2. As number of hours worked outside the home varied, so did the frequency of incidents of pre-delinquent behavior.

   3. Having a mother work many hours outside the home causes pre-delinquent behavior.

   4. Incidents of pre-delinquent behavior cause mothers to work more and more hours outside the home.

   5. As number of hours worked outside the home increased, so did the frequency of incidents of pre-delinquent behavior.

   6. The researchers avoided a type II error, in relation to the association between these two variables.

   7. The researchers operationalized the two study variables.

      ANS: A, B, F, G

      Correlational analysis provides two pieces of information about the data: the nature or direction of the linear relationship (positive or negative) between the two variables and the magnitude (or strength) of the linear relationship. No direction of relationship is stated here— merely the fact that the variables are strongly correlated, meaning that as one varied, the other varied. Since the relationship between these two variables was statistically significant, no type II error occurred. The probability of failing to reject the null hypothesis when it is in fact false is called type II error, and it is related to using a sample that is of insufficient size.

      Operationalization of a variable indicates how it will be measured or manipulated in a study; without operationalization, no measurement can occur.

      DIF: Cognitive Level: Synthesis REF: Page 561

2. In the results and conclusions sections of a research article about adult morbid obesity and a history of being underweight during the first two years of life, the researcher mentions the strong negative correlation between these two variables. What does the author imply by stating this? (Select all that apply.)

   1. Some sort of test of correlation was performed and it reached statistical significance.

   2. A person with morbid obesity is more likely than someone without it to have been underweight during the first two years of life.

   3. A person with morbid obesity is less likely than someone without it to have been underweight during the first two years of life.

   4. Having been underweight during the first two years of life prevents morbid obesity in adulthood.

   5. The researchers avoided a type I error, in relation to the association between these two variables.

   6. The researchers operationalized the two study variables.

      ANS: A, C, E

      Correlational analysis provides two pieces of information about the data: the nature or direction of the linear relationship (positive or negative) between the two variables and the magnitude (or strength) of the linear relationship. In a negative linear relationship, when one value is high, the other value tends to be low. The probability of rejecting the null hypothesis when it is in fact true is called type I error, and it is impossible to know whether it has occurred until replication research takes place. Operationalization of a variable indicates how it will be measured or manipulated in a study; without operationalization, no measurement can occur.

      DIF: Cognitive Level: Synthesis REF: Page 561

3. What does bivariate correlational analysis do? (Select all that apply.)

   1. Provides an idea of which variable causes the other one

   2. Reflects a two-way connection or pattern

   3. Measures the strength of multiple relationships connected with a concept

   4. Measures the strength of the relationship between two variables

   5. Determines the direction of the relationship between two variables

      ANS: B, D, E

      Bivariate correlational analysis measures the magnitude of linear relationship between two, and only two, variables and is performed on data collected from a single sample. Correlational analysis provides two pieces of information about the data: the nature or direction of the linear relationship (positive or negative) between the two variables and the magnitude (or strength) of the linear relationship.

      DIF: Cognitive Level: Comprehension REF: Page 560

4. What is the connection between a scatter plot and a calculation of correlation? (Select all that apply.)

   1. Constructing a scatter plot allows the researcher to visualize in advance whether a calculation of linear correlation is likely to reveal a relationship between the variables.

   2. Constructing a scatter plot produces a correlation coefficient, as does calculating correlation.

   3. A calculation of correlation should be performed before constructing a scatter plot, because the calculation is more scientific.

   4. The scatter plot provides a visual representation of the connection between two variables; a correlational calculation provides a quantification of the connection between the same variables.

   5. Just like calculation of correlation, constructing a scatter plot provides a way to quantify explained variance.

      ANS: A, D

      Scatter plots or scatter diagrams provide useful preliminary information about the nature of the relationship between variables. The researcher should develop and examine scatter diagrams before performing correlational analysis. Scatter plots may be useful for selecting appropriate correlational procedures, but most correlational procedures are useful for examining linear relationships only. A scatter plot can easily identify nonlinear relationships; if the data are nonlinear, the researcher should select statistical alternatives such as nonlinear regression analysis. A scatter plot is created by plotting the values of two variables on an x and y axis.

      DIF: Cognitive Level: Analysis REF: Page 560

5. For which of the following levels of measurement would a parametric statistical test like the Pearson product-moment correlation be used?

   1. Nominal level

   2. Ordinal level

   3. Interval level

   4. Ratio level

   5. Dichotomous

      ANS: C, D

      The Pearson product-moment correlation coefficient is conducted to determine the relationship between two variables measured at least at the interval level of measurement. Nominal level of measurement is the lowest of the four measurement levels or categories. It is used when data can be organized into categories of a defined property but the categories cannot be ordered. In interval level of measurement, distances between intervals of the scale are numerically equal. However, it is not possible to provide the absolute amount of the attribute because of the absence of a zero point that actually means none of the measured quantity, on the interval scale. Ratio level of measurement is the highest form of measure and meets all the rules of the lower forms of measures: mutually exclusive categories, exhaustive categories, rank ordering, equal spacing between intervals, and a continuum of values. In addition, ratio-level measures have absolute zero points.

      DIF: Cognitive Level: Analysis REF: Page 561

6. Which of the following variables are able to be analyzed using Pearson’s product-moment correlation? (Select all that apply.)

   1. Age

   2. Race

   3. Gender

   4. Score on the Spielberger State Trait Anxiety Inventory

   5. Years of education

   6. Temperature

   7. Nickname

   8. Size of hospital gown worn

      ANS: A, D, E, F

      Use of the Pearson product-moment correlation assumes that the variables are at the interval or ratio level of measurement. In this example, they would be only the four: age, score on the STAI, years of education, and temperature. Nominal level of measurement is the lowest of the four measurement levels or categories. It is used when data can be organized into categories of a defined property but the categories cannot be ordered. In interval level of measurement, distances between intervals of the scale are numerically equal. However, it is not possible to provide the absolute amount of the attribute because of the absence of a zero point that actually means none of the measured quantity, on the interval scale. Ratio level of measurement is the highest form of measure and meets all the rules of the lower forms of measures: mutually exclusive categories, exhaustive categories, rank ordering, equal spacing between intervals, and a continuum of values. In addition, ratio-level measures have absolute zero points.

      DIF: Cognitive Level: Application REF: Page 561

7. Twelve research studies show a strong correlation between low levels of education and poverty. A social scientist declares that the “cure” for poverty is in free education for all of the children of the poor. What are valid arguments against this declaration? (Select all that apply.)

   1. The scientist believes that a low level of education, in and of itself, causes poverty, but no study has demonstrated this.

   2. It is possible that low levels of education cause Item B, and Item B causes poverty.

   3. It is possible that multigenerational poverty causes lower levels of education.

   4. It is possible that low levels of education and poverty are both caused by social injustice.

   5. Twelve correlational research studies are not enough to demonstrate cause: at least 50 studies of 100 subjects each would be required for this.

      ANS: A, B, C, D

      Correlational analysis provides two pieces of information about the data: the nature or direction of the linear relationship (positive or negative) between the two variables and the magnitude (or strength) of the linear relationship. A positive correlation is not an indication of causality, no matter how strong the statistical result.

      DIF: Cognitive Level: Application REF: Page 561

8. The calculated Pearson’s r was –.95 in a research study on number of hours parents spent at children’s sporting events and number of arrests those children had experienced by age 30. What does this Pearson’s value signify? (Select all that apply.)

   1. No relationship

   2. Weak linear relationship

   3. Moderate linear relationship

   4. Strong linear relationship

   5. Positive relationship

   6. Inverse relationship

   7. Negative relationship

ANS: D, F, G

Pearson’s product-moment correlation is represented by the letter r, and the value of the r is always between –1.00 and +1.00. A value of zero indicates no relationship between the two variables. The further the value from zero, the stronger the relationship. The number indicates the strength of the relationship, and the sign connotes whether that relationship is positive or negative (inverse). Consequently, a relationship of –.60 is exactly as strong as a relationship of

.60, although one is a positive relationship and the other a negative, or inverse, one. Values greater than .50 or less than –.50 indicate strong correlations.

DIF: Cognitive Level: Analysis REF: Page 561

Chapter 24: Using Statistics to Predict Test Bank

MULTIPLE CHOICE

1. A researcher is studying daily carbohydrate intake and the next day’s first morning Accu-Chek value. After drawing a scatter plot, the researcher develops a multiple regression equation. What does the value R represent?

   1. The line of best fit

   2. The amount of change in Accu-Chek values that daily carbohydrate intake predicts

   3. Daily carbohydrate intake times Accu-Chek value

   4. The correlation between daily carbohydrate intake and the next day’s first morning Accu-Chek value

      ANS: D

      R is defined as the correlation between the actual y values and the predicted y values using the new regression equation. The R2represents the percentage of variance in y explained by the predictor and is called the coefficient of determination.

      DIF: Cognitive Level: Application REF: Page 572

2. A researcher is studying stress and various factors that seem to be related to it, in women with terminally ill spouses.Among other things, the researcher finds out that depression contributes to total stress; depression contributes to lack of exercise; a decreased amount of exercise contributes to depression; exercise relieves stress; guilt contributes to depression; exercise has no effect on guilt, but it affects total stress; stress worsens depression; and stress decreases motivation to perform exercise. This is an example of what problem commonly encountered in regression analyses?

   1. Multicollinearity

   2. Hazard ratio

   3. Odds ratio

   4. Predictive validity

      ANS: A

      Multicollinearity occurs when the independent variables in a multiple regression equation are strongly correlated with one another. The presence of multicollinearity does not affect predictive power; rather it causes problems related to generalizability and the stability of the findings. The first step in identifying multicollinearity is to examine the bivariate correlations among the independent variables.

      DIF: Cognitive Level: Application REF: Page 573

3. Why does a researcher decide to calculate odds ratio instead of calculating linear regression when comparing whether a person voted in the last election and the person’s gender?

   1. Voting records are sealed.

   2. Both predictor and dependent variable are dichotomous.

   3. Odds ratio is a simpler calculation.

   4. Strength of relationship is not an issue.

ANS: B

When both the predictor and the dependent variable are dichotomous (having only two values; also called binary), the odds ratio is a commonly used statistic to obtain an indication of association. Linear regression is used to determine relationships with interval or ratio data.

The odds ratio (OR) is defined as the ratio of the odds of an event occurring in one group to the odds of it occurring in another group. Put simply, the OR is a way of comparing whether the odds of a certain event is the same for two groups.

DIF: Cognitive Level: Analysis REF: Page 575

MULTIPLE RESPONSE

1. A researcher collects a nationally based set of data about cholesterol levels and age at first circulatory incident (myocardial infarction or cerebrovascular accident). The researcher performs a linear regression analysis in order to do which of the following? (Select all that apply.)

   1. Estimate the age at which circulatory incidents are likely to occur, given the cholesterol level.

   2. Determine how well the data fit the theoretical framework.

   3. Calculate the strength of the relationship between cholesterol levels and circulatory incidents.

   4. Determine whether there is a linear relationship between cholesterol levels and circulatory incidents.

   5. Derive the formula for the line of best fit.

   6. Obtain information from which to construct a better scatter plot.

      ANS: A, C, D, E

      Simple linear regression provides a means to estimate the value of a dependent variable based on the value of an independent variable. Through regression, the strength of the relationship between two variables can be determined. Simple linear regression is an effort to explain the dynamics within the scatter plot by developing a formula for a straight line that best fits the data. This has nothing to do with a theoretical framework. A scatter plot precedes development of a regression formula.

      DIF: Cognitive Level: Application REF: Page 570

2. A researcher is studying number of cats in the home, and number of rodents plus crawling insects in the home, daily carbohydrate intake and the next day’s first morning Accu-Chek value. After drawing a scatter plot, the researcher develops a multiple regression equation and determines R as .75 and R2as .5625. What does the calculated value R2represent? (Select all that apply.)

   1. It means the standard error, squared.

   2. It is the amount of rodent plus insect count that can be explained by the number of cats.

   3. It stands for the standard deviation of the data set y, squared.

   4. It estimates shrinking regression.

   5. It is the coefficient of determination.

   6. It is the explained variance.

      ANS: B, E, F

      R is defined as the correlation between the actual y values and the predicted y values using the new regression equation. The R2represents the percentage of variance in y explained by the predictor and is called the coefficient of determination.

      DIF: Cognitive Level: Application REF: Page 573

3. Which of the following terms in correlational research mean the same thing? (Select all that apply.)

   1. Predictor variable

   2. Dichotomous variable

   3. Dependent variable

   4. Multicollinearity

   5. Independent variable

      ANS: A, E

      The independent (predictor) variable or variables are identified as being predictive of variation in the value of the dependent (outcome) variable. Multicollinearity refers to highly correlated predictor variables that are difficult to tease out from one another. A dichotomous variable has only two possible values.

      DIF: Cognitive Level: Comprehension REF: Page 574

4. A researcher conducts research on optimism. The researcher is calculating a multiple regression equation to predict levels of optimism and wishes to consider religious affiliation as one of the predictor variables. The researcher creates several dummy variables for this purpose. Why must this be done? (Select all that apply.)

   1. It is safer to create more variables than fewer, since they may each contribute.

   2. Multiple regression requires that the researcher enter numerical values, not names such as Lutheran, Orthodox Jewish, Buddhist, Islamic, and so forth.

   3. Reducing nominal or categorical data to one or a series of dichotomous values allows mathematical computation of the regression equation.

   4. Religious affiliation is a protected entity under HIPAA and must be coded before it is used in calculations.

   5. The researcher’s aim is to develop a formula with which to calculate optimism, given certain other variables, so these must all be represented as numbers.

      ANS: B, C, E

      Variables in a regression equation can take many forms. Traditionally, as with most multivariate analyses, variables are measured at the interval or ratio level. However, researchers also use categorical or dichotomous variables, by assigning the terms numbers to represent them (referred to as dummy variables). These numbers are further converted to binary numbers; after this, they are entered one digit at a time as a series of dummy variables. For instance, if a nominal or categorical variable has two values, one dummy variable may be used (0, 1). If a nominal or categorical variable has three or four values, however, two different dummy variables are used to represent them. For five to eight values, three dummy variables are used, and so forth.

      DIF: Cognitive Level: Analysis REF: Page 574

5. What is a multiple regression equation? (Select all that apply.)

   1. One that represents the mathematical effect that several independent variables have on the dependent variable

   2. One in which the x-values are multiplied by one another

   3. One that explains more of the variance in y than does a single linear regression equation

   4. An experimental model for determining best practices

   5. One that uses more than one predictor variable to predict the value of the outcome variable

   6. One that explains all of the variance in the dependent variable, in terms of several independent variables

      ANS: A, C, E

      Multiple regression is an extension of simple linear regression in which more than one independent variable is entered into the analysis. Because the relationships between multiple predictors and y are tested simultaneously, the calculations involved in multiple regression analysis are very complex. Multiple regression is best conducted using a statistical software package. A multiple regression formula explains some or all of the variance in the dependent variable; it cannot explain all of it.

      DIF: Cognitive Level: Analysis REF: Page 573

6. Why does a researcher decide to use logistic regression instead of linear regression to calculate survival odds after suffering an out-of-hospital heart attack, in persons of various ages, genders, and cardiac diagnoses? (Select all that apply.)

   1. Survival versus non-survival is a dichotomous variable.

   2. Having a heart attack is a variable that has many possible outcomes.

   3. Linear regression is less logical than is logistic regression.

   4. Age is a ratio-level variable.

   5. Gender is a nominal-level variable.

   6. Cardiac diagnosis is a nominal-level variable.

      ANS: A, D, E, F

      Logistic regression replaces linear regression when the researcher wants to test a predictor or predictors of a dichotomous dependent variable. Logistic regression can have continuous predictors or nominal predictors or a combination of the two, with no assumptions regarding normality of the distribution.

      DIF: Cognitive Level: Analysis REF: Page 576

7. Which of the following dependent variables is suitable for logistic regression analysis? (Select all that apply.)

   1. How many compressions were delivered in the first minute post-code

   2. Serum sodium value

   3. Born on earth–not born on earth

   4. Height at adulthood

   5. Birth gender

   6. Whether a patient with cancer goes into remission

      ANS: C, E, F

      Logistic regression replaces linear regression when the researcher wants to test a predictor or predictors of a dichotomous dependent variable. Logistic regression can have continuous predictors or nominal predictors or a combination of the two, with no assumptions regarding normality of the distribution.

      DIF: Cognitive Level: Analysis REF: Page 576

8. A researcher decides to study how many college freshmen with continuous enrollment graduate within four years, four-and-a-half years, five years, five-and-a-half years, and six years, and to analyze this according to what their majors at graduation are, as well as other demographic variables. Why would a Cox proportional hazards regression analysis be suitable for this research? (Select all that apply.)

   1. Demographic variables could affect time until graduation.

   2. The data of people who do not graduate at all may be informative.

   3. Attendance at college can present hazard.

   4. A predictor of the dependent variable is time-related.

   5. Only people who actually graduate by the end of twelve semesters will have their data analyzed.

      ANS: A, B, D

      The purpose of a regression analysis is to predict or explain as much of the variance in the value of a dependent variable as possible. The major difference between using Cox regression as opposed to linear regression is the ability of survival analysis to handle cases where survival time is unknown. Whereas logistic regression yields odds ratios for each predictor to represent the relationship between that predictor and y, Cox regression yields hazard ratios.

      DIF: Cognitive Level: Application REF: Page 570

9. Which of the following statements about prediction is true? (Select all that apply.)

   1. Simple linear regression can predict possible changes in A, given B.

   2. Multicollinearity is used to provide definitive attribution in predicting dependent variables with similar outcomes.

   3. Multiple regression can provide information about the strongest predictors, C, D, E, and F, associated with an outcome variable G.

   4. Odds ratio is used to predict the likelihood of a dichotomous event, in the light of a different dichotomous variable.

   5. Logistic regression is used to predict a dichotomous variable, using a variety of other variables.

   6. Cox hazard regression can predict the likelihood of an event occurring at certain points in time.

ANS: A, C, D, E, F

Simple linear regression provides a means to estimate the value of a dependent variable based on the value of an independent variable. Multicollinearity occurs when the independent variables in a multiple regression equation are strongly correlated with one another. Multiple regression is an extension of simple linear regression in which more than one independent variable is entered into the analysis. When both the predictor and the dependent variable are dichotomous (having only two values; also called binary), the odds ratio is a commonly used statistic to obtain an indication of association. Logistic regression replaces linear regression when the researcher wants to test a predictor or predictors of a dichotomous dependent variable. Logistic regression can have continuous predictors or nominal predictors or a combination of the two, with no assumptions regarding normality of the distribution. The major difference between using Cox regression as opposed to linear regression is the ability of survival analysis to handle cases where survival time is unknown. Whereas logistic regression yields odds ratios for each predictor to represent the relationship between that predictor and y, Cox regression yields hazard ratios.

DIF: Cognitive Level: Comprehension REF: Page 570 Chapter 25: Using Statistics to Determine Differences Test Bank

MULTIPLE CHOICE

1. What does the two-way chi-square test measure?

   1. Whether one variable seems related to another one

   2. Whether two variables cause one another

   3. Whether an intervention changes the dependent variable’s value

   4. Change over time

      ANS: A

      The chi-square (²) test compares differences in proportions of nominal level variables. A two-way chi-square is a statistic that tests whether proportions in levels of one variable are significantly different from proportions of the second variable. In other words, it detects whether one nominal variable seems to be related to another one.

      DIF: Cognitive Level: Analysis REF: Page 587

2. In an ANOVA calculation evaluating causation, the mean square within groups value represents the ordinary amount of variation that exists in the data set. What does the mean square between groups value represent?

   1. The effect that the interventional conditions produce

   2. The average of all variations in the data set

   3. Total variation

   4. The differences that exist among the several interventional conditions

      ANS: A

      The term “mean square” (MS) is used interchangeably with the word “variance.” The formulas for ANOVA compute two estimates of variance: the between groups variance and the within groups variance. The between groups variance represents differences between the groups/conditions being compared, and the within groups variance represents differences among (within) each groups’ data. Therefore, the formula is F = MS between/MS within.

      DIF: Cognitive Level: Analysis REF: Page 585

3. Which of the following tests is essentially a comparison of means?

   1. Mann-Whitney U

   2. Chi-square

   3. ANOVA

   4. t-test

      ANS: D

      One of the most common parametric analyses used to test for significant differences between group means of two samples is the t-test. In its calculation, the numerator is the difference scores of the means of the two samples. In addition, the test uses the pooled standard deviation of the two samples as the denominator.

      DIF: Cognitive Level: Comprehension REF: Page 580

4. Why is post hoc statistical testing not performed with a two-group ANOVA?

   1. A researcher is reluctant to perform a post hoc analysis that would require a more stringent level of significance.

   2. The F-statistic would be invalidated by the second test.

   3. If hypothesis testing reveals that a difference between groups exists, it is obvious what two groups those are.

   4. Sample sizes are not large enough for this analysis.

      ANS: C

      Post hoc tests have been developed specifically to determine the location of group differences after ANOVA is performed on data from more than two groups. The post-hoc analyses performed after the ANOVA preserves the same level of analysis as the ANOVA itself. The F- statistic is not invalidated by performing a post hoc analysis. Sample size is not a consideration when performing a post hoc analysis.

      DIF: Cognitive Level: Analysis REF: Page 586

5. What is unique about chi-square analysis?

   1. It is almost always statistically significant.

   2. It is used for two nominal variables

   3. It demands normal distribution, even of dichotomous variables.

   4. It is parametric.

ANS: B

The chi-square (²) test compares differences in proportions of nominal level variables. Statistical significance may or may not exist. The test does not demand normal distribution, and it is non-parametric.

DIF: Cognitive Level: Analysis REF: Page 587

MULTIPLE RESPONSE

1. Below the third table in a research report, concerning switching infants to cow’s milk at six months of age instead of 12 months, is a notation: “t(22) = –0.76, p = .41” What does this mean? (Select all that apply.)

   1. A t-test was performed.

   2. Apparently 24 subjects participated in the study.

   3. There was a difference between groups.

   4. The difference between groups was not statistically significant.

   5. If there was an intervention, the intervention was more effective than the control condition.

   6. The results are generalizable.

   7. The researcher failed to reject the null hypothesis.

   8. A type I error occurred.

      ANS: A, B, C, D, G

      One of the most common parametric analyses used to test for significant differences between group means of two samples is the t-test. It is conducted to discover whether a difference exists between two groups, or between a previous condition and the current condition in paired subjects. Degrees of freedom are equal to n – 2. Not enough is known about the research to discern in which group the intervention was more effective. In this example, there was a difference between groups, but it was apparently not statistically significant, since p = . 41, according to the notation below the graph. Only p-values of .05 and less would be statistically significant. If the researcher failed to reject the null hypothesis, no type I error could have occurred.

      DIF: Cognitive Level: Synthesis REF: Page 580

2. A researcher is studying the effect upon pain of providing hypnosis with dental work. The researcher’s three groups are (1) hypnosis before and during the procedure, (2) hypnosis before but not during the procedure, and (3) no hypnosis. If the researcher plans to use an ANOVA for the statistical analysis, which would be an acceptable way to measure pain, for this study? (Select all that apply.)

   1. Present versus absent

   2. Worse ... Some ... A Lot ... Unbearable

   3. 0- to 100-point verbal numerical scale

   4. Systolic blood pressure readings

   5. The force with which the subject squeezes a rubber ball with pressure gauge attached

      ANS: C, D, E

      The parametric statistics used to determine differences that are covered in this chapter are the independent samples t-test, paired or dependent samples t-test, and analysis of variance (ANOVA). ANOVA requires that the dependent variable be at the interval or ratio level: a verbal numerical scale, systolic blood pressure readings, and force with which the subject squeezes a rubber ball are all interval or ratio level variables.

      DIF: Cognitive Level: Analysis REF: Page 580

3. A statistician measures the difference in songbird warble variation in twenty-five mockingbirds, both before and after nutritional supplementation with Dr. Petit Oiseau’s Musical Bird Seed. Warble variation is determined by a computer program that detects sound frequency and pattern changes during a 15-minute period twice a day, and this data is averaged to represent number of warble variations per minute. What considerations determine choice of a test for this research? (Select all that apply.)

   1. The sample size is small to moderate.

   2. There is one group of birds and all receive the treatment.

   3. A before-after type of design is used.

   4. The independent variable is nominal level.

   5. Birds are divided into two groups.

   6. The independent variable is ratio level.

   7. The dependent variable is ratio level.

      ANS: A, B, C, D, G

      The parametric statistics used to determine differences that are covered in this chapter are the independent samples t-test, paired or dependent samples t-test, and analysis of variance (ANOVA). If the assumptions for parametric analyses are not achieved or if study data are at the ordinal level, then the nonparametric analyses of Mann-Whitney U, Wilcoxon signed- ranks test, and Kruskal-Wallis H are appropriate techniques to use to test the researcher’s hypotheses. In this study, one group is compared before and after treatment. In such an instance, a paired t-test can be used, if the dependent variable is at the ratio or interval level. This test is particularly useful when only small samples are available for analysis; the sample is large enough.

      DIF: Cognitive Level: Analysis REF: Page 580

4. A statistician measures the difference in songbird warble variation in twenty-five mockingbirds, both before and after nutritional supplementation with Dr. Petit Oiseau’s Musical Bird Seed. Warble variation is determined by a cranky librarian, who characterizes the birds, before and after treatment, as one of the following “Lots of Notes There!” “Fair Variety,” and “Quite The Redundant Little Song.” What considerations determine choice of a test for this research? (Select all that apply.)

   1. The sample size is small to moderate.

   2. There is one group of birds and all receive the treatment.

   3. A before-after type of design is used.

   4. The independent variable is nominal level.

   5. Birds are divided into two groups.

   6. The dependent variable is ordinal level.

   7. The dependent variable is ratio level.

      ANS: B, C, D, F

      The parametric statistics used to determine differences that are covered in this chapter are the independent samples t-test, paired or dependent samples t-test, and analysis of variance (ANOVA). If the assumptions for parametric analyses are not achieved or if study data are at the ordinal level, then the nonparametric analyses of Mann-Whitney U, Wilcoxon signed- ranks test, and Kruskal-Wallis H are appropriate techniques to use to test the researcher’s hypotheses. In this study, one group is compared before and after treatment, and the dependent variable is at the ordinal level of measurement. In such an instance, a Wilcoxon signed-ranks test is appropriate. This test is useful when a paired t-test would otherwise be performed, if only the dependent variable weren’t ordinal.

      DIF: Cognitive Level: Analysis REF: Page 580

5. A researcher designs a study to measure whether receiving a free season pass to a beautiful ski resort near Bountiful, Utah, increases the number of days a subject who has lived in the area for 1 to 3 years skis during the season. An independent samples t-test of correlation is used to measure the effect of receiving a season pass upon number of ski days. If, instead, the researcher decided to measure the subjects’ responses by asking them to check one of these four replies on a survey, “Much more often than last year,” “More often than last year,” “Just about the same as last year,” or “Less often than last year,” why would the independent samples t-test have to be abandoned for a Mann-Whitney U test instead? (Select all that apply.)

   1. The variable of skiing is measured at the nominal instead of the ratio level.

   2. The variable of skiing is now measured at the ordinal instead of ratio level.

   3. The variable amount skied is now measured at the nominal level instead of the ratio level.

   4. The variable amount skied is now measured at the ordinal level instead of the ratio level.

   5. Both variables’ levels have changed.

   6. The independent samples t-test used demands ratio-level or interval-level data.

   7. The Mann-Whitney U test allows for ordinal level values, but not nominal.

      ANS: D, F, G

      The parametric statistics used to determine differences that are covered in this chapter are the independent samples t-test, paired or dependent samples t-test, and analysis of variance (ANOVA). If the assumptions for parametric analyses are not achieved or if study data are at the ordinal level, then the nonparametric analyses of Mann-Whitney U, Wilcoxon signed- ranks test, and Kruskal-Wallis H are appropriate techniques to use to test the researcher’s hypotheses. If the data do not meet the assumptions involving normality and/or equal variances for an independent samples t-test, then the nonparametric alternative is the Mann- Whitney U test. The Mann-Whitney U calculations involve converting the data to ranks, thereby discarding any variance or normality issues associated with the original values. In some studies, the data collected is ordinal level and the Mann-Whitney U test is appropriate for analysis of the data.

      DIF: Cognitive Level: Analysis REF: Page 580

6. Which of the following tests are parametric statistics that may be used to measure, clarify, or evaluate causation? (Select all that apply.)

1. t-test for independent samples

2. Mann-Whitney U test

3. t-test for dependent samples

4. Wilcoxon signed-rank test

5. ANOVA

6. Tukey Honestly Significant Difference (HSD)

7. Kruskal-Wallis test

8. Chi-square

   ANS: A, C, E, F

   The parametric statistics used to determine differences that are covered in this chapter are the independent samples t-test, paired or dependent samples t-test, and analysis of variance (ANOVA). In addition, the Tukey Honestly Significant Difference test is a post hoc test used to clarify which variables are related, after an ANOVA shows a significant difference.

   DIF: Cognitive Level: Analysis REF: Page 580

• What are the principal reasons why any nonparametric test of causality was used instead of a parametric one? (Select all that apply.)

  1. The assumptions for parametric analyses were not achieved.

  2. The effect that the interventional conditions produced was not measurable.

  3. The data were not normally distributed.

  4. The dependent variable was measured at the ordinal level.

  5. The results were not statistically significant.

     ANS: A, C, D

     If the assumptions for parametric analyses are not achieved or if study data are at the ordinal level, then the nonparametric analyses of Mann-Whitney U, Wilcoxon signed-ranks test, and Kruskal-Wallis H are appropriate techniques to use to test the researcher hypotheses. T-tests and ANOVA assume a normal distribution and measurement of the dependent variable at the interval/ratio level.

     DIF: Cognitive Level: Analysis REF: Page 580

• What do the t-test and the ANOVA have in common? (Select all that apply.)

  1. They are both used when the dependent variable is ordinal.

  2. They both assume a normal distribution.

  3. They both compare groups to decide if they are the same or different.

  4. They both can be used to compare two groups.

  5. They both require secondary post hoc analyses.

  6. They both use the same statistical tables for interpretation of results.

  7. They are both parametric analyses.

     ANS: B, C, D, G

     The t-test and ANOVA are both parametric analyses; as such, they both assume a normal distribution and cannot be used when the dependent variable is ordinal. Both are used to compare groups, and both can actually be used when there are two groups, although for more than one only the ANOVA is used. If used with three or more categories, the ANOVA requires secondary post hoc analysis if its results are statistically significant. They use the t-test and F- test, respectively, and each has a separate table.

     DIF: Cognitive Level: Application REF: Page 580

• Which of the following results would represent statistical significance, if the level of significance were set at .05 for each? (Select all that apply.)

  1. t = 8.43, p <.01

  2. X2= 10.83, p <0.1

  3. F = 2.37, p <0.07

  4. r = 0.2, p = .23

  5. rs= .74, p = .049

ANS: A, E

The obtained result from the calculation of the statistic is compared with the appropriate table, at the level of significance set by the researcher at the outset of the study. If that is p <.05, it is essential that the correct value be retrieved from the table, for comparison. Researchers often set the level of significance at .05. By that criterion, the two statistically significant values above are p <.01 and p = .049.

DIF: Cognitive Level: Analysis REF: Page 584

aChapter 26: Interpreting Research Outcomes Test Bank

MULTIPLE CHOICE

1. A researcher studies the effect on reading comprehension level of providing fourth-grade boys who are slow and ponderous readers with illustrated comic books for a six-week summer session instead of textbooks, hypothesizing that reading associated with pictures will results in a higher reading comprehension level. The researcher set a level of significance at p <.05. Analysis of the data from a study indicates that there was a significant difference between the two groups, which were randomly selected and composed of 100 subjects each. However, the experimental comic book group’s scores improved less than did the scores of the boys who used the textbooks. The measured p-level was 0.026. What type of finding is this?

   1. Significant results that are in keeping with those predicted by the researcher

   2. Nonsignificant results

   3. Significant results that oppose those predicted by the researcher

   4. Mixed results

      ANS: C

      Significant results opposite those predicted, if the results are valid, are an important addition to the body of knowledge. An example would be a study in which the researchers proposed that social support and ego strength were positively related. If the study showed that high social support was related to low ego strength, the result would be the opposite of that predicted. Such results, when verified by other studies, indicate that the theory being tested needs modification and refinement. Because these types of studies can affect nursing practice, this information is important.

      DIF: Cognitive Level: Application REF: Page 594

2. The analysis of the data from a study indicates that there was a significant difference between the two groups, which were randomly selected and composed of 100 subjects each. The instruments measuring stress, mood, and various scaled measures of emotion were well normed, widely tested, and suitable. As the researcher begins interpretation of the data, she discovers that during data collection one of her assistants had recorded the demographic item “household size” incorrectly, understanding the item as “number of people who live with you.” There is no way to determine which research assistant worked with which research subject. What effect did this way of recording the data have on the study findings?

   1. That item cannot be analyzed as a ratio item and will have to be treated in a different way.

   2. None, because the numbers will be the same either way the data are collected.

   3. That particular item will have to be discarded, because it can no longer be analyzed.

   4. None, because post hoc statistical analysis will automatically adjust for this type of “error.”

      ANS: A

      Many activities that occur during data collection affect the meaning of study results. Did your study have a high refusal rate for subject participation, or was the attrition high? Was the sample size sufficient? Did strategies for acquiring a sample eliminate important groups whose data would have influenced the results? Did you and your research team achieve intervention fidelity when the treatment was implemented? Did unforeseen events occur during the study that might have changed or had an impact on the data? Were measurement techniques consistent? What impact do inconsistencies have on interpreting results?

      Methodological limitations result from factors such as nonrepresentative samples, weak designs, single setting, limited control over treatment (intervention) implementation, instruments with limited reliability and validity, limited control over data collection, and improper use of statistical analyses. Nominal level of measurement is the lowest of the four measurement levels or categories. It is used when data can be organized into categories of a defined property but the categories cannot be ordered. Data that can be measured at the ordinal level can be assigned to categories of an attribute that can be ranked. In interval level of measurement, distances between intervals of the scale are numerically equal. Interval scales are assumed to be a continuum of values. Ratio level of measurement is the highest form of measure and meets all the rules of the lower forms of measures.

      DIF: Cognitive Level: Synthesis REF: Page 592

3. In a cross-sectional study, a researcher studies career trajectories in nurses over the past twenty years. There are five correlational research hypotheses. Why are mixed results, related to significance of findings, to be expected?

   1. The study is cross-sectional, and the economy has made bedside care a more practical decision over the past few years.

   2. Groups across time cannot be expected to have the same responses to career advancement.

   3. The study is merely correlational.

   4. Five statistical hypotheses are being tested; not all of these can be expected to demonstrate statistical significance.

      ANS: D

      Mixed results are probably the most common outcome of studies. In this case, one variable may uphold the characteristics predicted whereas another does not, or two dependent measures of the same variable may show opposite results.

      DIF: Cognitive Level: Analysis REF: Page 594

4. A researcher working for a company that produces a standardized exam that predicts whether or not nursing students will pass the national licensure exam tests this tool at a level of significance of  = .01, with power = .91. The results are statistically significant. What interpretation can the researcher justifiably make?

   1. Findings are important to nursing schools, and valuable for them.

   2. The exam should be used by all nursing schools.

   3. There is good evidence that the results can be replicated, with similar results.

   4. Results will be the same if the study is repeated with another sample.

      ANS: C

      The researcher chooses the probability of making a Type I error when setting α, the level of significance. Nursing researchers usually set a level of significance of p <.05. A level of significance of p <.01 is much more stringent, and decreases the possibility of error to 1%. Significant results that coincide with the researcher’s predictions are the easiest to explain and, unless weaknesses are present, validate the proposed logical links among the elements of the study. There is good evidence that the reports are reproducible.

      DIF: Cognitive Level: Analysis REF: Page 594

5. Which of the following interpretations is acceptable as worded?

   1. The study proved that cigarette smoking causes lung cancer. Financial incentives must be offered by insurance companies to all persons who cease smoking.

   2. Findings suggest that antihypertensives influence both length and quality of life, and that their use is more beneficial than formerly realized.

   3. The positive correlation between owning a dog who demands to be walked daily and the owner’s cardiovascular health indicates that all people should own dogs.

   4. Results imply that all humans who use amphetamines will have shortened life spans, and patient teaching needs to include this vital information.

      ANS: B

      Implications of research findings for nursing are the meanings of the conclusions for the body of nursing knowledge, theory, and practice. Implications for practices are often based, in part, on whether treatment decisions or outcomes would be different in view of the study findings. The study implications provide specific suggestions for implementing the findings in practice. Even when the results are significant and in keeping with those predicted by the researcher, the researcher must consider alternative explanations for the positive findings and cannot use the word “should” or its synonyms. One study does not “prove” that smoking causes lung cancer. A correlational study merely provides evidence of association.

      DIF: Cognitive Level: Analysis REF: Page 599

6. A researcher studies the effect upon pain control of providing pet therapy for children on a pediatric ward. While conducting the study, the researcher becomes aware of a strong correlation between parental presence and hours of children’s sleep. What is this correlation?

   1. The ability to consent far more subjects than were originally projected: a lucky occurrence

   2. A relationship between variables that were not hypothesized or predicted from the framework: serendipitous finding

   3. The identification of a variable that affects the dependent variable and distorts its value: extraneous variable

   4. A condition that affects generalization: limitation

      ANS: B

      Serendipitous results are relationships found between variables that were not hypothesized and not predicted from the framework guiding the study. These unexpected results are also called serendipitous results. Most researchers examine as many elements of data as possible in addition to those directed by the research objectives, questions, or hypotheses. They can use these findings to develop or refine theories and to formulate later studies. In addition, serendipitous results are as important as evidence in developing the implications of the study. However, researchers must deal carefully with serendipitous results when considering their meaning, because the study was not designed to examine these results.

      DIF: Cognitive Level: Analysis REF: Page 595

7. A researcher summarizes the findings and then makes generalizations. Why does the researcher refer to the literature before making generalizations?

   1. If the current study is a replication of previous research, its generalizations will be identical to those of the study it replicates.

   2. If there is no previous research in this area, no generalizations can be made.

   3. If the current study is the second by this researcher, its generalizations will be to the population from which the second sample was drawn, and will specifically exclude the sample from the first study.

   4. If there is a lone study in this area, generalizations are narrow; if there is previous research of a parallel nature, more widespread generalization is in order.

      ANS: D

      Generalization extends the implications of the findings from the sample studied to a larger population or from the situation studied to a larger situation. If there is previous identical or very similar research in this area, generalizations can be made to the populations from which this and other studies were drawn, thus increasing generalizability. Generalizations based on accumulated evidence from many studies are called empirical generalizations. These generalizations are important for verifying theoretical statements or developing new theories. Empirical generalizations are the base of a science and contribute to scientific conceptualization, which provide a basis for generating evidence-based guidelines to manage specific practice problems.

      DIF: Cognitive Level: Analysis REF: Page 598

8. Near the end of a research article, the researcher states that the findings contribute to nursing’s body of knowledge and they also provide evidence that the intervention may be helpful in the population from which the sample was drawn. What does this comment address?

   1. Serendipitous findings

   2. Implications

   3. Generalizations

   4. Limitations

ANS: B

Implications are the meanings of conclusions for the body of knowledge, theory, and practice. Implications are based on the conclusions and are more specific than conclusions. They provide specific suggestions for implementing the findings. Generalization extends the implications of the findings from the sample studied to a larger population or from the situation studied to a larger situation. Serendipitous findings are relationships found between variables that were not hypothesized and not predicted from the framework guiding the study. Limitations are restrictions or problems in a study that may decrease the generalizability of the findings.

DIF: Cognitive Level: Application REF: Page 598

MULTIPLE RESPONSE

1. The analysis of the data from a study indicates that there was a significant difference between the two groups, which were randomly selected and composed of 100 subjects each. The instruments measuring stress, mood, and various scaled measures of emotion were well normed, widely tested, and suitable. As the researcher begins interpretation of the data, she discovers that during data collection one of her assistants had recorded the demographic item “household size” incorrectly, understanding the item as “number of people who live with you.” The original paper surveys are still available, and the ones this particular assistant collected are all clearly marked with her initial on each page. How can this data item be “saved”? (Select all that apply.)

   1. Erroneous values can be identified and eliminated from the data analysis for this single item.

   2. Erroneous values can be located and re-entered as the true values, since the systematic error has been identified, quantified, and attributed.

   3. Data analysis may proceed and the error noted in the final report as a methodological limitation.

   4. An overlapping ordinal measurement can be used, in which the categories are 0-1,

      1-2, 2-3, and so forth.

   5. The data may be analyzed as a nominal variable and so coded.

      ANS: A, B

      Many activities that occur during data collection affect the meaning of study results. Methodological limitations result from factors such as nonrepresentative samples, weak designs, single setting, limited control over treatment (intervention) implementation, instruments with limited reliability and validity, limited control over data collection, and improper use of statistical analyses. Nominal level of measurement is the lowest of the four measurement levels or categories. It is used when data can be organized into categories of a defined property but the categories cannot be ordered. Data that can be measured at the ordinal level can be assigned to categories of an attribute that can be ranked. In interval level of measurement, distances between intervals of the scale are numerically equal. Interval scales are assumed to be a continuum of values. Ratio level of measurement is the highest form of measure and meets all the rules of the lower forms of measures. To be meaningful, measurements must be mutually exclusive. Changing the data to a nominal or ordinal measurement will not “save” the item. Reporting the item as erroneous does not “save” the item.

      DIF: Cognitive Level: Synthesis REF: Page 592

2. A researcher has conducted a study that uses a measurement tool for agitation, normed in a hospital setting, in an outpatient mental health setting. After completion of the data analysis phase, which of the following is the next logical step in evaluating the evidence?

   1. Recalibration of all instruments used for physiologic measurements

   2. Review of the literature

   3. Identification of statistically significant findings

   4. Examination of the measurement tool’s reliability in this setting

   5. Re-evaluation of the tool’s validity in this population

      ANS: D, E

      One assumption often made in interpreting study results is that the study variables were adequately measured. This adequacy is determined by examining the fit of operational definitions with the framework and through validity and reliability information. Although reliability and validity of measurement strategies are reviewed before use, one must reexamine the measures at this point to determine the strength of evidence available from the results. For example, did the measurement truly reflect the concept in the study population? Were the validity and reliability of instruments examined in the present study? The validity and reliability of measurement methods are critical to the validity of results.

      DIF: Cognitive Level: Application REF: Page 591

3. A researcher studies the effect of a computerized hospital charting system on nurses’ compliance with charting the exact times of tracheostomy care, periodic turning of patients, and bed baths. The researcher hypothesizes that instituting the new charting system would improve compliance. The sample size is 120. The level of significance is set at .05 and the power at 80%. Findings are nonsignificant, at p = .146. How might this be discussed by the researcher? (Select all that apply.)

   1. The null hypothesis was accepted. There was no difference in compliance when paper charting was replaced with computer charting, in terms of the variables of

      tracheostomy care, periodic turning, and bed bath charting.

   2. Nurses do not chart consistently the tracheostomy care, periodic turning, and bed baths they deliver, regardless of charting system.

   3. The effect size was smaller than expected; a repeat power analysis revealed that the sample size of 120 was insufficient to demonstrate a significant difference.

   4. This study showed no significant difference between the two charting methods, in terms of compliance.

   5. Had the level of significance been set at 0.15, the findings would have reached statistical significance.

      ANS: A, C, D, E

      Unpredicted nonsignificant or inconclusive results are the most difficult to explain. These results are often referred to as negative results. The negative results could be a true reflection of reality. In this case, the reasoning of the researcher or the theory used by the researcher to develop the hypothesis is in error. If so, the negative findings are an important addition to the body of knowledge. With nonsignificant results, it is important to determine if adequate power of 0.8 or higher was achieved for the data analysis. Thus, the researcher needs to conduct a power analysis to determine if the sample size was adequate to prevent the risk of a type II error. A type II error means that in reality the findings are significant, but, because of weaknesses in the methodology, the significance was not detected. Negative results, in any case, do not mean that there are no relationships among the variables or differences between groups; they indicate that the study failed to find any.

      DIF: Cognitive Level: Application REF: Page 594

4. A nurse manager in a trauma intensive care unit conducts a quality improvement evaluation project. During this process, she discovers that patients with adult respiratory distress syndrome almost always have better outcomes when they are placed in the five beds located further away from the nursing station. Examining the data, she discovers that the room doors in these five rooms are consistently half-closed or three-quarters closed. In addition, nurses have been documenting that these patients sleep more than the other ten patients on the unit. What are the nurse’s options for generalizing the findings?

   1. There is no practical use for this research; no generalization is appropriate.

   2. Findings should be generalized immediately, and in print. These are important findings.

   3. The nurse can present the findings at conferences, but generalization is limited to the hospital in which the data were collected.

   4. The nurse manager can obtain permission from an institutional review board to conduct a formal research study, in order to formally test hypotheses, and then generalize the findings of this second study.

   5. Arrangements should be made immediately on the unit to keep all patients’ doors half-closed or three-quarters closed.

      ANS: C, D

      Methodological limitations limit the credibility of the findings and restrict the population to which the findings can be generalized. Methodological limitations result from factors such as nonrepresentative samples, weak designs, single setting, limited control over treatment (intervention) implementation, instruments with limited reliability and validity, limited control over data collection, and improper use of statistical analyses. Quality improvement research, by definition, is methodologically limited, because of its location-specific findings and lack of controls.

      DIF: Cognitive Level: Analysis REF: Page 594

5. If, after power analysis, a researcher’s interventional study findings are nonsignificant, what might this imply? (Select all that apply.)

   1. The effect size was smaller than originally expected.

   2. The effect size was larger than originally expected.

   3. The operational definition of the independent variable was faulty.

   4. The operational definition of the dependent variable was faulty.

   5. A type I error occurred.

   6. A type II error occurred.

   7. The intervention is not an effective one.

      ANS: A, C, D, F, G

      Negative results could be due to inappropriate methodology, a deviant sample, problems with internal validity, inadequate measurement, poor variable definition, the use of weak statistical techniques, or faulty analysis. Negative results, in any case, do not mean that there are no relationships among the variables or differences between groups; they indicate that the study failed to find any. The sample size was initially judged to have been adequate enough to prevent the risk of a type II error, based on initial calculations, but if the effect size was very small, a type II error might have occurred. The negative results could be a true reflection of reality. In this case, the reasoning of the researcher or the theory used by the researcher to develop the hypothesis is in error.

      DIF: Cognitive Level: Evaluation REF: Page 594

6. How are markedly negative results of a multi-site interventional nursing study with a huge sample and stringent level of significance helpful?

   1. They rule out the usefulness of the intervention for all clients.

   2. They provide evidence that may change clinical practice, if the intervention is currently being applied in practice to all health care clients.

   3. They contribute to the total body of nursing knowledge.

   4. They may indicate different directions for theoretical ideas.

   5. They establish the fact that the intervention is not universally effective with all clients.

   6. They allow only cautious generalization.

      ANS: B, C, D, E

      The negative results could be a true reflection of reality. In this case, the reasoning of the researcher or the theory used by the researcher to develop the hypothesis is in error. Since this was a huge multi-site interventional study, it establishes the fact that the intervention does not work with a sizable number of clients. This is useful to know.

      DIF: Cognitive Level: Application REF: Page 594

7. In interpreting the findings of a study, the researcher should do which of the following? (Select all that apply.)

   1. Discuss the findings, with respect to clinical implications.

   2. Boldly and fearlessly identify the limitations of the study.

   3. Make cautious and well-founded conclusions, based on the findings.

   4. Based on the existing literature, plus this study, recommend further research.

   5. Make excuses for limitations.

   6. Relate findings back to the purpose and framework of the study.

   7. Generalize broadly.

      ANS: A, B, C, D, F

      Interpretation includes several intellectual activities, such as examining evidence, forming conclusions, identifying study limitations, generalizing the findings, considering implications, and suggesting further research. Generalizations should be specific to the population from which the sample was drawn, and should be based on the total contribution of research, to date. Excuses should not be made.

      DIF: Cognitive Level: Analysis REF: Page 600

8. A researcher has just completed a study demonstrating the effectiveness of three daily servings of freshly pressed tomato juice for prevention of cancers of the gastrointestinal tract. The results were statistically significant at the p <.01 level. During interpretation, which of the following will the researcher employ? (Select all that apply.)

   1. Examination of the results, in comparison with similar literature about fresh tomatoes and cancer, to decide whether the sum of all knowledge constitutes sufficient evidence for widespread generalization

   2. Exploration of the clinical significance of the findings, as opposed to the statistical significance

   3. Initiation of discussions with manufacturers of juice machines, so as to take advantage of the anticipated increase in sales

   4. Formation of some sort of conclusions, relative to the study findings and related literature

   5. Promulgation of the results to the popular media, so that as many people as possible in the world can advantage themselves of the intervention

   6. Recommendations for further studies on fresh tomato juice and its apparent effects on health

   7. Consideration of implications related to nursing’s body of knowledge

      ANS: A, B, D, F, G

      The process of interpreting research outcomes for quantitative, outcomes, and intervention studies includes the following: (1) examining study evidence, (2) determining findings, (3) forming conclusions, (4) identifying limitations, (5) generalizing the findings, (6) considering implications for practice, and (7) suggesting further studies.

      DIF: Cognitive Level: Application REF: Page 590

9. The United States census is an example of a huge descriptive research project that uses the entire population as the sample. What are some of the limitations of generalizing census findings back to the entire population? (Select all that apply.)

   1. Although all homes must fill out a census report, the homeless population often

      cannot be accessed, surveyed, and counted, so the homeless population is underrepresented in the findings.

   2. Persons whose primary language is something other than English or Spanish, and who do not speak either language, are more likely to be missed in the census.

   3. The survey method of data collection relies on self-report; some misrepresentation or error is inevitable.

   4. The population changes continuously, and the one described in the census isn’t very much like the population on the day the results are published.

   5. Persons in the United States who are no longer here legally but plan to stay do not fill out a report.

      ANS: A, B, C, E

      Limitations are restrictions or problems in a study that may decrease the generalizability of the findings. All studies have limitations, and these might be theoretical and/or methodological in nature. Theoretical limitations are weaknesses in a study framework and conceptual and operational definitions of variables that restrict the abstract generalization of the findings.

      Methodological limitations are factors in the study design that can limit the credibility of the findings and restrict the population to which the findings can be generalized.

      DIF: Cognitive Level: Analysis REF: Page 598

10. Choose which of the following limitations are methodological, in a study of home UV treatment of depressive illnesses. (Select all that apply.)

    1. A study performed in Afghanistan is published only in a British journal.

    2. The operational definitions are not in line with the conceptual definitions.

    3. The study framework is related to the social costs of depressive illness.

    4. The subjects excluded from participation in a study of depressive illness and UV home treatment were those who had been hospitalized in the past for depression.

    5. A multi-site study examining UV home treatment and depressive illness is conducted only in major west coast urban centers.

ANS: A, B, D, E

Limitations are restrictions or problems in a study that may decrease the generalizability of the findings. All studies have limitations, and these might be theoretical and/or methodological in nature. Theoretical limitations are weaknesses in a study framework and conceptual and operational definitions of variables that restrict the abstract generalization of the findings.

Methodological limitations are factors in the study design that can limit the credibility of the findings and restrict the population to which the findings can be generalized. Studies can be generalized to the population from which the sample was drawn; a sample drawn from one geographic area can, in general, be generalized back only to that area. The findings from a study conducted in Afghanistan (and published in English in a British journal) can be generalized back to Afghanistan. Studies conducted in one language and published in another may be flawed in other ways.

DIF: Cognitive Level: Analysis REF: Page 598

Chapter 27: Disseminating Research Findings Test Bank

MULTIPLE CHOICE

1. A master’s student states, in her thesis, that “despite public awareness programs to educate the public about the safety of pediatric immunizations, a staunch core of highly educated and

   well-informed parents continues to attribute the rise in childhood autism to vaccination. Because of this, recent efforts have been brought to bear in the qualitative arena, attempting to identify and isolate factoids and half-truths that perpetuate the myth. Nonetheless, mostly because belief structures appear bound by geography, not enough is known about reasons that some clusters of parents postpone or avoid vaccination.” The quotation is an example of a

   and appears in the section of the research report.

   1. Objective, methods

   2. Purpose statement, introduction

   3. Problem statement, introduction

   4. Literature review, results

      ANS: C

      The problem statement identifies the specific gap in the knowledge needed for practice. The introduction of a research report discusses the background and significance of the problem; identifies the problem statement and purpose, reviews the relevant empirical and theoretical literature, describes the study framework, and identifies the research purpose (aims, objectives, questions, or hypotheses if applicable).

      DIF: Cognitive Level: Application REF: Page 604

2. Prior to conducting a grounded theory study, in which eleven women undergoing radiation for breast cancer were interviewed multiple times, the researchers conducted a pilot study in which they interviewed three women every two weeks from the time radiation was planned until four weeks after it was completed. The purpose for the pilot study was to refine the interview instrument and to discover whether women would be willing to be interviewed this frequently about such a private topic. The pilot was not published separately, and the researcher wants to include information about revisions in the instrument during the pilot phase. Where would this be included in the research report?

   1. Introduction

   2. Methods

   3. Results

   4. Appendix

      ANS: B

      If the research project included a pilot study, in the methods section the researcher will briefly describe the planning, implementation, and results obtained from the pilot study. Any changes made in the research project based on the pilot study are mentioned here.

      DIF: Cognitive Level: Application REF: Page 605

3. Prior to conducting a grounded theory, in which eleven women undergoing radiation for breast cancer were interviewed multiple times, the researchers conducted a pilot study in which they interviewed three women every two weeks from the time radiation was planned until four weeks after it was completed. The purpose for the pilot study was to refine the interview instrument and to discover whether women would be willing to be interviewed this frequently about such a private topic. The pilot was not published separately, and the institutional review board application indicated the researcher’s intent to include information in the research report about what going through the process of radiation therapy was like for the three pilot study women, in addition to the eleven main study women. In this case, if it were not included in the method section, where would the information about the process of going through radiation therapy obtained from the pilot study women be included?

   1. Introduction

   2. Results

   3. Discussion

   4. Appendix

      ANS: B

      If the research project included a pilot study, in the methods section the researcher will briefly describe the planning, implementation, and results obtained from the pilot study. Any changes made in the research project based on the pilot study are mentioned here. However, data analysis in qualitative research occurs concurrently with data collection. In addition, analysis of an interview’s data may result in additional questions being asked in subsequent interviews to confirm or not confirm initial interpretations of the data. Because of this, information related to the phenomenon and obtained in the pilot phase may be included in the results section.

      DIF: Cognitive Level: Application REF: Page 605

4. “All subjects were asked whether they would be willing to participate in this descriptive study, while they waited to be seen by a gastroenterologist, prior to their initial colonoscopies. They were given basic information about the research and told that participation was strictly voluntary, according to guidelines from the institutional review board (IRB) for the clinics and hospital. The research had been approved as minimal risk by the IRB. All thirty-one subjects asked to participate agreed to do so.” During the write-up of the study, the researcher should include this information about this process in which of the following sections?

   1. Abstract

   2. Introduction

   3. Methods

   4. Appendix

      ANS: C

      The data collection process was clear and concise; IRB approval was indicated; subjects’ informed consent was described; use of trained data collectors was addressed; and timing and setting was discussed.

      DIF: Cognitive Level: Application REF: Page 607

5. “Lazarus’s coping paradigm suggests that it is the appraisal of a stressor as potentially harmful that begins the avoidance cascade. Thomason further characterized adaptations to management of chemotherapy symptomatology as mere reflections of a primary appraisal of potential harm, providing a set point for intensity of reactions. We used these conceptual connections to formulate testable assumptions for this study.” Where in the research report would this quotation be located?

   1. Introduction

   2. Methods

   3. Results

   4. Discussion

      ANS: A

      The introduction of a research report discusses the background and significance of the problem, identifies the problem statement and purpose, reviews the relevant empirical and theoretical literature, describes the study framework, and identifies the research purpose (aims, objectives, questions, or hypotheses if applicable).

      DIF: Cognitive Level: Application REF: Page 604

6. “Thomason’s set-point theorizations explain, in part, why patients in chemotherapy who reported high levels of apprehension and anxiety prior to initiation invariably reported more severe average symptomatology levels. In addition, their symptoms were ameliorated less completely by standard therapeutic interventions, such as antiemetics and soporifics.” Where in the research report would this quotation be located?

   1. Introduction

   2. Methods

   3. Results

   4. Discussion

      ANS: D

      In the discussion section, the researcher’s major findings, which are generated through an interpretation of the results, should be discussed in relation to the overriding conceptual framework as well as the research problem, purpose, and questions, or hypotheses.

      DIF: Cognitive Level: Application REF: Page 630

7. What part of the research report names the study design?

   1. Introduction

   2. Methods

   3. Results

   4. Discussion

      ANS: B

      In the methods section the researcher describes the study design, sample, setting, methods of measurement, data collection process, and plan for data analysis.

      DIF: Cognitive Level: Comprehension REF: Page 605

8. The results of an applied research study for anxiety management in children were published in both a highly respected nursing research journal and a second journal specific to pediatrics that focused on practice issues. The first article contained detailed statistical analyses and discussions of the results, as an extension of the author’s previous basic research. The second presented the research in much simpler language, providing pictures of the children and discussing practice applications. Why does this represent or not represent duplicate publication?

   1. It does represent duplicate publication, because both articles reported results of the same study.

   2. It does not represent duplicate publication, because the language was completely different in the two articles, and the journal audience was different.

   3. It does represent duplicate publication, because the second article was a paraphrase of the first.

   4. It does not represent duplicate publication, because the second article referenced the first and focused heavily on practice applications, which were not included in the first.

      ANS: D

      Duplicate publication is the practice of publishing the same article or major portions of the article in two or more print or electronic media without notifying the editors or referencing the other publication in the reference list.

      DIF: Cognitive Level: Analysis REF: Page 632

9. In the results section of a thesis measuring the effectiveness on a geriatric ward of using a procedure room for all painful procedures including IV starts, a master’s student lists the four principal study findings, one by one, following each with an explanation of how each finding contributes to nursing knowledge. The major thesis advisor directs the student to fix this in the second draft of the thesis. Why does the thesis advisor require this?

   1. This entire segment of the thesis should appear in the discussion section. The results section contains all of the study findings, with detailed statistics on each.

   2. A thesis should not explain how its findings contribute to nursing knowledge.

   3. This is applied research. Its findings should apply only to practice.

   4. Findings appear in the results section, which includes only facts and nothing else. The explanation part of the above must be placed in the discussion section.

ANS: A

The discussion section includes conclusions, study limitations, implications for nursing, and recommendations for further research. Implications of the findings for nursing practice and theory development are explored, and suggestions are provided for further research.

DIF: Cognitive Level: Application REF: Page 618

MULTIPLE RESPONSE

1. In which parts of the research report could the reader find the one most important result of the study? (Select all that apply.)

   1. Abstract

   2. Introduction

   3. Methods

   4. Table 1

   5. Results

   6. Discussion

   7. References

   8. Appendix

      ANS: A, E, F

      An abstract is usually about 200 to 300 words and describes the problem, purpose, framework, methods, sample size, key results, and conclusions. The results section reveals what was learned from the study and includes the results generated from the study’s statistical analyses. The discussion section includes the study’s major findings, limitations, conclusions, implications, and recommendations for further research.

      DIF: Cognitive Level: Synthesis REF: Page 603

2. There was a research gap before the study was performed. The research filled the research gap. In what part of the research report would the research gap be identified? In what part of the research report would the researcher’s way of filling the research gap be reported? (Select all that apply.)

   1. Abstract ... References

   2. Abstract ... Abstract

   3. Introduction ... Discussion

   4. Introduction ... Methods

   5. Abstract ... Methods

   6. Methods ... Methods

   7. Results ... Discussion

   8. Introduction ... Discussion

      ANS: D, E

      An abstract is usually about 200 to 300 words and describes the problem, purpose, framework, methods, sample size, key results, and conclusions. In describing the problem and purpose, it strongly implies the gap. The introduction of a research report discusses the background and significance of the problem, identifies the problem statement and purpose, reviews the relevant empirical and theoretical literature, describes the study framework, and identifies the research purpose. The summary of the literature review clearly identifies what is known, what is not known or the gap in knowledge, and the contribution of this study to the current knowledge base. The methods section of a research report describes how the study was conducted.

      DIF: Cognitive Level: Synthesis REF: Page 605

3. What part of the research report may provide potential applications of the findings in practice? (Select all that apply.)

   1. Abstract

   2. Introduction

   3. Methods

   4. Results

   5. Discussion

      ANS: A, E

      An abstract is usually about 200 to 300 words and describes the problem, purpose, framework, methods, sample size, key results, and conclusions. Conclusions can include potential applications for practice. The discussion section ties the other sections of the research report together, and includes major findings, limitations of the study, conclusions drawn from the findings, implications of the findings for nursing, and recommendations for further research.

      DIF: Cognitive Level: Synthesis REF: Page 603

4. A master’s thesis uses Husserlian phenomenology as its method. In the research report, the student has mentioned the method by name and has adhered to all of the tenets of that method. The thesis advisor requires the student to include in the thesis a two- to five-page summary of the philosophy of Husserlian phenomenology. Why does the thesis advisor require this? (Select all that apply.)

   1. The thesis advisor is not familiar with the method and cannot evaluate the thesis without this information.

   2. It is important that the thesis makes clear what Husserlian phenomenology implies, relative to the researcher’s part in data collection and data analysis.

   3. Several assumptions of the thesis may emanate from Husserlian phenomenology, and they should be consistent with its philosophy.

   4. The reader of the thesis, and publications emanating from it, may not be clear as to what Husserlian phenomenology is. An explanation is in order.

   5. The reader can follow the analysis better when the method is better understood.

   6. The philosophy that underlies qualitative research is, in essence, the study’s theoretical framework. A framework should include a summary of its main points.

      ANS: B, C, D, E, F

      The philosophical perspective of the researcher guides the questions asked and the methods selected for conducting a specific study. Both quantitative and qualitative researchers have philosophical perspectives. Qualitative studies are based on a wide range of philosophies, such as phenomenology, symbolic interactionism, constructivism, and hermeneutics, each of which espouses slightly different approaches to gaining new knowledge. Most qualitative researchers do not identify specific theoretical frameworks during the design of their studies, as is expected for quantitative studies. Instead, the philosophical basis provides “theoretical grounding” for qualitative studies without predisposing the data analysis to a single interpretation—this is another way to say that the philosophy is the study’s theoretical framework. As such, it deserves a few pages of exposition, to aid the reader’s understanding.

      DIF: Cognitive Level: Synthesis REF: Page 616

5. A researcher presents the results of a recent research project at several conferences. Duplicate publications are not acceptable and represent self-plagiarism, but duplicate presentations seem valued. Which of the following facts explains this? (Select all that apply.)

   1. Duplicate conference presentations are valued only when they occur in widely separated geographic areas.

   2. Questions and comments from conference audiences can contribute to the researcher’s ongoing analysis and inspire new analyses of data.

   3. If similar research by the same author is ongoing, each conference presentation can include new insights and interpretations, reflecting work in progress.

   4. Reaching a broad audience necessitates presentation at several conferences.

   5. Self-plagiarism is a term that refers to the printed word, not to conference

      presentations.

   6. If a researcher submits a different abstract to each conference that publishes printed conference abstracts, there is no self-plagiarism.

      ANS: B, C, D, E, F

      Duplicate publication is the practice of publishing the same article or major portions of the article in two or more print or electronic media without notifying the editors or referencing the other publication in the reference list. Duplicate publication does not refer to oral presentations. However, if portions of an article have been presented at a scientific meeting in the form of an oral podium or poster presentation, this should be acknowledged along with funding sources and any potential conflict of interest.

      DIF: Cognitive Level: Analysis REF: Page 632

6. Which of the following are considered poor scholarly writing and, consequently, should not appear in a published research report? (Select all that apply.)

   1. “Subjects who could not decide whether to select A, B, or C as item options were instructed to leave the item blank.”

   2. “Regardless of amount of the independent variable of electricity that was applied, dependent variable changes were negligible thus indicating lack of causation.”

   3. “Any subject desiring to retract their permission for the study had his or her name removed from the master list.”

   4. “Erstwhile subjects had little insight into the retained fragments of their sublimated ignoscency.”

      ANS: B, C, D

      A quality research report has no errors in punctuation, spelling, or sentence structure. It is also important to avoid confusing words, clichés, jargon, and excessive wordiness and abbreviations. Word processing programs have “tools” commands that have the capacity to proofread manuscripts for errors.

      DIF: Cognitive Level: Synthesis REF: Page 629

7. Which of the following additional items are considered poor scholarly writing and, consequently, should not appear in a published research report? (Select all that apply.)

   1. “Subjects A and B completed the trial in half the time taken by other subjects, without caffeine enhancement. Hah!”

   2. “Subject attrition was nil. Not one person dropped out of the study, even in progress. Except the ones we kicked out, of course.”

   3. “Subject’s responses were markedly different across groups.”

   4. “The intervention group was expected to document symptoms at least daily, using a journal. Twice-daily documentation was encouraged.”

   5. “Instruments were calibrated, both before, and after, use: they were cleaned, as well; using soap and water.”

      ANS: A, B, C, E

      A quality research report has no errors in punctuation, spelling, or sentence structure. It is also important to avoid confusing words, clichés, jargon, and excessive wordiness and abbreviations. Word processing programs have “tools” commands that have the capacity to proofread manuscripts for errors.

      DIF: Cognitive Level: Synthesis REF: Page 629

8. Which of the following represent poor scholarly writing and, consequently, should not appear as they are written in a journal article? (Select all that apply.)

   1. “Regretfully nobody in the control group survived past three years this is because of the continued effects of the disease process itself if untreated it is fatal.”

   2. “Results of the study indicated that causation was directional in the A, B, F, and K groups however none were identified as impacting the final outcome.”

   3. “We as experienced researchers cannot explain why the intervention failed in not one, but three consecutive mini-trails, numbers 5, 6, and 7, becoming suddenly effective in the subsequent twenty-three mini-trials. We checked and rechecked instrument calibrations, controlled diligently for intra-rater reliability, recomputed coefficients of change, trended all data, reentered data manually, examined the effect of sixteen potentially extraneous variables, and ultimately ended as baffled as we started.”

   4. “The result’s were a complete surprise. 44% of the control subject’s experienced spontaneous remission’s.”

   5. “Attrition continued over the course of the experiment, with additive attrition of 2% in the first quarter, 5% in the second quarter, 16% in the third quarter, and 25% in the fourth. In the second year, attrition claimed another half of the sample. Data collection was suspended after the eighth quarter, since the results had limited applicability, due to extensive attrition.”

   6. “An inadequate sample threatened to end the study. Inclusion criteria were broadened, to include those who had participated in clinical research, in the past, but there were no takers.”

   7. “There was no way of determining who’s answers had been positive on the pre- test, until the post-test was completed.”

      ANS: A, B, C, D, F, G

      A quality research report has no errors in punctuation, spelling, or sentence structure. It is also important to avoid confusing words, clichés, jargon, and excessive wordiness and abbreviations. Word processing programs have “tools” commands that have the capacity to proofread manuscripts for errors.

      DIF: Cognitive Level: Synthesis REF: Page 629

9. There are several steps in the process of converting a master’s thesis into a publishable article: selecting a journal, writing a query letter, preparing an original manuscript, submitting the manuscript for review, and performing the revisions the editor indicates. Why should preparation of the manuscript not occur first? (Select all that apply.)

   1. It would be foolish to write a manuscript without knowing the maximum length of manuscript that a journal accepts.

   2. If the response to several query letters is negative, it is best to abandon attempts to get the information into print.

   3. Various journals use different formatting. Waiting until editor interest is expressed saves unneeded reformatting.

   4. Some journals limit the number of items in the reference list. It is best to know this before editing the thesis down to the length of an article.

   5. Every contact with an editor results in at least a request for revisions. An initial manuscript cannot be prepared without editor input.

      ANS: A, C, D

      Developing a manuscript for publication includes the following steps: (1) selecting a journal,

      (2) developing a query letter, (3) preparing a manuscript, (4) submitting the manuscript for review, and (5) revising the manuscript. A query letter should be no more than one page and usually includes the abstract as well as the researcher’s qualifications for writing the article. If the response to the query letter is possible, then a manuscript should be prepared, according to the formatting and specifications of that publication. A negative response to a query letter merely implies that the journal is not interested in the topic of the submitted abstract.

      DIF: Cognitive Level: Comprehension REF: Page 628

10. What should an abstract for quantitative research contain? (Select all that apply.)

    1. The name of the research method used

    2. A brief statement of the problem

    3. The research purpose

    4. The population or sample

    5. The major study findings

    6. Conclusions

    7. The research hypothesis

    8. The research question

       ANS: A, B, C, D, E, F

       Most research reports include an abstract that summarizes of the key aspects of the study. An abstract is a terse summary, often between 200 and 300 words, that describes the problem, purpose, framework, methods, sample size, key results, and conclusions.

       DIF: Cognitive Level: Application REF: Page 603

11. What else should an abstract for quantitative research contain? (Select all that apply.)

    1. The research question

    2. Operationalized variables

    3. The research hypothesis

    4. The major study findings

    5. Conclusions

    6. References

       ANS: D, E

       Most research reports include an abstract that summarizes of the key aspects of the study. An abstract is a terse summary, often between 200 and 300 words, that describes the problem, purpose, framework, methods, sample size, key results, and conclusions.

       DIF: Cognitive Level: Application REF: Page 603

12. What are the proper components of a query letter? (Select all that apply.)

    1. Suggestions for further research

    2. A description of the research problem

    3. The sample demographics

    4. Discussion of one or more of the major findings

    5. Academic or professional titles held by the letter writer

    6. Details of the study methodology

    7. The meaning of the study findings

       ANS: B, D, E, G

       A query letter is developed to determine an editor’s interest in reviewing a manuscript for publication. A query letter should be no more than one page and usually includes the abstract, as well as the researcher’s qualifications for writing the article.

       DIF: Cognitive Level: Comprehension REF: Page 628

13. A researcher who has just submitted a trimmed-down version of her doctoral dissertation to a journal editor receives the following. What type of letter is it? (Select all that apply.)

    Dear Ms. Smith:

    We have received your manuscript and are returning it to you. Our journal’s focus is exclusively quantitative research, and your manuscript uses a mixed methodology. Despite notable strengths of the quantitative portion, which contains cutting-edge information about medication errors and their correlates, our peer reviewers feel that you might be better served in seeking a venue that allowed both aspects of the study to be presented. The Nursing Journal of Mixed Methodologies springs to mind.

    Nonetheless, if you should wish to resubmit only the quantitative portion, essentially as it stands, we should be quite interested in returning it to the peer reviewers.

    Please see the one accompanying suggestion for table insertion.

    1. An outright rejection

    2. An acceptance

    3. An acceptance with minor revisions

    4. A rejection of the manuscript as currently written

    5. A suggestion for an alternative avenue of publication

    6. A compliment

       ANS: C, D, E, F

       After reviewing a manuscript, the journal editor will reach one of four possible decisions: (1) acceptance of the manuscript as submitted, (2) acceptance of the manuscript pending minor revisions, (3) tentative acceptance of the manuscript pending major revisions, or (4) rejection of the manuscript. Accepting a manuscript as submitted is extremely rare. At the end of the revision process, the editor will send the author a letter that indicates final acceptance and the likely date of publication.

       DIF: Cognitive Level: Analysis REF: Page 630

14. What are the advantages of presenting a poster session, displayed for two hours a day for three days at a well-attended conference, instead of a 15-minute verbal presentation with a 5-minute question period, at a breakout session? (Select all that apply.)

    1. For authors who suffer presentation anxiety, a poster presentation can be much less stressful, since it provides many small conversations instead of a large lecture.

    2. A poster session allows the researcher to display more information than a verbal presenter can.

    3. A poster presentation provides the opportunity for one-to-one interaction with the viewers.

    4. The poster presentation may reach more people than does the verbal presentation.

    5. A verbal presentation requires more time to develop than does a poster.

       ANS: A, C, D

       Research findings are communicated at conferences and meetings through verbal and poster presentations. With presentations, researchers have an opportunity to share their preliminary findings, answer questions about their studies, interact with other interested researchers, and receive immediate feedback on their study. A 15-minute verbal presentation would consist of a 15-slide show (PowerPoint or otherwise). A poster session is a visual presentation of your study, all on one surface, with either three or four columns. Posters usually take from 10 to 20 hours to develop based on the complexity of the study and the experience of the researcher.

       Novice researchers usually need more than 20 hours to develop a poster. One major advantage of a poster session is the opportunity for one-to-one interaction between the researcher and the viewer. At the end of the poster session, individuals interested in a study will frequently stay to speak to the researcher. A quality poster is easily comprehended in 5 minutes or less.

       DIF: Cognitive Level: Analysis REF: Page 630

15. A journal states on its editorial page, “A query letter is required before article submission to this refereed journal. If a manuscript is requested, both hard copy and an electronic copy will be required. After initial acknowledgement of receipt, authors will receive a response from the editor within four months.” What does this statement mean? (Select all that apply.)

    1. Within four months, the author will be notified whether the article is accepted.

    2. The author will be notified immediately of the manuscript’s acceptance.

    3. Only the editor reviews manuscripts.

    4. The journal uses peer review.

    5. If authors send a manuscript without an initial query, it will be returned.

    6. If authors send a query letter, they will be requested to send a manuscript.

    7. If a manuscript is accepted, it will be published within four months.

    8. No manuscripts are ever accepted.

       ANS: A, D, E

       A query letter is developed to determine an editor’s interest in reviewing a manuscript for publication. A query letter should be no more than one page and usually includes the abstract as well as the researcher’s qualifications for writing the article. Journals that require a query letter will not accept manuscripts without that initial query. A refereed journal is peer- reviewed and uses referees or expert reviewers to determine whether a manuscript is acceptable for publication. Most refereed journals require manuscripts to be reviewed anonymously, or blinded, by two or three reviewers. Most academic institutions support the refereed system and may only recognize publications that appear in peer reviewed journals for faculty seeking tenure and promotion.

       DIF: Cognitive Level: Comprehension REF: Page 629

16. A master’s student has just completed a thesis. Which of the following are considered dissemination of the results? (Select all that apply.)

1. Interactions with the thesis committee—through reading the thesis, they have been informed of the results

2. Presentation of a poster session at a professional conference

3. Presentation of an oral (podium) presentation at a professional conference

4. Presentation of a guest lecture about the thesis results at a university

5. Having an article about the research results published by a journal

6. Having an article about the research results published by a popular magazine

ANS: B, C, D, E, F

Communicating research findings, the final step in the research process, after completion of the thesis, involves developing a research report and disseminating it through presentations and publications to audiences of nurses, health care professionals, policy makers, and health care consumers.

DIF: Cognitive Level: Analysis REF: Page 632

Chapter 29: Seeking Funding for Research Test Bank

MULTIPLE CHOICE

1. What do the Association of Women’s Health, Obstetric, and Neonatal Nurses, National Gerontological Nursing Association, and Emergency Nurses Association have in common, relative to funded research?

   1. All three were established based on funded research.

   2. All provide proofreaders, free of charge, who will assist with grant writing.

   3. All three fund research.

   4. All three provide research guidance and funding through Sigma Theta Tau.

      ANS: C

      Many of the specialty practice nursing organizations provide support for studies relevant to their specialty, including nurse practitioner groups. These organizations often provide guidance to budding new researchers who need assistance in beginning the process of planning and seeking funding for research. To determine the resources provided by a particular nursing organization, search their website or contact the organization by e-mail, letter, or phone. Three of these are the Association of Women’s Health, Obstetric, and Neonatal Nurses; National Gerontological Nursing Association; and Emergency Nurses Association.

      DIF: Cognitive Level: Analysis REF: Page 668

2. A researcher receives a rejection letter concerning a proposal submitted for major funding. What should now be done?

   1. The researcher should not apply for another grant for at least a year.

   2. The comments in the letter should be reviewed, so as to rewrite the proposal for the next review cycle.

   3. A formal protest should be filed.

   4. The contact person for the grant should be reached by e-mail as soon as possible.

      ANS: B

      The researcher’s reaction to a rejected proposal is usually anger and then depression. The frustrated researcher may abandon the proposal, stuff it in a bottom drawer somewhere, and forget it. There seems to be no way to avoid the anger and depression after a rejection because of the significant emotion and time invested in writing the proposal. However, after a few weeks it is advisable to examine the rejection letter again. The comments can be useful in rewriting the proposal for resubmission. The learning experience of rewriting the proposal and evaluating the comments will provide a background for seeking funding for another study.

      A skilled grant writer will have approximately one proposal funded for every five submitted. The average is far less than this.

      DIF: Cognitive Level: Comprehension REF: Page 671

3. What is the percentage rejection rate for new grant writers?

   1. Less than 20%

   2. Approximately 50%

   3. 80%

   4. Greater than 80%

ANS: D

A skilled grant writer will have approximately one proposal funded for every five submitted. The average is far less than this.

DIF: Cognitive Level: Analysis REF: Page 671

MULTIPLE RESPONSE

1. Why is seeking research funding important? (Select all that apply.)

   1. Funding implies both scientific and social merit.

   2. Funding allows the researcher to hire assistants who attend to the tasks of research, leaving the researcher free for design of more and better projects.

   3. The academic reputation of the researcher increases as grant funding increases.

   4. Research cannot be conducted unless formal funding is obtained.

   5. Well-designed studies can be expensive, especially those with complex designs.

   6. A funded study is much more likely to be published.

      ANS: A, B, C, E

      Seeking funding for research is important, both for the researcher and for the profession. Well- designed studies can be expensive. As the rigor and complexity of the study design increase, the cost tends to increase. By obtaining funding, the researcher can conduct a complex, well- designed study. Funding indicates that others have reviewed the study and recognize its scientific and social merit. In fact, the scientific credibility of the profession is related to the quality of studies conducted by its researchers. Thus, scientific credibility and funding for research are interrelated. The profession of nursing has invested a great deal of energy in increasing the sources of funding and amount of money available for nursing research. Each award of funding enhances the status of the researcher and increases the possibilities of greater funding for later studies. In addition, funding provides practical advantages. For example, funding may reimburse part or all of the researcher’s salary and release the researcher from other responsibilities, allowing the researcher to devote time to conducting the study. Funding provides the researcher with the resources to hire research assistants and study coordinators to facilitate data collection and enhance your productivity.

      DIF: Cognitive Level: Analysis REF: Page 663

2. What are the advantages of a research apprenticeship? (Select all that apply.)

   1. Entry into a functional research team

   2. Extremely good wages

   3. Experience gained in grant writing

   4. A chance to read proposals that have been funded

   5. The opportunity to learn research and grantsmanship

   6. A chance to read proposals that have not been funded

   7. A guaranteed job after the apprenticeship ends

      ANS: A, C, D, E, F

      Volunteering to assist with the activities of another researcher is an excellent way to learn research and grantsmanship. Graduate students can gain this experience by becoming graduate research assistants. Through an apprenticeship, one may gain experience in writing grants and reading proposals that have been funded. Examining proposals that have been rejected can be useful if the comments of the review committee are available. The criticisms of the review committee point out the weaknesses of the study and clarify the reasons why the proposal was rejected. Examining these comments on the proposal can increase one’s insight as a new grant writer and prepare a novice for similar experiences. However, some researchers are sensitive about these criticisms and may be reluctant to share them. If an experienced researcher is willing, it is enlightening to hear his or her perceptions and opinions about the criticisms.

      Ideally, by working closely with an experienced researcher, one has the opportunity to demonstrate one’s commitment and the researcher may ultimately invite the novice to become a permanent member of a research team.

      DIF: Cognitive Level: Synthesis REF: Page 666

3. Why is serving on a research committee or institutional review board useful for the person interested in gaining research funding? (Select all that apply.)

   1. People who serve on research committees are given priority funding approval.

   2. Seeing the mistakes others make creates an awareness of common errors.

   3. Contacts with researchers can be made.

   4. When one’s own proposals are reviewed, the committee will feel more inclined to approve them.

   5. Reading a clear, organized proposal provides a template.

      ANS: B, C, E

      Research committees and institutional review boards exist in many health care and professional organizations. Through membership on these committees, contacts with researchers can be made. Also, many research committees are involved in reviewing proposals for the funding of small grants or granting approval to collect data in an institution. Often reading proposals for approval for human subjects’ research or for funding can give the novice researcher insight into the importance of clarity and organization in the research proposal.

      Reviewing proposals and making decisions about funding help researchers become better able to critique and revise their own proposals before submitting them for review.

      DIF: Cognitive Level: Synthesis REF: Page 667

4. What is the difference between a nursing project grant proposal and a nursing research grant? (Select all that apply.)

   1. A research grant is awarded for a promising planned study.

   2. Research grants and project grants are identical.

   3. A project grant’s program can be academic or clinical.

   4. A research grant is awarded for outstanding past research.

   5. A project grant is awarded to support a novel program.

      ANS: A, C, E

      Two main types of grants are sought in nursing: project grants and research grants. Project grant proposals are written to obtain funding for the development of new educational programs in nursing, such as a program designed to teach nurses to provide a new type of nursing care or a project to support nursing students seeking advanced degrees. These grants may fund a project manager to achieve the goals of the grant. Although these programs may involve evaluation, they seldom involve research. For example, the effectiveness of a new approach to patient care may be evaluated, but the findings can seldom be generalized beyond the unit or institution in which the patient care was provided. The emphasis is on implementing the project, not on conducting research. Research grants provide funding to conduct a study. Although the two types of grant proposals have similarities, they have important differences in writing techniques and flow of ideas, as well as content.

      DIF: Cognitive Level: Synthesis REF: Page 667

5. Many hospitals and universities have access to both SPIN and The Foundation Directory. Why are these useful for a researcher? (Select all that apply.)

   1. They provide leads for thousands of grant opportunities.

   2. They provide information only for small grants of less than $5,000 each.

   3. They provide information on federal agencies, private foundations, and corporate foundations.

   4. They are computerized information resources.

   5. They provide funding information; all fees are then used to support future grants.

      ANS: A, C, D

      A computerized information system, the Sponsored Programs Information Network (SPIN), can assist researchers in locating the most appropriate funding sources to support their research interests. The database contains approximately 2,000 programs that provide information on federal agencies, private foundations, and corporate foundations. Many universities and research institutions have access to SPIN. Other databases include private funding as well.

      DIF: Cognitive Level: Analysis REF: Page 669

6. A new researcher obtains a large grant and proceeds to hire nine assistants, as the grant specifies. The new researcher hires a statistician, three persons to collect data, one person to schedule and coordinate the activities of the persons collecting data, one person to help with qualitative data analysis, one person to begin writing for the grant renewal, one person to write the interim report, and one person to manage the grant budget, writing weekly checks to the research assistants based on their submitted timecards. Which of these activities is appropriate for a hired assistant? (Select all that apply.)

   1. Advising the research team about appropriate statistical tests

   2. Recalculating the study power after data collection on the first thirty subjects, to be sure of the effect size

   3. Performing initial qualitative coding of raw data

   4. Writing the first draft of a renewal grant

   5. Writing the interim report for the institutional review board

   6. Managing the grant budget

   7. Writing weekly checks to the research assistants

      ANS: A, B, C, G

      Although the supporting institution is ultimately responsible for dispensing and controlling grant monies, the primary investigator (PI) is responsible for keeping track of budget expenditures and making decisions about how the money is to be spent. If funding is through a federal agency, the PI will be required to provide interim reports as well as updates on the progress of the study. The PI interviews, hires, trains, and oversees grant personnel. During a large study with several investigators and other grant personnel, the PI coordinates activities, often through formal meetings of all grant workers at intervals to share ideas and solve problems. Federal grants require the PI to submit interim reports according to preset deadlines. The PI often writes the renewal grant as soon as the first grant has been made, so that continuous research activity can be accomplished. In theory, the PI could be planning one study, collecting data on a second study, analyzing data on a third study, and writing papers for publication on a fourth study. A full-time researcher could have completed one funded study, be in the last year of funding for a second study, be in the first year of funding for a third study, and be seeking funding for a fourth study.

      DIF: Cognitive Level: Application REF: Page 671

7. What are two national nursing organizations that provide small grants not linked to a nursing specialty area? (Select the two that apply.)

   1. The Society for Pediatric Nurses

   2. American Nurses’ Foundation

   3. The Board of Registered Nursing

   4. The American Cancer Society

   5. Sigma Theta Tau, International

   6. The National Association of Hospitals and Clinics

ANS: B, E

Two national nursing organizations that provide small grants not linked to a specialty are the American Nurses’ Foundation and Sigma Theta Tau, International. These grants are usually for less than $7,500 each year, are very competitive, and are awarded to new investigators with promising ideas. Receiving funding from these organizations is held in high regard.

DIF: Cognitive Level: Analysis REF: Page 668

Chapter 29: Seeking Funding for Research Test Bank

MULTIPLE CHOICE

1. What do the Association of Women’s Health, Obstetric, and Neonatal Nurses, National Gerontological Nursing Association, and Emergency Nurses Association have in common, relative to funded research?

   1. All three were established based on funded research.

   2. All provide proofreaders, free of charge, who will assist with grant writing.

   3. All three fund research.

   4. All three provide research guidance and funding through Sigma Theta Tau.

      ANS: C

      Many of the specialty practice nursing organizations provide support for studies relevant to their specialty, including nurse practitioner groups. These organizations often provide guidance to budding new researchers who need assistance in beginning the process of planning and seeking funding for research. To determine the resources provided by a particular nursing organization, search their website or contact the organization by e-mail, letter, or phone. Three of these are the Association of Women’s Health, Obstetric, and Neonatal Nurses; National Gerontological Nursing Association; and Emergency Nurses Association.

      DIF: Cognitive Level: Analysis REF: Page 668

2. A researcher receives a rejection letter concerning a proposal submitted for major funding. What should now be done?

   1. The researcher should not apply for another grant for at least a year.

   2. The comments in the letter should be reviewed, so as to rewrite the proposal for the next review cycle.

   3. A formal protest should be filed.

   4. The contact person for the grant should be reached by e-mail as soon as possible.

      ANS: B

      The researcher’s reaction to a rejected proposal is usually anger and then depression. The frustrated researcher may abandon the proposal, stuff it in a bottom drawer somewhere, and forget it. There seems to be no way to avoid the anger and depression after a rejection because of the significant emotion and time invested in writing the proposal. However, after a few weeks it is advisable to examine the rejection letter again. The comments can be useful in rewriting the proposal for resubmission. The learning experience of rewriting the proposal and evaluating the comments will provide a background for seeking funding for another study.

      A skilled grant writer will have approximately one proposal funded for every five submitted. The average is far less than this.

      DIF: Cognitive Level: Comprehension REF: Page 671

3. What is the percentage rejection rate for new grant writers?

   1. Less than 20%

   2. Approximately 50%

   3. 80%

   4. Greater than 80%

ANS: D

A skilled grant writer will have approximately one proposal funded for every five submitted. The average is far less than this.

DIF: Cognitive Level: Analysis REF: Page 671

MULTIPLE RESPONSE

1. Why is seeking research funding important? (Select all that apply.)

   1. Funding implies both scientific and social merit.

   2. Funding allows the researcher to hire assistants who attend to the tasks of research, leaving the researcher free for design of more and better projects.

   3. The academic reputation of the researcher increases as grant funding increases.

   4. Research cannot be conducted unless formal funding is obtained.

   5. Well-designed studies can be expensive, especially those with complex designs.

   6. A funded study is much more likely to be published.

      ANS: A, B, C, E

      Seeking funding for research is important, both for the researcher and for the profession. Well- designed studies can be expensive. As the rigor and complexity of the study design increase, the cost tends to increase. By obtaining funding, the researcher can conduct a complex, well- designed study. Funding indicates that others have reviewed the study and recognize its scientific and social merit. In fact, the scientific credibility of the profession is related to the quality of studies conducted by its researchers. Thus, scientific credibility and funding for research are interrelated. The profession of nursing has invested a great deal of energy in increasing the sources of funding and amount of money available for nursing research. Each award of funding enhances the status of the researcher and increases the possibilities of greater funding for later studies. In addition, funding provides practical advantages. For example, funding may reimburse part or all of the researcher’s salary and release the researcher from other responsibilities, allowing the researcher to devote time to conducting the study. Funding provides the researcher with the resources to hire research assistants and study coordinators to facilitate data collection and enhance your productivity.

      DIF: Cognitive Level: Analysis REF: Page 663

2. What are the advantages of a research apprenticeship? (Select all that apply.)

   1. Entry into a functional research team

   2. Extremely good wages

   3. Experience gained in grant writing

   4. A chance to read proposals that have been funded

   5. The opportunity to learn research and grantsmanship

   6. A chance to read proposals that have not been funded

   7. A guaranteed job after the apprenticeship ends

      ANS: A, C, D, E, F

      Volunteering to assist with the activities of another researcher is an excellent way to learn research and grantsmanship. Graduate students can gain this experience by becoming graduate research assistants. Through an apprenticeship, one may gain experience in writing grants and reading proposals that have been funded. Examining proposals that have been rejected can be useful if the comments of the review committee are available. The criticisms of the review committee point out the weaknesses of the study and clarify the reasons why the proposal was rejected. Examining these comments on the proposal can increase one’s insight as a new grant writer and prepare a novice for similar experiences. However, some researchers are sensitive about these criticisms and may be reluctant to share them. If an experienced researcher is willing, it is enlightening to hear his or her perceptions and opinions about the criticisms.

      Ideally, by working closely with an experienced researcher, one has the opportunity to demonstrate one’s commitment and the researcher may ultimately invite the novice to become a permanent member of a research team.

      DIF: Cognitive Level: Synthesis REF: Page 666

3. Why is serving on a research committee or institutional review board useful for the person interested in gaining research funding? (Select all that apply.)

   1. People who serve on research committees are given priority funding approval.

   2. Seeing the mistakes others make creates an awareness of common errors.

   3. Contacts with researchers can be made.

   4. When one’s own proposals are reviewed, the committee will feel more inclined to approve them.

   5. Reading a clear, organized proposal provides a template.

      ANS: B, C, E

      Research committees and institutional review boards exist in many health care and professional organizations. Through membership on these committees, contacts with researchers can be made. Also, many research committees are involved in reviewing proposals for the funding of small grants or granting approval to collect data in an institution. Often reading proposals for approval for human subjects’ research or for funding can give the novice researcher insight into the importance of clarity and organization in the research proposal.

      Reviewing proposals and making decisions about funding help researchers become better able to critique and revise their own proposals before submitting them for review.

      DIF: Cognitive Level: Synthesis REF: Page 667

4. What is the difference between a nursing project grant proposal and a nursing research grant? (Select all that apply.)

   1. A research grant is awarded for a promising planned study.

   2. Research grants and project grants are identical.

   3. A project grant’s program can be academic or clinical.

   4. A research grant is awarded for outstanding past research.

   5. A project grant is awarded to support a novel program.

      ANS: A, C, E

      Two main types of grants are sought in nursing: project grants and research grants. Project grant proposals are written to obtain funding for the development of new educational programs in nursing, such as a program designed to teach nurses to provide a new type of nursing care or a project to support nursing students seeking advanced degrees. These grants may fund a project manager to achieve the goals of the grant. Although these programs may involve evaluation, they seldom involve research. For example, the effectiveness of a new approach to patient care may be evaluated, but the findings can seldom be generalized beyond the unit or institution in which the patient care was provided. The emphasis is on implementing the project, not on conducting research. Research grants provide funding to conduct a study. Although the two types of grant proposals have similarities, they have important differences in writing techniques and flow of ideas, as well as content.

      DIF: Cognitive Level: Synthesis REF: Page 667

5. Many hospitals and universities have access to both SPIN and The Foundation Directory. Why are these useful for a researcher? (Select all that apply.)

   1. They provide leads for thousands of grant opportunities.

   2. They provide information only for small grants of less than $5,000 each.

   3. They provide information on federal agencies, private foundations, and corporate foundations.

   4. They are computerized information resources.

   5. They provide funding information; all fees are then used to support future grants.

      ANS: A, C, D

      A computerized information system, the Sponsored Programs Information Network (SPIN), can assist researchers in locating the most appropriate funding sources to support their research interests. The database contains approximately 2,000 programs that provide information on federal agencies, private foundations, and corporate foundations. Many universities and research institutions have access to SPIN. Other databases include private funding as well.

      DIF: Cognitive Level: Analysis REF: Page 669

6. A new researcher obtains a large grant and proceeds to hire nine assistants, as the grant specifies. The new researcher hires a statistician, three persons to collect data, one person to schedule and coordinate the activities of the persons collecting data, one person to help with qualitative data analysis, one person to begin writing for the grant renewal, one person to write the interim report, and one person to manage the grant budget, writing weekly checks to the research assistants based on their submitted timecards. Which of these activities is appropriate for a hired assistant? (Select all that apply.)

   1. Advising the research team about appropriate statistical tests

   2. Recalculating the study power after data collection on the first thirty subjects, to be sure of the effect size

   3. Performing initial qualitative coding of raw data

   4. Writing the first draft of a renewal grant

   5. Writing the interim report for the institutional review board

   6. Managing the grant budget

   7. Writing weekly checks to the research assistants

      ANS: A, B, C, G

      Although the supporting institution is ultimately responsible for dispensing and controlling grant monies, the primary investigator (PI) is responsible for keeping track of budget expenditures and making decisions about how the money is to be spent. If funding is through a federal agency, the PI will be required to provide interim reports as well as updates on the progress of the study. The PI interviews, hires, trains, and oversees grant personnel. During a large study with several investigators and other grant personnel, the PI coordinates activities, often through formal meetings of all grant workers at intervals to share ideas and solve problems. Federal grants require the PI to submit interim reports according to preset deadlines. The PI often writes the renewal grant as soon as the first grant has been made, so that continuous research activity can be accomplished. In theory, the PI could be planning one study, collecting data on a second study, analyzing data on a third study, and writing papers for publication on a fourth study. A full-time researcher could have completed one funded study, be in the last year of funding for a second study, be in the first year of funding for a third study, and be seeking funding for a fourth study.

      DIF: Cognitive Level: Application REF: Page 671

7. What are two national nursing organizations that provide small grants not linked to a nursing specialty area? (Select the two that apply.)

   1. The Society for Pediatric Nurses

   2. American Nurses’ Foundation

   3. The Board of Registered Nursing

   4. The American Cancer Society

   5. Sigma Theta Tau, International

   6. The National Association of Hospitals and Clinics

ANS: B, E

Two national nursing organizations that provide small grants not linked to a specialty are the American Nurses’ Foundation and Sigma Theta Tau, International. These grants are usually for less than $7,500 each year, are very competitive, and are awarded to new investigators with promising ideas. Receiving funding from these organizations is held in high regard.

DIF: Cognitive Level: Analysis REF: Page 668