The nurse is comparing the effectiveness of two smoking cessation programs, Program A and Program B, which were designed for adolescent clients who reported smoking for one year or longer.

Adolescents in three high schools in the American southeast were randomly assigned to one of the two study programs.

Significantly more adolescents stopped smoking after completing Program A than those who completed Program B, and the effect size was 0.8. Based on these findings, which action should the community health nurse take?

Choice B rationale:

A retrospective 30-day chart audit that identifies the frequency of narcotic administration to clients one day following surgery. Rationale: This research design may involve unethical practices, as it could potentially involve accessing and auditing patient records without proper consent and may compromise patient confidentiality. It also raises ethical concerns about privacy and data protection.

Choice A rationale:

A qualitative study comparing responses of African-American and Caucasian clients about the levels of pain they experienced on their first postoperative day. Rationale: This qualitative study does not inherently involve unethical practices. Ethical considerations would depend on how the study is conducted, including obtaining informed consent and ensuring participant confidentiality.

Choice C rationale:

A quantitative, experimental design study used to detect pain level differences of groups receiving IM or PCA narcotics and a control group receiving placebos. Rationale: This quantitative experimental design does not inherently involve unethical practices. Ethical considerations would depend on how the study is conducted, including obtaining informed consent and ensuring participant safety.

Choice D rationale:

A prospective study that compares female and male clients' responses about their expectations of postoperative pain. Rationale: This prospective study does not inherently involve unethical practices. Ethical considerations would depend on how the study is conducted, including obtaining informed consent and ensuring participant confidentiality.

Choice A rationale:

A measurement error does not seem to be the primary issue in this scenario. While improving randomization through a double-blind approach can enhance the study's internal validity, the core problem here is not a measurement error but the introduction of a new walker, which could introduce confounding variables.

Choice B rationale:

While manipulation of the dependent variable can indeed pose a threat to external validity, it is not the primary concern in this case. The primary issue is the potential for confounding due to the introduction of a new walker, which affects the study's internal validity.

Choice C rationale:

This is the correct answer. The introduction of a new walker is an external factor that was not controlled for in the study. It can introduce confounding variables that affect the study's internal validity. Therefore, a threat to internal validity has occurred.

Choice D rationale:

Selection bias is not the primary issue here. The primary concern is the introduction of a new walker affecting the study's internal validity. Selection bias pertains to the process of selecting subjects and does not directly address the impact of the new walker on the study's validity.