Adult-Gerontology Primary Care Nurse Practitioner Exam Research & Evidence-Based Practice 3 — Questions and Answers
Question 1: An NP reads a meta-analysis reporting a pooled odds ratio of 1.8 (95% CI: 1.2–2.7) for cardiovascular events with a specific medication. What does the confidence interval indicate?
- The study has a 95% power to detect a difference
- The true population odds ratio falls between 1.2 and 2.7 with 95% confidence (Correct answer)
- 5% of study participants had cardiovascular events
- The result is not statistically significant
Correct answer: The true population odds ratio falls between 1.2 and 2.7 with 95% confidence
A 95% confidence interval means that if the study were repeated 100 times, 95 of the intervals would contain the true population parameter.
Question 2: When translating research into practice, the IOWA Model of Evidence-Based Practice identifies 'triggers' that initiate the EBP process. Which of the following is a knowledge-focused trigger?
- Increased fall rate on the unit
- New clinical practice guideline published by AHA (Correct answer)
- Patient complaint about medication side effects
- High rate of hospital-acquired infections
Correct answer: New clinical practice guideline published by AHA
Knowledge-focused triggers arise from new research findings, updated guidelines, or conference proceedings rather than identified clinical problems.
Question 3: Which level of evidence in the AHRQ hierarchy is assigned to well-designed cohort or case-control analytic studies?
- Level I
- Level II
- Level III (Correct answer)
- Level IV
Correct answer: Level III
Cohort and case-control studies are typically classified as Level III evidence, below systematic reviews and RCTs but above descriptive studies.
Question 4: An NP wants to assess the accuracy of a new point-of-care test for UTI in older women. Which study design is most appropriate?
- Randomized controlled trial
- Diagnostic accuracy study comparing to gold standard (Correct answer)
- Case series
- Delphi consensus method
Correct answer: Diagnostic accuracy study comparing to gold standard
Diagnostic accuracy studies compare a new test against a reference (gold) standard to calculate sensitivity, specificity, and predictive values.
Question 5: In a study of osteoporosis prevention, the absolute risk reduction (ARR) is 3% and the relative risk reduction (RRR) is 30%. What is the number needed to treat (NNT)?
- 10
- 30
- 33 (Correct answer)
- 3
Correct answer: 33
NNT = 1/ARR = 1/0.03 = 33, meaning 33 patients must be treated to prevent one adverse outcome.
Question 6: A practice guideline recommends annual lipid screening for adults over 65. The NP notes the guideline was last updated in 2012. What is the most appropriate next step?
- Follow the guideline as published
- Search for more current systematic reviews or updated guidelines (Correct answer)
- Implement a different intervention based on patient preference alone
- Discontinue lipid screening until updated guidance is found
Correct answer: Search for more current systematic reviews or updated guidelines
Guidelines older than 5 years may not reflect current evidence; the NP should search for updated systematic reviews or newer guidelines.
Question 7: Which statistical method is used in a meta-analysis to visually assess publication bias?
- Forest plot
- Funnel plot (Correct answer)
- Kaplan-Meier curve
- ROC curve
Correct answer: Funnel plot
A funnel plot displays individual study results against sample size; asymmetry in the plot suggests potential publication bias.
Adult-Gerontology Primary Care Nurse Practitioner Exam Research & Evidence-Based Practice 3
An NP reads a meta-analysis reporting a pooled odds ratio of 1.8 (95% CI: 1.2–2.7) for cardiovascular events with a specific medication.
What does the confidence interval indicate?