Adult-Gerontology Primary Care Nurse Practitioner Exam Research & Evidence-Based Practice 4 — Questions and Answers
Question 1: An NP is appraising a study on antibiotic prescribing for older adults with acute bronchitis. The study uses intention-to-treat (ITT) analysis. What is the primary advantage of this approach?
- It excludes non-compliant participants to show the true drug effect
- It preserves randomization and reflects real-world effectiveness (Correct answer)
- It increases statistical power by reducing sample size
- It eliminates the need for a control group
Correct answer: It preserves randomization and reflects real-world effectiveness
ITT analysis includes all randomized participants in their original groups, preserving the benefits of randomization and reflecting real-world conditions.
Question 2: A research team conducting a study on pain management in cognitively impaired elders uses a validated observational pain scale. This practice best exemplifies which principle?
- Minimizing Type II error
- Using reliable and valid measurement instruments (Correct answer)
- Applying convenience sampling
- Ensuring external validity through large samples
Correct answer: Using reliable and valid measurement instruments
Using validated instruments ensures the tool consistently measures what it is intended to measure, a fundamental principle of rigorous research.
Question 3: When reviewing a pharmacological study for geriatric applicability, the NP notes the trial excluded adults over age 75. This most significantly impacts which aspect of the study?
- Internal validity
- Statistical power
- External validity (generalizability) (Correct answer)
- Blinding integrity
Correct answer: External validity (generalizability)
Excluding older adults from trials limits external validity, making it unclear whether findings apply to the geriatric population.
Question 4: The PICO framework is used to formulate clinical questions. In a question about fall prevention in nursing home residents, what does the 'C' represent?
- Clinical context
- Comparison intervention or control (Correct answer)
- Comorbidity burden
- Cost-effectiveness
Correct answer: Comparison intervention or control
In PICO, 'C' stands for Comparison, referring to the alternative intervention or control condition against which the intervention is compared.
Question 5: Which type of research question is best answered by a phenomenological qualitative study?
- What is the incidence of delirium in ICU patients over 65?
- Does early mobilization reduce length of stay after hip replacement?
- What is the lived experience of older adults transitioning to assisted living? (Correct answer)
- Which antihypertensive regimen lowers systolic BP most effectively in adults over 70?
Correct answer: What is the lived experience of older adults transitioning to assisted living?
Phenomenological studies explore the meaning of lived experiences, making them ideal for understanding subjective phenomena like life transitions.
Question 6: An NP implements a new wound care protocol based on a recent RCT. After 3 months, outcomes have not improved. According to EBP principles, what should the NP do next?
- Abandon EBP and return to previous practice immediately
- Evaluate fidelity of implementation and assess for barriers to practice change (Correct answer)
- Wait 12 months before reassessing outcomes
- Conduct a new RCT within the practice setting
Correct answer: Evaluate fidelity of implementation and assess for barriers to practice change
EBP implementation requires evaluating whether the protocol was applied correctly and identifying contextual barriers before concluding the evidence is ineffective.
Question 7: A study reports sensitivity of 92% and specificity of 78% for a dementia screening tool. Which statement is most accurate?
- The tool correctly identifies 78% of true dementia cases
- The tool has a low false-negative rate and will miss few true cases (Correct answer)
- The tool correctly rules in dementia 92% of the time
- The tool is more useful for ruling in disease than ruling out disease
Correct answer: The tool has a low false-negative rate and will miss few true cases
High sensitivity (92%) means the test correctly identifies most true cases, resulting in a low false-negative rate and making it valuable for ruling out disease.
Adult-Gerontology Primary Care Nurse Practitioner Exam Research & Evidence-Based Practice 4
An NP is appraising a study on antibiotic prescribing for older adults with acute bronchitis.
The study uses intention-to-treat (ITT) analysis.
What is the primary advantage of this approach?