Adult-Gerontology Primary Care Nurse Practitioner Exam Research & Evidence-Based Practice 5 — Questions and Answers
Question 1: An NP is evaluating a clinical practice guideline on heart failure management. The GRADE system rates evidence quality as 'moderate.' This means:
- The true effect is likely close to the estimate but further research could change confidence (Correct answer)
- The estimate of effect is very uncertain and further research is unlikely to help
- The evidence is sufficient and no further research is warranted
- The recommendation is based solely on expert opinion
Correct answer: The true effect is likely close to the estimate but further research could change confidence
GRADE 'moderate' quality evidence means further research is likely to have an important impact on confidence in the estimate and may change the estimate.
Question 2: A study on anticoagulation in older adults with atrial fibrillation reports a hazard ratio (HR) of 0.65 for stroke. How should the NP interpret this finding?
- Treated patients have a 65% probability of stroke
- Treated patients have a 35% lower instantaneous risk of stroke compared to controls (Correct answer)
- The treatment increases stroke risk by 65%
- 65% of treated patients remained stroke-free
Correct answer: Treated patients have a 35% lower instantaneous risk of stroke compared to controls
An HR of 0.65 indicates a 35% reduction (1 - 0.65) in the rate of stroke events in the treatment group compared to the control group over time.
Question 3: Triangulation in qualitative research refers to:
- Using three statistical tests to confirm significance
- Using multiple data sources, methods, or investigators to enhance credibility (Correct answer)
- Recruiting participants from three different geographic regions
- Conducting three rounds of data collection
Correct answer: Using multiple data sources, methods, or investigators to enhance credibility
Triangulation strengthens qualitative research credibility by cross-verifying findings using multiple data sources, methods, or investigator perspectives.
Question 4: An NP conducts a chart audit to evaluate adherence to annual thyroid screening in adults over 65 with hypothyroidism. This activity best represents:
- Translational research
- Quality improvement (QI) initiative (Correct answer)
- Randomized practice-based trial
- Ethnographic research
Correct answer: Quality improvement (QI) initiative
Chart audits to assess adherence to standards are quality improvement activities aimed at improving care processes within a clinical setting.
Question 5: Which source would provide the highest level of pre-appraised evidence for an NP seeking guidance on managing type 2 diabetes in older adults?
- PubMed keyword search
- UpToDate clinical decision support tool
- Cochrane systematic review (Correct answer)
- Expert opinion from a diabetes specialist
Correct answer: Cochrane systematic review
Cochrane systematic reviews represent the highest level of pre-appraised synthesized evidence, rigorously pooling data from multiple RCTs.
Question 6: A study assessing a new balance training program uses a convenience sample of 30 older adults from one senior center. The main limitation of this sampling strategy is:
- It increases the risk of Type I error
- Results may not be generalizable to broader older adult populations (Correct answer)
- It prevents the use of inferential statistics
- It introduces recall bias into the study design
Correct answer: Results may not be generalizable to broader older adult populations
Convenience sampling limits generalizability because participants are not randomly selected and may not represent the larger target population.
Question 7: An NP uses shared decision-making to integrate EBP with patient values when discussing bone density treatment. Which EBP component does this BEST exemplify?
- Best research evidence
- Clinical expertise
- Patient preferences and values (Correct answer)
- Healthcare resources and costs
Correct answer: Patient preferences and values
EBP integrates best evidence, clinical expertise, AND patient values; shared decision-making specifically operationalizes the incorporation of patient preferences.
Adult-Gerontology Primary Care Nurse Practitioner Exam Research & Evidence-Based Practice 5
An NP is evaluating a clinical practice guideline on heart failure management.
The GRADE system rates evidence quality as 'moderate.' This means: