Clinical Nurse Specialist Evidence-Based Practice & Research

Question 1

A CNS wants to implement a new evidence-based practice change on a unit. Using the Iowa Model of Evidence-Based Practice, what is the first step when the CNS identifies a problem-focused trigger?

Accepted Answer

Determine if the topic is a priority for the organization before investing resources in an EBP project

Answer

The Iowa Model begins with determining organizational priority — not all problems warrant full EBP projects; alignment with organizational priorities ensures resource support and sustainability.

Question 2

A CNS is critically appraising a randomized controlled trial studying a new wound care dressing. The trial reports a relative risk reduction (RRR) of 50% but the absolute risk reduction (ARR) is 2%. How should the CNS interpret these findings for clinical decision-making?

Accepted Answer

ARR of 2% means 50 patients need treatment to prevent one additional wound healing failure — NNT should guide clinical and economic decisions

Answer

ARR and NNT provide clinically meaningful context that RRR alone obscures — an NNT of 50 means treating 50 patients to prevent one outcome, which must be weighed against cost and burden.

Question 3

A CNS is leading a journal club and asks staff to evaluate the internal validity of a cohort study examining the association between nurse staffing ratios and patient falls. Which threat to internal validity is most relevant to this study design?

Accepted Answer

Selection bias — patients with higher fall risk may be preferentially cared for on lower-staffed units

Answer

Confounding by indication (selection bias) is the primary threat — sicker, higher-fall-risk patients may cluster on units with different staffing due to acuity-based assignments, making staffing appear causative.

Question 4

A CNS wants to understand nurses' lived experience of implementing a rapid response system. Which research methodology is most appropriate?

Accepted Answer

Phenomenological qualitative study to explore nurses' lived experiences of RRS implementation

Answer

Phenomenology examines lived experience and subjective meaning — the appropriate qualitative methodology for understanding nurses' experiences of a new practice change.

Question 5

When appraising a systematic review and meta-analysis, which statistical measure quantifies the heterogeneity across included studies?

Accepted Answer

I-squared statistic — quantifies the proportion of variation across studies due to heterogeneity rather than chance

Answer

The I-squared statistic quantifies heterogeneity in meta-analysis: values of 25%, 50%, and 75% represent low, moderate, and high heterogeneity respectively.

Clinical Nurse Specialist Practice Test

Clinical Nurse Specialist Practice Test

Clinical Nurse Specialist Evidence-Based Practice & Research