Clinical Nurse Specialist Research & Evidence-Based Practice 2 — Questions and Answers
Question 1: A CNS wants to evaluate the strength of a systematic review that includes only randomized controlled trials. Which hierarchy tool is MOST appropriate for grading this evidence?
- GRADE framework (Correct answer)
- AGREE II instrument
- PRISMA checklist
- CONSORT statement
Correct answer: GRADE framework
The GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework is designed to rate the quality of evidence and strength of clinical recommendations from systematic reviews.
Question 2: When conducting a literature search for an EBP project, the CNS uses Boolean operators. Which search string would MOST effectively narrow results?
- sepsis AND nurse-led intervention AND ICU (Correct answer)
- sepsis OR nurse-led intervention OR ICU
- sepsis NOT intervention
- sepsis AND ICU OR nurse
Correct answer: sepsis AND nurse-led intervention AND ICU
Using AND between all terms requires each result to include all concepts, producing the most targeted and narrowed search.
Question 3: A CNS critically appraises a cohort study examining smoking and lung cancer. The study reports a relative risk of 2.5 with a 95% CI of 1.8–3.4. What does this confidence interval indicate?
- The true population RR likely falls between 1.8 and 3.4 (Correct answer)
- The study is not statistically significant
- 50% of subjects had an RR between 1.8 and 3.4
- There is a 95% chance the null hypothesis is true
Correct answer: The true population RR likely falls between 1.8 and 3.4
A 95% CI means we are 95% confident the true population relative risk lies within the interval 1.8–3.4, and since it excludes 1.0, the finding is statistically significant.
Question 4: Which research design is BEST suited for studying the lived experience of patients following a traumatic amputation?
- Phenomenological qualitative study (Correct answer)
- Double-blind randomized controlled trial
- Retrospective cohort study
- Cross-sectional survey
Correct answer: Phenomenological qualitative study
Phenomenology explores the subjective lived experience of individuals, making it ideal for understanding patients' personal perspectives after trauma.
Question 5: A CNS is evaluating internal validity of a clinical trial. Which threat to internal validity is MOST directly addressed by randomization?
- Selection bias (Correct answer)
- Attrition bias
- Detection bias
- Reporting bias
Correct answer: Selection bias
Randomization distributes known and unknown confounders equally between groups, directly addressing selection bias.
Question 6: In an EBP model, after identifying the clinical question and searching evidence, what is the NEXT step in the Iowa Model?
- Critique and synthesize the evidence (Correct answer)
- Implement a pilot change
- Evaluate outcomes
- Form a team to support the change
Correct answer: Critique and synthesize the evidence
The Iowa Model requires critiquing and synthesizing the collected evidence to determine its quality and applicability before piloting any practice change.
Question 7: A CNS notes that a published study's p-value is 0.03. Which interpretation is CORRECT?
- There is a 3% probability the results occurred by chance alone if the null hypothesis is true (Correct answer)
- The intervention is clinically significant
- The study has a 97% chance of being replicated
- The null hypothesis is proven false
Correct answer: There is a 3% probability the results occurred by chance alone if the null hypothesis is true
A p-value of 0.03 means there is a 3% probability of obtaining results at least as extreme as observed if the null hypothesis were true, indicating statistical significance.
Clinical Nurse Specialist Research & Evidence-Based Practice 2
A CNS wants to evaluate the strength of a systematic review that includes only randomized controlled trials.
Which hierarchy tool is MOST appropriate for grading this evidence?