Nurse Executive Test Research & Evidence-Based Practice 2 — Questions and Answers
Question 1: A nurse executive is evaluating a systematic review to guide a policy change. Which feature BEST distinguishes a systematic review from a narrative review?
- Includes expert opinion from senior clinicians
- Uses a predefined, reproducible search strategy with explicit inclusion criteria (Correct answer)
- Summarizes findings from a single large randomized controlled trial
- Focuses on qualitative interviews with bedside nurses
Correct answer: Uses a predefined, reproducible search strategy with explicit inclusion criteria
Systematic reviews use a predefined, reproducible methodology with explicit inclusion/exclusion criteria to minimize bias, unlike narrative reviews.
Question 2: When applying the GRADE framework to rate evidence quality, which finding would result in UPGRADING the evidence level?
- High risk of bias detected in included studies
- Large magnitude of effect with no plausible confounders (Correct answer)
- Significant heterogeneity across studies
- Wide confidence intervals in the pooled estimate
Correct answer: Large magnitude of effect with no plausible confounders
In GRADE, evidence can be upgraded when a very large effect size is present and confounding is unlikely to explain it.
Question 3: A nurse executive implements a new sepsis bundle and wants to measure its effect using a pre-post design. What is the PRIMARY limitation of this design?
- It cannot measure mortality outcomes
- Confounding variables and temporal trends may explain observed changes rather than the intervention (Correct answer)
- It requires a control group from another hospital
- It is unethical to withhold treatment from a control group
Correct answer: Confounding variables and temporal trends may explain observed changes rather than the intervention
Pre-post designs lack a concurrent control group, making it impossible to rule out confounding or secular trends as causes of change.
Question 4: Which statistical measure best captures the clinical significance of an intervention when absolute risk reduction is small but relative risk reduction appears large?
- Number needed to treat (NNT) (Correct answer)
- Odds ratio
- P-value
- Cronbach's alpha
Correct answer: Number needed to treat (NNT)
NNT translates absolute risk reduction into the number of patients who must be treated to prevent one adverse outcome, conveying practical clinical impact.
Question 5: A nurse executive is reviewing a study where the researcher collected data knowing which patients received the intervention. What bias does this MOST likely introduce?
- Selection bias
- Attrition bias
- Observer bias (Correct answer)
- Publication bias
Correct answer: Observer bias
Observer (or detection) bias occurs when knowledge of treatment assignment influences how outcomes are measured or recorded.
Question 6: In evidence-based practice, what does the acronym PICO stand for?
- Population, Intervention, Comparison, Outcome (Correct answer)
- Patient, Illness, Clinician, Organization
- Problem, Indicator, Control, Objective
- Practice, Implementation, Compliance, Oversight
Correct answer: Population, Intervention, Comparison, Outcome
PICO structures a clinical question by defining the Population, Intervention, Comparison, and Outcome to guide an efficient literature search.
Question 7: A nurse executive notices that only studies showing positive effects of a new nursing protocol have been published. This phenomenon is BEST described as:
- Recall bias
- Publication bias (Correct answer)
- Hawthorne effect
- Regression to the mean
Correct answer: Publication bias
Publication bias occurs when studies with positive or statistically significant results are more likely to be published, skewing the evidence base.
Nurse Executive Test Research & Evidence-Based Practice 2
A nurse executive is evaluating a systematic review to guide a policy change.
Which feature BEST distinguishes a systematic review from a narrative review?