NSGD 2216 — Critical Inquiry & Evidence-Informed Practice Examination | 2026/2027
NSGD 2216
Critical Inquiry & Evidence-Informed Practice
Comprehensive Examination
2026/2027 Academic Year | Premium Exam Package
EXAM INSTRUCTIONS
• This examination consists of 188 multiple-choice and select-all-that-apply questions.
• Total testing time: 150-180 minutes. Passing score: 75-80% (141-150 correct).
• Read each question carefully before selecting your answer(s).
• For SATA questions, select ALL correct answers (two or more may apply).
• Correct answers are highlighted in green bold. Rationales follow each question.
• Questions cover EBP foundations, critical appraisal, research methodology, statistics, ethics,
knowledge translation, systematic reviews, quality improvement, scholarly writing, and scenario-based
clinical application.
EXAM CONTENT BREAKDOWN
Domain Questions Points
I. Foundations of EBP 19 1 pt
each
II. Critical Appraisal 19 1 pt
each
III. Research Design 19 1 pt
each
IV. Statistical Analysis 19 1 pt
each
V. Ethical Principles 18 1 pt
each
VI. Knowledge Translation 19 1 pt
each
VII. Systematic Reviews 19 1 pt
each
VIII. Quality Improvement 19 1 pt
each
IX. Scholarly Writing 19 1 pt
each
X. Scenario-Based Application 18 1 pt
each
TOTAL 188 188
pts
Page 1
, NSGD 2216 — Critical Inquiry & Evidence-Informed Practice Examination | 2026/2027
Foundations of Evidence-Informed Practice
19 Questions
1. A nurse is preparing to implement evidence-based practice (EBP) on a medical-surgical
unit. Which of the following best describes the difference between EBP and research?
[Single Best Answer]
A) EBP integrates clinical expertise with the best available evidence, whereas research
generates new knowledge through systematic investigation
B) EBP relies solely on randomized controlled trials, whereas research uses qualitative methods
C) EBP is conducted in laboratory settings, whereas research occurs at the bedside
D) EBP focuses on generating hypotheses, whereas research tests existing interventions in practice
Correct Answer: A
EBP is the conscientious integration of clinical expertise, patient preferences, and the best available
evidence from research to guide clinical decision-making (Melnyk & Fineout-Overholt, 2023). Research,
in contrast, is the systematic process of generating new knowledge through rigorous investigation. EBP
applies existing research findings; research creates the evidence that EBP later utilizes.
2. The Iowa Model of Evidence-Based Practice is widely used in healthcare organizations. In
which phase of the Iowa Model does a clinical practice guideline or systematic review first get
considered?
[Single Best Answer]
A) Select a topic
B) Formulate the EBP question
C) Search for the best evidence
D) Implement the practice change
Correct Answer: C
In the Iowa Model (revised 2017), after identifying a clinical trigger (either a problem-focused or
knowledge-focused trigger) and forming a team, the next step is to search for the best evidence, which
includes locating systematic reviews and clinical practice guidelines (Buckwalter et al.). The selection of
a topic precedes this, but the consideration of systematic reviews occurs specifically during the evidence
search phase.
3. A nurse educator wants to use the Johns Hopkins Nursing EBP Model to guide a practice
change project. Which of the following is the first step in this model?
[Single Best Answer]
A) Develop the EBP question
B) Define the practice question using the evidence-level scale
C) Identify a practice question using the PET (Practice, Education, Research) process
D) Appraise the evidence using a rating system
Correct Answer: C
The Johns Hopkins Nursing EBP Model begins with the Practice question step, where clinicians identify
a question arising from practice, education, or research (the PET process). Only after the practice
question is identified does the team move on to searching for evidence and appraising it using the Johns
Hopkins evidence-leveling and quality-rating systems (Dearholt & Dang, 2021).
4. Which of the following are components of the PICO(T) framework used to formulate
clinical questions in evidence-based practice? (Select all that apply.)
[Select All That Apply]
A) Population/Patient
B) Intervention
C) Correlation
D) Comparison
E) Outcome
Correct Answer: A, B, D, E
The PICO(T) framework stands for Population/Patient, Intervention, Comparison, Outcome, and
(optionally) Time. Correlation is not a component of PICO(T). This framework helps clinicians structure
Page 2
, NSGD 2216 — Critical Inquiry & Evidence-Informed Practice Examination | 2026/2027
searchable, focused clinical questions that facilitate efficient literature retrieval and evidence appraisal
(Stillwell et al., 2010; Melnyk & Fineout-Overholt, 2023).
5. According to the hierarchy of evidence, which of the following represents the highest level
of evidence for answering a therapy/intervention question?
[Single Best Answer]
A) Single randomized controlled trial
B) Systematic review of multiple well-designed randomized controlled trials
C) Cohort study
D) Expert committee report or clinical opinion
Correct Answer: B
A systematic review of multiple well-designed RCTs (or a meta-analysis) represents the highest level of
evidence in most evidence hierarchies because it synthesizes data from multiple primary studies,
reducing bias and increasing statistical power (Melnyk & Fineout-Overholt, 2023). While single RCTs
are strong, systematic reviews are considered Level I evidence in the Johns Hopkins model. Cohort
studies are Level III, and expert opinion is the lowest level.
6. The ACE Star Model of Knowledge Transformation includes five stages. In which stage are
findings from individual research studies synthesized and translated into clinical guidelines?
[Single Best Answer]
A) Discovery
B) Evidence summary
C) Translation
D) Integration
Correct Answer: B
The ACE Star Model (Stevens, 2004) includes Discovery (research), Evidence Summary (synthesis of
research findings), Translation (guideline development), Integration (practice), and Evaluation
(outcomes). The Evidence Summary stage is where individual research findings are synthesized into
systematic reviews, meta-analyses, and evidence-based guidelines before being translated for clinical
use.
7. A nurse leader is implementing the ARCC (Advancing Research and Clinical Practice
through Close Collaboration) Model in a hospital. What is the primary role of the EBP mentor
in this model?
[Single Best Answer]
A) Conduct original research studies on the clinical unit
B) Advise and support clinicians in integrating evidence into practice
C) Serve as the sole decision-maker for clinical practice changes
D) Manage the hospital's quality improvement budget
Correct Answer: B
In the ARCC Model developed by Melnyk and Fineout-Overholt, the EBP mentor serves as a critical
resource who coaches, advises, and supports bedside clinicians in developing EBP competencies and
implementing evidence-based changes. The mentor does not replace clinical decision-making but
facilitates the integration of evidence into daily practice (Melnyk et al., 2011).
8. Which of the following statements correctly distinguish quality improvement (QI) from
research? (Select all that apply.)
[Select All That Apply]
A) QI projects aim to improve local processes and outcomes, whereas research aims to
generate generalizable knowledge
B) QI projects typically require IRB approval, whereas research does not
C) QI uses established evidence to guide practice change, whereas research tests new
hypotheses
D) QI projects are generally not considered publishable unless they contribute new
knowledge
E) QI always requires a control group, whereas research does not
Correct Answer: A, C, D
Page 3
, NSGD 2216 — Critical Inquiry & Evidence-Informed Practice Examination | 2026/2027
QI is designed to improve local care processes and outcomes using existing evidence, while research
generates new generalizable knowledge (Polit & Beck, 2021). QI projects typically do not require IRB
review (B is incorrect), and they often use pre/post designs without control groups (E is incorrect). QI
projects may be publishable only when they offer broader insights, but their primary purpose is local
improvement.
9. The AACN Essentials (2021) identify which competency domain as foundational for
baccalaureate nursing graduates in evidence-based practice?
[Single Best Answer]
A) Clinical judgment only
B) Knowledge for nursing practice, including scholarship and evidence-based practice
C) Information technology management
D) Health policy and advocacy
Correct Answer: B
The AACN Essentials (2021) include 'Knowledge for Nursing Practice' as Domain 2, which specifically
encompasses scholarship, evidence-based practice, and the translation of evidence into clinical care. This
domain requires BSN graduates to locate, critically appraise, and apply best evidence to clinical
situations, integrate patient preferences, and participate in scholarly activities (AACN, 2021).
10. A clinical nurse asks: 'In adult patients with type 2 diabetes, does a Mediterranean diet
compared to a standard low-fat diet reduce HbA1c levels over 6 months?' Which PICO
component is 'reduce HbA1c levels'?
[Single Best Answer]
A) Population
B) Intervention
C) Comparison
D) Outcome
Correct Answer: D
In this PICO question, 'reduce HbA1c levels' is the Outcome (O) — the measurable effect of the
intervention. The Population (P) is adult patients with type 2 diabetes, the Intervention (I) is a
Mediterranean diet, and the Comparison (C) is a standard low-fat diet. The time frame of 6 months
represents the optional T (Time) component.
11. A nurse is reviewing a meta-synthesis of qualitative studies on the lived experience of
stroke survivors. Where does this type of evidence fall on a traditional evidence hierarchy?
[Single Best Answer]
A) Level I — highest level of evidence
B) Level III — controlled studies without randomization
C) Level VI — single descriptive or qualitative study
D) It does not fit within quantitative evidence hierarchies
Correct Answer: D
Traditional evidence hierarchies (e.g., Johns Hopkins, Melnyk & Fineout-Overholt) were designed
primarily for quantitative research evaluating interventions. Qualitative evidence requires separate
hierarchies or frameworks, such as the Joanna Briggs Institute (JBI) levels of evidence for qualitative
research. Meta-synthesis represents the highest level within qualitative evidence but cannot be directly
ranked on quantitative hierarchies (Polit & Beck, 2021).
12. A nurse is using the Johns Hopkins Evidence Rating System. Which of the following
correctly pair the evidence level with its description? (Select all that apply.)
[Select All That Apply]
A) Level I: Evidence from a systematic review of RCTs, meta-analysis, or clinical practice
guideline
B) Level II: Evidence from at least one well-designed RCT
C) Level III: Evidence from systematic reviews of qualitative or descriptive studies
D) Level V: Evidence from case reports or expert opinion
E) Level III: Evidence from well-designed case-control or cohort studies
Correct Answer: A, B, D
Page 4
NSGD 2216
Critical Inquiry & Evidence-Informed Practice
Comprehensive Examination
2026/2027 Academic Year | Premium Exam Package
EXAM INSTRUCTIONS
• This examination consists of 188 multiple-choice and select-all-that-apply questions.
• Total testing time: 150-180 minutes. Passing score: 75-80% (141-150 correct).
• Read each question carefully before selecting your answer(s).
• For SATA questions, select ALL correct answers (two or more may apply).
• Correct answers are highlighted in green bold. Rationales follow each question.
• Questions cover EBP foundations, critical appraisal, research methodology, statistics, ethics,
knowledge translation, systematic reviews, quality improvement, scholarly writing, and scenario-based
clinical application.
EXAM CONTENT BREAKDOWN
Domain Questions Points
I. Foundations of EBP 19 1 pt
each
II. Critical Appraisal 19 1 pt
each
III. Research Design 19 1 pt
each
IV. Statistical Analysis 19 1 pt
each
V. Ethical Principles 18 1 pt
each
VI. Knowledge Translation 19 1 pt
each
VII. Systematic Reviews 19 1 pt
each
VIII. Quality Improvement 19 1 pt
each
IX. Scholarly Writing 19 1 pt
each
X. Scenario-Based Application 18 1 pt
each
TOTAL 188 188
pts
Page 1
, NSGD 2216 — Critical Inquiry & Evidence-Informed Practice Examination | 2026/2027
Foundations of Evidence-Informed Practice
19 Questions
1. A nurse is preparing to implement evidence-based practice (EBP) on a medical-surgical
unit. Which of the following best describes the difference between EBP and research?
[Single Best Answer]
A) EBP integrates clinical expertise with the best available evidence, whereas research
generates new knowledge through systematic investigation
B) EBP relies solely on randomized controlled trials, whereas research uses qualitative methods
C) EBP is conducted in laboratory settings, whereas research occurs at the bedside
D) EBP focuses on generating hypotheses, whereas research tests existing interventions in practice
Correct Answer: A
EBP is the conscientious integration of clinical expertise, patient preferences, and the best available
evidence from research to guide clinical decision-making (Melnyk & Fineout-Overholt, 2023). Research,
in contrast, is the systematic process of generating new knowledge through rigorous investigation. EBP
applies existing research findings; research creates the evidence that EBP later utilizes.
2. The Iowa Model of Evidence-Based Practice is widely used in healthcare organizations. In
which phase of the Iowa Model does a clinical practice guideline or systematic review first get
considered?
[Single Best Answer]
A) Select a topic
B) Formulate the EBP question
C) Search for the best evidence
D) Implement the practice change
Correct Answer: C
In the Iowa Model (revised 2017), after identifying a clinical trigger (either a problem-focused or
knowledge-focused trigger) and forming a team, the next step is to search for the best evidence, which
includes locating systematic reviews and clinical practice guidelines (Buckwalter et al.). The selection of
a topic precedes this, but the consideration of systematic reviews occurs specifically during the evidence
search phase.
3. A nurse educator wants to use the Johns Hopkins Nursing EBP Model to guide a practice
change project. Which of the following is the first step in this model?
[Single Best Answer]
A) Develop the EBP question
B) Define the practice question using the evidence-level scale
C) Identify a practice question using the PET (Practice, Education, Research) process
D) Appraise the evidence using a rating system
Correct Answer: C
The Johns Hopkins Nursing EBP Model begins with the Practice question step, where clinicians identify
a question arising from practice, education, or research (the PET process). Only after the practice
question is identified does the team move on to searching for evidence and appraising it using the Johns
Hopkins evidence-leveling and quality-rating systems (Dearholt & Dang, 2021).
4. Which of the following are components of the PICO(T) framework used to formulate
clinical questions in evidence-based practice? (Select all that apply.)
[Select All That Apply]
A) Population/Patient
B) Intervention
C) Correlation
D) Comparison
E) Outcome
Correct Answer: A, B, D, E
The PICO(T) framework stands for Population/Patient, Intervention, Comparison, Outcome, and
(optionally) Time. Correlation is not a component of PICO(T). This framework helps clinicians structure
Page 2
, NSGD 2216 — Critical Inquiry & Evidence-Informed Practice Examination | 2026/2027
searchable, focused clinical questions that facilitate efficient literature retrieval and evidence appraisal
(Stillwell et al., 2010; Melnyk & Fineout-Overholt, 2023).
5. According to the hierarchy of evidence, which of the following represents the highest level
of evidence for answering a therapy/intervention question?
[Single Best Answer]
A) Single randomized controlled trial
B) Systematic review of multiple well-designed randomized controlled trials
C) Cohort study
D) Expert committee report or clinical opinion
Correct Answer: B
A systematic review of multiple well-designed RCTs (or a meta-analysis) represents the highest level of
evidence in most evidence hierarchies because it synthesizes data from multiple primary studies,
reducing bias and increasing statistical power (Melnyk & Fineout-Overholt, 2023). While single RCTs
are strong, systematic reviews are considered Level I evidence in the Johns Hopkins model. Cohort
studies are Level III, and expert opinion is the lowest level.
6. The ACE Star Model of Knowledge Transformation includes five stages. In which stage are
findings from individual research studies synthesized and translated into clinical guidelines?
[Single Best Answer]
A) Discovery
B) Evidence summary
C) Translation
D) Integration
Correct Answer: B
The ACE Star Model (Stevens, 2004) includes Discovery (research), Evidence Summary (synthesis of
research findings), Translation (guideline development), Integration (practice), and Evaluation
(outcomes). The Evidence Summary stage is where individual research findings are synthesized into
systematic reviews, meta-analyses, and evidence-based guidelines before being translated for clinical
use.
7. A nurse leader is implementing the ARCC (Advancing Research and Clinical Practice
through Close Collaboration) Model in a hospital. What is the primary role of the EBP mentor
in this model?
[Single Best Answer]
A) Conduct original research studies on the clinical unit
B) Advise and support clinicians in integrating evidence into practice
C) Serve as the sole decision-maker for clinical practice changes
D) Manage the hospital's quality improvement budget
Correct Answer: B
In the ARCC Model developed by Melnyk and Fineout-Overholt, the EBP mentor serves as a critical
resource who coaches, advises, and supports bedside clinicians in developing EBP competencies and
implementing evidence-based changes. The mentor does not replace clinical decision-making but
facilitates the integration of evidence into daily practice (Melnyk et al., 2011).
8. Which of the following statements correctly distinguish quality improvement (QI) from
research? (Select all that apply.)
[Select All That Apply]
A) QI projects aim to improve local processes and outcomes, whereas research aims to
generate generalizable knowledge
B) QI projects typically require IRB approval, whereas research does not
C) QI uses established evidence to guide practice change, whereas research tests new
hypotheses
D) QI projects are generally not considered publishable unless they contribute new
knowledge
E) QI always requires a control group, whereas research does not
Correct Answer: A, C, D
Page 3
, NSGD 2216 — Critical Inquiry & Evidence-Informed Practice Examination | 2026/2027
QI is designed to improve local care processes and outcomes using existing evidence, while research
generates new generalizable knowledge (Polit & Beck, 2021). QI projects typically do not require IRB
review (B is incorrect), and they often use pre/post designs without control groups (E is incorrect). QI
projects may be publishable only when they offer broader insights, but their primary purpose is local
improvement.
9. The AACN Essentials (2021) identify which competency domain as foundational for
baccalaureate nursing graduates in evidence-based practice?
[Single Best Answer]
A) Clinical judgment only
B) Knowledge for nursing practice, including scholarship and evidence-based practice
C) Information technology management
D) Health policy and advocacy
Correct Answer: B
The AACN Essentials (2021) include 'Knowledge for Nursing Practice' as Domain 2, which specifically
encompasses scholarship, evidence-based practice, and the translation of evidence into clinical care. This
domain requires BSN graduates to locate, critically appraise, and apply best evidence to clinical
situations, integrate patient preferences, and participate in scholarly activities (AACN, 2021).
10. A clinical nurse asks: 'In adult patients with type 2 diabetes, does a Mediterranean diet
compared to a standard low-fat diet reduce HbA1c levels over 6 months?' Which PICO
component is 'reduce HbA1c levels'?
[Single Best Answer]
A) Population
B) Intervention
C) Comparison
D) Outcome
Correct Answer: D
In this PICO question, 'reduce HbA1c levels' is the Outcome (O) — the measurable effect of the
intervention. The Population (P) is adult patients with type 2 diabetes, the Intervention (I) is a
Mediterranean diet, and the Comparison (C) is a standard low-fat diet. The time frame of 6 months
represents the optional T (Time) component.
11. A nurse is reviewing a meta-synthesis of qualitative studies on the lived experience of
stroke survivors. Where does this type of evidence fall on a traditional evidence hierarchy?
[Single Best Answer]
A) Level I — highest level of evidence
B) Level III — controlled studies without randomization
C) Level VI — single descriptive or qualitative study
D) It does not fit within quantitative evidence hierarchies
Correct Answer: D
Traditional evidence hierarchies (e.g., Johns Hopkins, Melnyk & Fineout-Overholt) were designed
primarily for quantitative research evaluating interventions. Qualitative evidence requires separate
hierarchies or frameworks, such as the Joanna Briggs Institute (JBI) levels of evidence for qualitative
research. Meta-synthesis represents the highest level within qualitative evidence but cannot be directly
ranked on quantitative hierarchies (Polit & Beck, 2021).
12. A nurse is using the Johns Hopkins Evidence Rating System. Which of the following
correctly pair the evidence level with its description? (Select all that apply.)
[Select All That Apply]
A) Level I: Evidence from a systematic review of RCTs, meta-analysis, or clinical practice
guideline
B) Level II: Evidence from at least one well-designed RCT
C) Level III: Evidence from systematic reviews of qualitative or descriptive studies
D) Level V: Evidence from case reports or expert opinion
E) Level III: Evidence from well-designed case-control or cohort studies
Correct Answer: A, B, D
Page 4
