NURS 346 ALL SP26 Quiz 4 AA University of Maryland School of Nursing
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Researchers conducted a single-group quasi-experiment on the impact of protein shakes on weight gain in underweight teens. They found that average weight increased by 4 ounces (p=0.02) after the protein shakes. In the discussion section they claim "the intervention caused a significant improvement in weight for the teens and will transform the health of these young people." Based on the information provided, you conclude that:
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The clinical significance outweighs the lack of statistical significance.
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The researchers will not be able to generalize findings to all teens.
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The researcher's claims may go beyond what is shown by the findings.
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Future research should focus on fat intake as well as protein intake.
Explanation
Correct Answer: (C) The researcher's claims may go beyond what is shown by the findings. The researchers' claim that the intervention "caused" improvement and "will transform health" significantly overstates what the data actually supports. A single-group quasi-experiment lacks a control group, so causation cannot be established — only association. Additionally, a 4-ounce weight gain has questionable clinical significance, and declaring it will "transform health" is an unsupported overreach of the findings.
Why Other Options are Incorrect:
- A. This is incorrect because statistical significance is present (p=0.02). The issue is the lack of clinical significance and the overstated causal claims — not a trade-off between clinical and statistical significance.
- B. While generalizability is a legitimate concern with quasi-experimental single-group designs, the primary problem identified in this scenario is the researchers' exaggerated causal claims that go far beyond what the study design and data can support.
- D. While future research directions may be valuable, there is no evidence in the scenario to suggest fat intake is a relevant variable. This conclusion is speculative and not supported by the information provided.
Researchers provide standardized training to all research staff to ensure that a virtual reality intervention is delivered in the same manner regardless of which staff member is conducting the session. By doing this, the researchers are attempting to improve:
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Type II errors
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Power analysis
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Treatment fidelity
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External validity
Explanation
Correct Answer: (C) Treatment fidelity Treatment fidelity refers to the degree to which an intervention is delivered consistently and as intended across all participants and research staff. By providing standardized training to ensure all staff deliver the virtual reality intervention in the same manner, the researchers are directly improving treatment fidelity, ensuring that any observed effects are due to the intervention itself rather than variability in how it was administered.
Why Other Options are Incorrect:
A. Type II errors (false negatives) occur when a study fails to detect a true effect. They are primarily addressed through adequate sample size and statistical power, not through standardized training of staff.
B. Power analysis is a statistical calculation performed before a study to determine the sample size needed to detect a meaningful effect. It is unrelated to how consistently the intervention is delivered.
D. External validity concerns the generalizability of findings to other populations and settings. While consistent intervention delivery may indirectly support replication, the primary purpose of standardized training is treatment fidelity, not generalizability.
Which of the following would make researchers hesitate to make a causal inference (to say that the IV caused a change in the DV)?
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A biological explanation exists that supports the relationship between the IV and DV.
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They controlled for confounders and no other variable can explain the change in outcome.
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They are confident that the intervention was given before a change in the outcome occurred.
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They are unsure if the change in outcome occurred before or after the intervention was given.
Explanation
Correct Answer: (D) They are unsure if the change in outcome occurred before or after the intervention was given. One of the fundamental requirements for establishing causation is temporal precedence — the cause must precede the effect. If researchers are uncertain about the temporal sequence (whether the outcome changed before or after the intervention), they cannot confidently establish that the independent variable caused the change in the dependent variable, making causal inference impossible.
Why Other Options are Incorrect:
- A. A biological explanation supporting the relationship between the IV and DV actually strengthens the case for causal inference by providing a plausible mechanism through which the cause produces the effect.
- B. Controlling for confounders and eliminating alternative explanations supports causal inference by ruling out competing variables that could explain the outcome — this is a condition that favors, not hinders, causation claims.
- C. Confidence that the intervention preceded the outcome change satisfies the temporal precedence criterion for causation, strengthening rather than weakening the ability to make a causal inference.
Researchers want to decrease their chance of a false positive finding (Type I error). They should:
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Set a lower p value
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Use multiple hypotheses
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Use random sampling
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Set a lower alpha
Explanation
Correct Answer: (D) Set a lower alpha A Type I error is a false positive — concluding that an effect exists when it does not. The alpha level is the threshold for statistical significance and directly controls the probability of committing a Type I error. Setting a lower alpha (e.g., from 0.05 to 0.01) means the researcher requires stronger evidence before rejecting the null hypothesis, thereby reducing the risk of a false positive finding.
Why Other Options are Incorrect:
A. The p value is calculated from the data and cannot be set by the researcher — only the alpha (significance threshold) is set in advance. This option confuses p value with alpha.
B. Using multiple hypotheses actually increases the risk of Type I error, as testing multiple comparisons increases the probability that at least one result will appear significant by chance (multiple comparisons problem).
C. Random sampling improves external validity and representativeness of the sample. While valuable, it does not directly control the probability of a Type I error.
Researchers investigated whether swimming, compared to yoga, improved balance in older adults. The researchers found that patients who swam scored better on a balance test than patients who did yoga. Which of the following best describes what "internal validity" means in this study?
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Balance was accurately measured by the tool used in the study.
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Swimming, not something else, was what improved balance.
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Experts examined the tool used and determined it was appropriate.
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The findings can be generalized to patients in other age groups.
Explanation
Correct Answer: (B) Swimming, not something else, was what improved balance. Internal validity refers to the degree to which a study can establish a true cause-and-effect relationship between the independent and dependent variables, ruling out alternative explanations. In this study, internal validity means that swimming itself — and not confounding variables such as motivation, baseline fitness, or other activities — was responsible for the improved balance scores.
Why Other Options are Incorrect:
- A. Accurately measuring balance with the tool describes instrument reliability and construct validity — not internal validity.
- C. Experts examining and approving the tool describes content validity, which relates to whether the measurement instrument is appropriate — not internal validity.
- D. Generalizing findings to other age groups describes external validity — the ability to apply results beyond the study population — not internal validity.
Researchers recruit for a study on fish oil intake and stroke. Their sample is 92% white women. The researchers may have a problem with:
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Content validity
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Treatment fidelity
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External validity
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Power analysis
Explanation
Correct Answer: (C) External validity External validity refers to the ability to generalize study findings to other populations, settings, and contexts. A sample that is 92% white women is not representative of the diverse general population. This lack of diversity severely limits the researchers' ability to generalize findings about fish oil and stroke to men, other racial and ethnic groups, and broader populations.
Why Other Options are Incorrect:
- A. Content validity refers to whether a measurement tool or instrument adequately covers the full scope of the concept being measured. It is not relevant to sample demographics.
- B. Treatment fidelity refers to the degree to which an intervention is implemented as intended and consistently across the study. It is unrelated to the demographic composition of the sample.
- D. Power analysis relates to the statistical adequacy of the sample size to detect a true effect. While sample diversity is an issue, the described problem is specifically about generalizability, not statistical power.
Researchers are investigating burnout in hospital-based nurses. Midway through data collection, a pandemic occurs, leading to an increase in hospital admissions and deaths. What is the main threat to the internal validity of this study?
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Maturation
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History
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Sample diversity
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Selection threat
Explanation
Correct Answer: (B) History History as a threat to internal validity refers to external events occurring during the study that are unrelated to the intervention but may influence the outcome. The pandemic is a major historical event that independently increased nurse burnout through elevated workload, moral distress, and increased patient mortality — making it impossible to attribute changes in burnout solely to the study variables.
Why Other Options are Incorrect:
- A. Maturation refers to changes occurring within participants due to natural passage of time (e.g., aging, fatigue). While nurses may experience fatigue over time, the pandemic is a discrete external event — not a natural developmental process.
- C. Sample diversity relates to external validity and the ability to generalize findings across populations. It does not threaten the internal causal relationship between variables.
- D. Selection threat involves pre-existing differences between groups. Since the pandemic affected all participants equally, this is not a selection issue but rather an uncontrolled external historical event.
Researchers find that an intervention to improve weight gain in underweight teens increased weight by an average of 4 ounces (p=0.02). Based on the information provided, this study may be lacking:
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Treatment fidelity
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Generalizability
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Clinical significance
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Statistical significance
Explanation
Correct Answer: (C) Clinical significance Although the study achieved statistical significance (p=0.02), an average weight gain of only 4 ounces is unlikely to be clinically meaningful for underweight teenagers. Clinical significance refers to whether the magnitude of the effect is large enough to make a real, practical difference in patient outcomes. A statistically significant result does not automatically translate to a clinically important one.
Why Other Options are Incorrect:
- A. Treatment fidelity refers to how consistently the intervention was delivered. There is no information provided suggesting the intervention was implemented inconsistently.
- B. Generalizability (external validity) concerns whether findings can be applied to other populations. The scenario does not indicate problems with the study sample's representativeness.
- D. Statistical significance is clearly present, as indicated by a p-value of 0.02, which is below the standard threshold of 0.05.
Participants in a study took either a high-dose supplement or a placebo to test whether the supplement helped with leg cramps. What would be an example of a mortality threat that could hurt the internal validity of the study?
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A TikTok video about the benefits of this supplement went viral during the study period.
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The participants ate a healthier diet and exercised more because they were in a study.
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The supplement caused constipation, leading to a 40% drop-out rate in the intervention group.
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Only people who could speak and read English were eligible to be included in the study.
Explanation
Correct Answer: (C) The supplement caused constipation, leading to a 40% drop-out rate in the intervention group. In research, mortality threat (also called attrition) refers to the differential loss of participants from study groups — not literal death. When 40% of participants in the intervention group drop out due to side effects of the supplement, the remaining participants may differ systematically from those who dropped out, biasing the results and threatening internal validity.
Why Other Options are Incorrect:
- A. A viral TikTok video about the supplement's benefits is a history threat — an external event occurring during the study that could influence participants' behavior or outcomes independent of the study intervention.
- B. Participants eating healthier and exercising more because they know they are in a study describes the Hawthorne effect — a form of participant behavior change due to observation — which is a threat to internal validity but not a mortality threat.
- D. Restricting eligibility to English speakers is a selection/sampling issue that affects external validity (generalizability) by limiting who can participate, not a mortality threat related to differential dropout.
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For most of the nurses, the intervention decreased stress from "severe" to "mild."
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The researchers set the alpha level at 0.05 and the p value returned was 0.03.
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The intervention was low-cost and easy to implement into the nurses' usual workflow.
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The researchers rejected the null hypothesis after comparing alpha and the p value.
Explanation
Correct Answers: (A) For most of the nurses, the intervention decreased stress from "severe" to "mild," (C) The intervention was low-cost and easy to implement into the nurses' usual workflow.
Option A describes clinical significance because it demonstrates a meaningful, real-world change in patient/nurse outcomes — a measurable shift from severe to mild stress represents a practically important improvement in wellbeing that goes beyond numbers.
Option C describes clinical significance because it addresses the practical applicability of the intervention in real clinical settings. Low cost and ease of implementation are clinically relevant factors that determine whether a finding can actually be translated into practice.
Why Other Options are Incorrect:
- B. Setting the alpha level at 0.05 and obtaining a p-value of 0.03 describes statistical significance — a mathematical comparison of probabilities used to determine whether results are due to chance, not whether they matter clinically.
- D. Rejecting the null hypothesis after comparing alpha and p-value is the definition of statistical significance — a purely mathematical/inferential process with no direct reference to real-world clinical impact.
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