EVIDENCE-BASED PRACTICE EXAM PRACTICE
QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT
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SECTION I: FOUNDATIONS OF EVIDENCE-BASED PRACTICE
1. A 55-year-old patient with hypertension asks about the best evidence for
blood pressure control. According to the SPRINT trial, what is the blood pressure
target that reduces cardiovascular events in high-risk patients?
• A) < 150/90 mmHg
• B) < 140/90 mmHg
• C) < 130/80 mmHg (intensive target)
• D) < 120/80 mmHg
Correct Answer: C
*Rationale: The SPRINT trial demonstrated that targeting a systolic BP of <120
mmHg reduced major cardiovascular events and mortality compared to the
standard target of <140 mmHg in high-risk patients. However, in clinical practice,
<130/80 mmHg is the ACC/AHA-recommended target for most hypertensive
patients. The evidence supports intensive BP control in patients who can tolerate
it.*
2. A 60-year-old patient with Type 2 diabetes and established cardiovascular
disease (CVD) is on metformin. According to the ADA/EASD consensus report,
,which class has the STRONGEST evidence for cardiovascular risk reduction and
should be added next?
• A) DPP-4 inhibitor
• B) Sulfonylurea
• C) SGLT-2 inhibitor (empagliflozin or canagliflozin) OR GLP-1 receptor
agonist (liraglutide or semaglutide)
• D) Insulin glargine
Correct Answer: C
*Rationale: The EMPA-REG OUTCOME, CANVAS, and LEADER trials demonstrated
that SGLT-2 inhibitors and GLP-1 receptor agonists with proven cardiovascular
benefit reduce major adverse cardiovascular events (MACE) in patients with Type
2 diabetes and established CVD. This is a Grade A recommendation from the
ADA/EASD, based on high-level evidence.*
3. A 65-year-old patient with heart failure with reduced ejection fraction (HFrEF)
is started on sacubitril/valsartan. Which landmark trial provided the evidence
for this medication?
• A) A-HeFT trial (hydralazine/isosorbide dinitrate)
• B) PARADIGM-HF trial (sacubitril/valsartan vs. enalapril)
• C) EMPEROR-Reduced trial (empagliflozin)
• D) DAPA-HF trial (dapagliflozin)
Correct Answer: B
Rationale: The PARADIGM-HF trial demonstrated that sacubitril/valsartan (ARNI)
was superior to enalapril in reducing cardiovascular death and heart failure
hospitalization in patients with HFrEF. This landmark trial established ARNI as a
cornerstone of HFrEF therapy.
,4. A 55-year-old patient with hyperlipidemia is started on a statin. According to
the 2013 ACC/AHA guidelines, what is the evidence-based recommendation for
statin therapy?
• A) Treat to a specific LDL-C target (e.g., <70 mg/dL)
• B) Use moderate- or high-intensity statin therapy based on the patient's 10-
year ASCVD risk, without treating to a specific target
• C) Use low-intensity statin for all patients
• D) No statin is indicated unless LDL-C >190 mg/dL
Correct Answer: B
*Rationale: The 2013 ACC/AHA guidelines shifted from treating to specific LDL
targets to using moderate- or high-intensity statin therapy based on the patient's
risk category (ASCVD risk score). This was based on evidence from multiple RCTs
showing that statin intensity, not LDL level, drives risk reduction.*
5. A 70-year-old patient with atrial fibrillation is started on apixaban for stroke
prevention. Which landmark trial provided the evidence for apixaban over
warfarin?
• A) RE-LY trial (dabigatran)
• B) ROCKET-AF trial (rivaroxaban)
• C) ARISTOTLE trial (apixaban)
• D) ENGAGE AF-TIMI 48 trial (edoxaban)
Correct Answer: C
Rationale: The ARISTOTLE trial demonstrated that apixaban was superior to
warfarin in reducing stroke and systemic embolism, with less bleeding, in patients
with atrial fibrillation. This high-level evidence led to the widespread adoption of
apixaban for stroke prevention.
, 6. A 60-year-old patient with COPD and frequent exacerbations is on triple
therapy (ICS/LABA/LAMA). Which landmark trial provided the evidence for
adding ICS to LABA/LAMA in patients with eosinophilia?
• A) TORCH trial (ICS/LABA)
• B) IMPACT trial (triple therapy vs. dual therapy)
• C) FLAME trial (LABA/LAMA vs. ICS/LABA)
• D) ISOLDE trial (ICS vs. placebo)
Correct Answer: B
Rationale: The IMPACT trial demonstrated that triple therapy (ICS/LABA/LAMA)
reduced exacerbations and improved lung function compared to dual therapy
(ICS/LABA or LAMA/LABA) in patients with symptomatic COPD and a history of
exacerbations, particularly those with blood eosinophilia. This evidence supports
the use of ICS in patients with eosinophilic COPD.
7. A 55-year-old patient with depression is started on an SSRI. According to the
STAR*D trial, what is the evidence-based approach for patients who do not
respond to the first antidepressant?
• A) Switch to a different SSRI
• B) Switch to a non-SSRI antidepressant (bupropion, mirtazapine) or
augment with bupropion or aripiprazole
• C) Add a benzodiazepine
• D) Increase the dose to the maximum
Correct Answer: B
Rationale: The STARD trial (Sequenced Treatment Alternatives to Relieve
Depression) provided evidence that for patients who do not respond to an initial
SSRI, switching to a different class (bupropion, mirtazapine) or augmenting with
bupropion or aripiprazole is an effective strategy. This trial established the
evidence base for treatment-resistant depression.*
QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT
DOWNLOAD PDF
SECTION I: FOUNDATIONS OF EVIDENCE-BASED PRACTICE
1. A 55-year-old patient with hypertension asks about the best evidence for
blood pressure control. According to the SPRINT trial, what is the blood pressure
target that reduces cardiovascular events in high-risk patients?
• A) < 150/90 mmHg
• B) < 140/90 mmHg
• C) < 130/80 mmHg (intensive target)
• D) < 120/80 mmHg
Correct Answer: C
*Rationale: The SPRINT trial demonstrated that targeting a systolic BP of <120
mmHg reduced major cardiovascular events and mortality compared to the
standard target of <140 mmHg in high-risk patients. However, in clinical practice,
<130/80 mmHg is the ACC/AHA-recommended target for most hypertensive
patients. The evidence supports intensive BP control in patients who can tolerate
it.*
2. A 60-year-old patient with Type 2 diabetes and established cardiovascular
disease (CVD) is on metformin. According to the ADA/EASD consensus report,
,which class has the STRONGEST evidence for cardiovascular risk reduction and
should be added next?
• A) DPP-4 inhibitor
• B) Sulfonylurea
• C) SGLT-2 inhibitor (empagliflozin or canagliflozin) OR GLP-1 receptor
agonist (liraglutide or semaglutide)
• D) Insulin glargine
Correct Answer: C
*Rationale: The EMPA-REG OUTCOME, CANVAS, and LEADER trials demonstrated
that SGLT-2 inhibitors and GLP-1 receptor agonists with proven cardiovascular
benefit reduce major adverse cardiovascular events (MACE) in patients with Type
2 diabetes and established CVD. This is a Grade A recommendation from the
ADA/EASD, based on high-level evidence.*
3. A 65-year-old patient with heart failure with reduced ejection fraction (HFrEF)
is started on sacubitril/valsartan. Which landmark trial provided the evidence
for this medication?
• A) A-HeFT trial (hydralazine/isosorbide dinitrate)
• B) PARADIGM-HF trial (sacubitril/valsartan vs. enalapril)
• C) EMPEROR-Reduced trial (empagliflozin)
• D) DAPA-HF trial (dapagliflozin)
Correct Answer: B
Rationale: The PARADIGM-HF trial demonstrated that sacubitril/valsartan (ARNI)
was superior to enalapril in reducing cardiovascular death and heart failure
hospitalization in patients with HFrEF. This landmark trial established ARNI as a
cornerstone of HFrEF therapy.
,4. A 55-year-old patient with hyperlipidemia is started on a statin. According to
the 2013 ACC/AHA guidelines, what is the evidence-based recommendation for
statin therapy?
• A) Treat to a specific LDL-C target (e.g., <70 mg/dL)
• B) Use moderate- or high-intensity statin therapy based on the patient's 10-
year ASCVD risk, without treating to a specific target
• C) Use low-intensity statin for all patients
• D) No statin is indicated unless LDL-C >190 mg/dL
Correct Answer: B
*Rationale: The 2013 ACC/AHA guidelines shifted from treating to specific LDL
targets to using moderate- or high-intensity statin therapy based on the patient's
risk category (ASCVD risk score). This was based on evidence from multiple RCTs
showing that statin intensity, not LDL level, drives risk reduction.*
5. A 70-year-old patient with atrial fibrillation is started on apixaban for stroke
prevention. Which landmark trial provided the evidence for apixaban over
warfarin?
• A) RE-LY trial (dabigatran)
• B) ROCKET-AF trial (rivaroxaban)
• C) ARISTOTLE trial (apixaban)
• D) ENGAGE AF-TIMI 48 trial (edoxaban)
Correct Answer: C
Rationale: The ARISTOTLE trial demonstrated that apixaban was superior to
warfarin in reducing stroke and systemic embolism, with less bleeding, in patients
with atrial fibrillation. This high-level evidence led to the widespread adoption of
apixaban for stroke prevention.
, 6. A 60-year-old patient with COPD and frequent exacerbations is on triple
therapy (ICS/LABA/LAMA). Which landmark trial provided the evidence for
adding ICS to LABA/LAMA in patients with eosinophilia?
• A) TORCH trial (ICS/LABA)
• B) IMPACT trial (triple therapy vs. dual therapy)
• C) FLAME trial (LABA/LAMA vs. ICS/LABA)
• D) ISOLDE trial (ICS vs. placebo)
Correct Answer: B
Rationale: The IMPACT trial demonstrated that triple therapy (ICS/LABA/LAMA)
reduced exacerbations and improved lung function compared to dual therapy
(ICS/LABA or LAMA/LABA) in patients with symptomatic COPD and a history of
exacerbations, particularly those with blood eosinophilia. This evidence supports
the use of ICS in patients with eosinophilic COPD.
7. A 55-year-old patient with depression is started on an SSRI. According to the
STAR*D trial, what is the evidence-based approach for patients who do not
respond to the first antidepressant?
• A) Switch to a different SSRI
• B) Switch to a non-SSRI antidepressant (bupropion, mirtazapine) or
augment with bupropion or aripiprazole
• C) Add a benzodiazepine
• D) Increase the dose to the maximum
Correct Answer: B
Rationale: The STARD trial (Sequenced Treatment Alternatives to Relieve
Depression) provided evidence that for patients who do not respond to an initial
SSRI, switching to a different class (bupropion, mirtazapine) or augmenting with
bupropion or aripiprazole is an effective strategy. This trial established the
evidence base for treatment-resistant depression.*
