UNC2 Practice Test Select the correct response and jot down your rationale for choosing the answer. 1. An MSN needs to assign a staff member to assist a medical director in the development of a quality program for a newly established service. Which of the following staff members is MOST appropriate for this project a. a newly hired staff member who has demonstrated competence and has time to complete the task b. a knowledgeable staff member who works best on defined tasks c. a motivated staff member who is actively seeking promotion d. a competent staff member who has good interpersonal skills 2. A surgeon s wound infection rate is 32%. Further examination of which of the following data will provide the MOST useful information in determining the cause of this surgeon s infection rate? a. mortality rate b. facility infection rate c. use of prophylactic antibiotics d. type of anesthesia used 3. Pharmacy and Nursing are having difficulty developing an action plan for medication errors. Pharmacy Services states that Nursing Services cause the majority of the problems related to errors, while Nursing Services states the opposite. The QI department s role in resolving this problem is to a. provide them with directives on how to solve the problem b. facilitate discussion between the groups to enable them to assume ownership of their portions of the problem c. assign the task to an uninvolved manager d. refer the problem to the facility-wide quality council 4. Which of the following is MOST likely to be a benefit of concurrent ambulatory surgical case review? a. decreased medical record review at discharge b. an increase in the number of cases failing screening criteria c. an increase in reviewer competence
d. decreased medical record requests 5. A well-designed patient safety program should include all of the following EXCEPT a. an annual patient safety committee meeting b. planned response to adverse events c. orientation and continuing education on patient safety issues d. review of patient safety policies and procedures for all departments. 6. Discharge planners regularly monitor the number of inappropriate referrals, the timeliness of discharge planning, and the number of days of discharge delays. What additional monitor should be added to evaluate the appropriateness of discharge planning interventions? a. adequacy of documentation in progress notes b. attainment of discharge planning goals c. timeliness of referrals to discharge planning d. number of discharge planning referrals from nursing 7. A primary purpose of an information management system is to allow an organization to a. save time b. centralize demographics c. reduce cost d. evaluate data 8. Which of the following monitors provides patient outcome information? a. healthcare-acquired infection rate b. nursing care documentation compliance c. antibiotic therapy discontinuation compliance d. equipment malfunction rate
9. The surgery department's monthly case review revealed twenty-six records meeting the criteria. Six records did not meet the criteria. When calculating the incidence risk, the denominator is a. 6 b. 20 c. 26 d. 32 10. Flowcharts are primarily used in quality improvement to a. analyze causal factors of process dispersion b. understand the overall process or system being audited c. distinguish variations in a process over time d. determine process capability and uniformity 11. In what instance is it acceptable to obtain additional time for a corrective action? a. When the auditor cannot perform the audit as scheduled b. When the group being audited determines that the proposed corrective action is not cost effective c. When the corrective action plan requires more time than originally anticipated d. When there has been a change in personnel who perform the task 12. Which of the following statistics best describes the central tendency of a sample of data? a. Mode b. Mean c. Standard deviation d. Range
13. Which of the following requests is likely to obtain the most objective evidence for verification? a. What kind of information do you receive? b. Who provides the information to you? c. Describe how you receive information. d. Show me the information you have received. 14. The process information shown in the graph above is indicative of a a. Cycle b. Run c. Trend d. Shift Many of the questions listed herein are either taken from or inspired by sample questions contained in the CPHQ Candidate Examination Handbook (2012). Please refer to the website for the National Association for Healthcare Quality for more information about eligibility and fees for certification. National Association for Healthcare Quality (2012). Certified professional in healthcare quality candidate examination handbook. Retrieved from http://www.nahq.org/uploads/nahq13_cphqhandbook_revised.pdf 1. An MSN needs to assign a staff member to assist a medical director in the development of a quality program for a newly established service. Which of the following staff members is MOST appropriate for this project a. a newly hired staff member who has demonstrated competence and has time to complete the task b. a knowledgeable staff member who works best on defined tasks c. a motivated staff member who is actively seeking promotion
d. a competent staff member who has good interpersonal skills Rationale: This is basically a question about delegation. The objective in delegation is to give a task to someone who can handle it efficiently, effectively and without a lot of oversight--so that the delegator does not turn in to the doer! In option a, the newly hired staff member would not have the contacts necessary to start a quality program in a new service. In option b, the staff member who needs defined tasks would not have the level of initiative needed to start a new program. In option c, the motivated staff member might not be the best choice to develop a new program because they intend to move on to another position (and the MSN might need to assign someone else to this eventually). The staff member with good interpersonal skills (option d) is the best choice this person can work with others and has demonstrated competence. 2. A surgeon s wound infection rate is 32%. Further examination of which of the following data will provide the MOST useful information in determining the cause of this surgeon s infection rate? a. mortality rate b. facility infection rate c. use of prophylactic antibiotics d. type of anesthesia used Rationale: This question is asking for a cause for this particular surgeon. The cause can be found by examining process. Options a and b refer to high level outcome measures these tell us about all patients in this facility, not just this surgeon. Option d refers to a process but it is not directly attributable to the problem of infection. Option c also refers to a process and we know that use of prophylactic antibiotics is known to reduce incidence of infection. Option c is the best response because we can use this information to inform this particular surgeon s practice (his process). 3. Pharmacy and Nursing are having difficulty developing an action plan for medication errors. Pharmacy Services states that Nursing Services cause the majority of the problems related to errors, while Nursing Services states the opposite. The QI department s role in resolving this problem is to a. provide them with directives on how to solve the problem b. facilitate discussion between the groups to enable them to assume ownership of their portions of the problem c. assign the task to an uninvolved manager d. refer the problem to the facility-wide quality council Rationale: While the Nursing and Pharmacy department could potentially let the QI department direct their activities, as in options a and c, they will likely choose to govern themselves. Option d is simply pawning off the problem to a (potentially) higher authority this tactic should be taken only after all other options have been explored.
Option b is the best response; the QI department would be well within their bounds to facilitate discussion and point out potential options for the two departments. This response supports development of a culture of safety and helps the QI department promote teamwork central to the idea of this culture. 4. Which of the following is MOST likely to be a benefit of concurrent ambulatory surgical case review? a. decreased medical record review at discharge b. an increase in the number of cases failing screening criteria c. an increase in reviewer competence d. decreased medical record requests Rationale: Retrospective review of records occurs after care is delivered. Concurrent case review indicates that the cases are being reviewed while care is being delivered in the ambulatory surgery dept. This should help decrease or prevent the need for medical record review at discharge (option a). Concurrent review should reduce (rather than increase) the number of cases that fail criteria, as listed in option b. It may not affect option d at all multiple departments (not just ambulatory surgery) request medical records and a review of a patient s current record would not reduce the need for prior records to be requested and reviewed by surgery. Concurrent review of ambulatory surgery cases might increase reviewer competence, as in option c, but there would be other factors influencing development of competence as well. 5. A well-designed patient safety program should include all of the following EXCEPT a. an annual patient safety committee meeting b. planned response to adverse events c. orientation and continuing education on patient safety issues d. review of patient safety policies and procedures for all departments. Rationale: Options b, c, and d are all important components of a patient safety program. In option a: although patient safety committee meetings are also important for a welldesigned patient safety program a once-a-year meeting would be insufficient. 6. Discharge planners regularly monitor the number of inappropriate referrals, the timeliness of discharge planning, and the number of days of discharge delays. What additional monitor should be added to evaluate the appropriateness of discharge planning interventions? a. adequacy of documentation in progress notes b. attainment of discharge planning goals c. timeliness of referrals to discharge planning d. number of discharge planning referrals from nursing
Rationale: Option b is the only response that would yield outcome data to evaluate the appropriateness (and effectiveness) of discharge planning interventions and tell us how our patients are doing! Options a, c, and d are process measures that might help us identify areas in need of improvement these would tell us how accurately or efficiently we perform these processes. In addition, Option a would not be highly specific to discharge planning multiple providers place documentation in progress notes and not just for purposes of discharge planning. Options c and d involve referrals to discharge planning a referral is a notification that discharge planning is needed; this would occur prior to any interventions being implemented by a discharge planner. 7. A primary purpose of an information management system is to allow an organization to a. save time b. centralize demographics c. reduce cost d. evaluate data Rationale: Information management systems are primarily used to collect and evaluate data of all types: patient care information, dates and times of care delivery, outcomes of care, costs of goods and services, multiple revenue streams and cost centers, payroll, etc. Such evaluation often leads to greater efficiency and cost reduction. Information management systems can also yield benefits like a centralized location of data demographics being just one type of data centrally stored. 8. Which of the following monitors provides patient outcome information? a. healthcare-acquired infection rate b. nursing care documentation compliance c. antibiotic therapy discontinuation compliance d. equipment malfunction rate Rationale: Options b, c, and d are all referring to process measures that might tell us what we can improve our accuracy or efficiency. Option A is the only outcome measure; it will help tell us how patients are doing. 9. The surgery department's monthly case review revealed twenty-six records meeting the criteria. Six records did not meet the criteria. When calculating the incidence risk, the denominator is a. 6 b. 20 c. 26 d. 32 Rationale: This is a thought problem it is telling you that 26 records in the review did meet criteria (compliant records), so you can t have 6 records out of that 26 that also did
not meet criteria (noncompliant records). So the 6 records that did not meet criteria would be an additional amount (6 records that did not meet criteria + 26 records that did meet criteria = 32 total records). The denominator in a calculation of rate is always the total number in the group being examined. Numerator Denominator - The upper part of a fraction - For example, the number of records that were compliant - The lower part of a fraction used to calculate a rate or ratio - For example, total number of records in the audit 26 32 Rate Numerator/Denominator (26/32 = Compliance Rate) 81% 10. Flowcharts are primarily used in quality improvement to a. analyze causal factors of process dispersion b. understand the overall process or system being audited c. distinguish variations in a process over time d. determine process capability and uniformity Rationale: A flowchart is an illustration of a process it allows us to understand it better (see diagram below for a simple example). Breakdowns in process or causal factors of such breakdowns can be identified in a flowchart but not before the process itself is mapped out and understood. A flowchart will not provide information of process variations that occur over time. It may help you look at process capability, efficiency, and standardization to provide insight into opportunities for improvement of the process but again, the process itself must be mapped out and understood first.
11. In what instance is it acceptable to obtain additional time for a corrective action? a. When the auditor cannot perform the audit as scheduled b. When the group being audited determines that the proposed corrective action is not cost effective c. When the corrective action plan requires more time than originally anticipated d. When there has been a change in personnel who perform the task Rationale: In this question, it helps to dissect the issues down. In option C, additional time will definitely cure the identified problem. In the other responses, additional time may not help we need to find a different auditor or a different schedule for the first one, we probably need more money for the second one (or the group being audited may be trying to offer an excuse to avoid the audit), and in option D, there could be several
problems including time (such as the hiring and training of new personnel or some general instability in that department) that may need to be addressed. Also keep in mind that when a corrective action has been implemented, it is generally because there is a critical issue that must be addressed in an appropriate and timely fashion additional time without good justification is delaying vital action that could potentially save a patient s life. 12. Which of the following statistics best describes the central tendency of a sample of data? a. Mode b. Mean c. Standard deviation d. Range Rationale: Mode, mean, and median are the 3 measures of central tendency. The mode is the value that appears most often in a set of data however, there could be more than one mode if more than one value occurs the same number of times in a data set. Example data set: 10, 5, 6, 10, 6, 7, 5, 3, 6, 4, 5, 10 Modes: 10, 6, and 5 each occurred 3 times. (The median is not one of your choices, but it is the value which occupies the middle position when all the observations are arranged in an ascending/descending order. It divides the frequency distribution exactly into two halves. Example data set: 10, 5, 6, 10, 6, 7, 5, 3, 6, 4, 5, 10 Median= 6 The mean is considered the preferred measure for central tendency. It is the average--the sum of the values in a data set divided by the number of values. Example data set: 10, 5, 6, 10, 6, 7, 5, 3, 6, 4, 5, 10 Mean= 77 divided by 12 = 6.4 Options c and d are not measures of central tendency. The Standard Deviation is a measure of how spread out a set of numbers is. The more spread apart the data, the higher the deviation. (Data plotted out in a wide bell curve represents a higher deviation than a skinny bell curve.) The range of a set of data is basically the difference between the largest and smallest values in a data set. 13. Which of the following requests is likely to obtain the most objective evidence for verification? a. What kind of information do you receive? b. Who provides the information to you? c. Describe how you receive information. d. Show me the information you have received. Rationale: In this question, responses a through c will result in limited or biased information, based on the knowledge base and motivations of the respondent. Viewing the information received gives the investigator an opportunity to objectively review the
data, and then also ask these questions. This will allow comparison between what was actually received and what the level of understanding is about the data. Remember to get objective, scientific information, we need to Test it, Measure it, or Observe it. 14. The process information shown in the graph above is indicative of a a. Cycle b. Run c. Trend d. Shift Rationale: The question is asking for the information contained in the chart to be interpreted (not for the type of chart to be identified). The chart above is a control chart (a special kind of run chart) demonstrating an upward trend from the initial baseline we clearly see more than 5 data points all going in the same direction. We don t have enough information here to decide if the trend is positive or negative, but it is a trend nevertheless. The control chart will also tell us whether a process is out of control or not. Due to the data being plotted between the upper and lower control limits (UCL and LCL), we have good assurance that the process is in control. There are several ways to interpret the information presented in a run or control chart. We need to look for shifts, runs, and trends. For more, see this article: http://www.med.unc.edu/cce/files/educationtraining/the%20run%20chart%20a%20simple%20analytical%20tool.pdf/at_download/fil e
The run chart below does not demonstrate a clear trend in the process being measured. An example of a cycle would be an EKG strip this usually shows a clear return to the baseline at regular intervals.
The picture below is an example of a shift as you can see the second trend starts with different baseline or beginning data, indicating a huge increase in demand in this case. The figure below shows a run chart with clear trends, including a concerning rise in infection rates. A mean or average line and a target line are also provided.