Cardiac Vascular Nursing Exam Quality Control & Assurance 2 — Questions and Answers
Question 1: A cardiovascular unit is implementing a Plan-Do-Study-Act (PDSA) cycle to reduce door-to-balloon times. Which phase involves analyzing collected data to determine if the change was effective?
- Plan
- Do
- Study (Correct answer)
- Act
Correct answer: Study
The Study phase involves analyzing data collected during the Do phase to evaluate whether the intervention achieved the desired improvement.
Question 2: A nurse notices that the anticoagulation protocol for STEMI patients is being inconsistently applied across shifts. Which quality improvement tool best identifies the root cause of this variation?
- Run chart
- Fishbone (Ishikawa) diagram (Correct answer)
- Control chart
- Pareto chart
Correct answer: Fishbone (Ishikawa) diagram
A fishbone diagram systematically categorizes potential root causes (people, process, equipment, environment) contributing to a problem.
Question 3: Which metric is considered the gold standard for measuring quality of care in ST-elevation myocardial infarction (STEMI) management?
- Door-to-ECG time under 10 minutes
- Door-to-balloon time under 90 minutes (Correct answer)
- Aspirin administration within 24 hours
- Beta-blocker use at discharge
Correct answer: Door-to-balloon time under 90 minutes
Door-to-balloon (DTB) time ≤90 minutes is the ACC/AHA benchmark quality indicator for primary PCI in STEMI patients.
Question 4: A cardiac cath lab reviews its radiation dose records as part of quality assurance. A patient's cumulative fluoroscopy time appears unusually high. What is the most appropriate next QA step?
- Report to the state radiation safety board immediately
- Compare the case against established dose reference levels and conduct peer review (Correct answer)
- Suspend the performing cardiologist pending investigation
- Notify the patient that an error occurred
Correct answer: Compare the case against established dose reference levels and conduct peer review
Comparing doses against diagnostic reference levels and conducting structured peer review determines whether the dose was clinically justified before escalating.
Question 5: In the context of cardiac nursing quality metrics, what does 'failure to rescue' measure?
- Rate of missed defibrillation during cardiac arrest
- Death rate among patients who develop a serious complication (Correct answer)
- Percentage of patients who do not receive prescribed medications
- Incidence of unplanned extubation in cardiac ICU patients
Correct answer: Death rate among patients who develop a serious complication
Failure to rescue is a quality indicator measuring mortality among patients who develop a major complication, reflecting nurses' ability to detect and act on deterioration.
Question 6: A cardiovascular unit tracks its central line-associated bloodstream infection (CLABSI) rate. After implementing a CLABSI bundle, the rate drops from 3.2 to 0.8 per 1,000 line-days. Which statement best describes this outcome?
- The result is clinically significant only if statistically significant
- A 75% reduction suggests the bundle is highly effective and should be sustained (Correct answer)
- The rate should be compared to a national benchmark before drawing conclusions
- Control charts must confirm the change before action is warranted
Correct answer: A 75% reduction suggests the bundle is highly effective and should be sustained
A 75% reduction in CLABSI rate is a clinically meaningful improvement; sustaining the bundle while continuing to monitor is appropriate.
Question 7: During a quarterly quality review, a cardiac nurse manager presents data showing that 30-day readmission rates for heart failure patients have increased. Which intervention has the strongest evidence for reducing these readmissions?
- Increasing inpatient length of stay by one day
- Implementing a structured discharge education and early follow-up program (Correct answer)
- Prescribing higher doses of loop diuretics at discharge
- Reducing sodium restrictions to improve medication adherence
Correct answer: Implementing a structured discharge education and early follow-up program
Structured discharge education combined with early post-discharge follow-up (within 7 days) is evidence-based for reducing heart failure readmissions.
Cardiac Vascular Nursing Exam Quality Control & Assurance 2
A cardiovascular unit is implementing a Plan-Do-Study-Act (PDSA) cycle to reduce door-to-balloon times.
Which phase involves analyzing collected data to determine if the change was effective?