1. An advanced practice nurse (APN) is working in a rural clinic that

provides primary care to a low-income population. The APN notices that

many of the patients have chronic conditions such as diabetes,

hypertension, and asthma that are poorly controlled. The APN wants to

implement a quality improvement project to improve the outcomes of

these patients. Which of the following steps should the APN take first?

a) Conduct a needs assessment to identify the gaps and barriers in the

current care delivery system.

b) Develop a multidisciplinary team that includes other health care

professionals, community leaders, and patients.

c) Establish measurable goals and objectives for the project based on

evidence-based guidelines and best practices.

d) Evaluate the impact of the project on patient outcomes, satisfaction, and

cost-effectiveness.

*Answer: A. Rationale: A needs assessment is a systematic process of

collecting and analyzing data to determine the current situation and

identify the problems and needs of a specific population or setting. It is an

essential first step in any quality improvement project as it helps to define

the scope, priorities, and resources for the project.*

2. A nurse practitioner (NP) is collaborating with a physician in a family

practice clinic. The NP sees a 45-year-old female patient who complains

of fatigue, weight gain, dry skin, hair loss, and constipation. The NP

suspects that the patient has hypothyroidism and orders a thyroid function

test. The test results show that the patient has a low level of thyroidstimulating hormone (TSH) and a normal level of free thyroxine (T4).

How should the NP interpret these results?

a) The patient has primary hypothyroidism and needs thyroid hormone

replacement therapy.

b) The patient has secondary hypothyroidism and needs further evaluation

of the pituitary gland.

c) The patient has subclinical hypothyroidism and needs close monitoring

and follow-up.

d) The patient has euthyroid sick syndrome and needs supportive care and

treatment of the underlying cause.

*Answer: B. Rationale: Secondary hypothyroidism is caused by a

deficiency of TSH due to a disorder of the pituitary gland or