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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 orÂ
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