D026 NURS 5203
Quality Outcomes in a
Culture of Value Based
Nursing Care
Final Assessment Review
(With Solutions)
2025
1
,1. A 78‐year‐old patient with congestive heart failure is discharged
home. Within 10 days, he returns with volume overload. As the nurse
quality manager, which intervention aligns best with value‐based
incentives to reduce 30-day readmissions?
a. Increase frequency of in-hospital diuretic dosing
b. Schedule a telehealth visit within 48 hours of discharge
c. Refer for home physical therapy
d. Prescribe a higher-dosage ACE inhibitor
ANS: b. Schedule a telehealth visit within 48 hours of discharge
Rationale: Early post-discharge telehealth follow-up has been
shown to identify issues promptly, improve medication adherence,
and reduce preventable readmissions under value-based purchasing
programs.
2. In analyzing HCAHPS (Hospital Consumer Assessment of
Healthcare Providers and Systems) data, a unit reports low scores for
“communication with nurses.” According to Donabedian’s model,
which domain is being evaluated?
a. Structure
b. Process
c. Outcome
d. Balancing measure
ANS: b. Process
Rationale: Communication with nurses is a process measure—how
care is delivered—whereas structure refers to staffing and
equipment, and outcome refers to end results like mortality or
readmission.
3. Under CMS’s Value-Based Purchasing program, which metric most
directly affects hospital reimbursement?
a. Unit nurse turnover rate
2
, b. 30-day all-cause readmission rate
c. Number of HCAHPS “cleanliness” complaints
d. Annual profit margin
ANS: b. 30-day all-cause readmission rate
Rationale: CMS penalizes hospitals financially for excessive 30-day
readmissions, making this a key outcome metric in value-based
payment.
4. A nurse leader applies Lean methodology to reduce medication
administration delays. Which Lean tool focuses on workplace
organization to eliminate waste?
a. Fishbone (Ishikawa) diagram
b. PDSA cycle
c. 5S (Sort, Set in order, Shine, Standardize, Sustain)
d. FMEA (Failure Mode and Effects Analysis)
ANS: c. 5S (Sort, Set in order, Shine, Standardize, Sustain)
Rationale: 5S is a Lean tool used to organize and standardize the
workplace to reduce wasted time and motion.
5. A hospital reduces central line–associated bloodstream infections
(CLABSIs) via a bundle approach. Which statement best describes
this strategy?
a. It’s a pay-for-performance penalty applied by CMS.
b. It’s a process standardization to improve outcomes.
c. It’s a structure measure ensuring adequate staffing.
d. It’s an outcome benchmark reported annually.
ANS: b. It’s a process standardization to improve outcomes.
Rationale: Care bundles specify evidence‐based practices
(processes) that, when implemented together, reduce CLABSI rates.
6. During a root‐cause analysis of frequent patient falls, the team
identifies unclear handoff communication as a contributor. Which
3
Quality Outcomes in a
Culture of Value Based
Nursing Care
Final Assessment Review
(With Solutions)
2025
1
,1. A 78‐year‐old patient with congestive heart failure is discharged
home. Within 10 days, he returns with volume overload. As the nurse
quality manager, which intervention aligns best with value‐based
incentives to reduce 30-day readmissions?
a. Increase frequency of in-hospital diuretic dosing
b. Schedule a telehealth visit within 48 hours of discharge
c. Refer for home physical therapy
d. Prescribe a higher-dosage ACE inhibitor
ANS: b. Schedule a telehealth visit within 48 hours of discharge
Rationale: Early post-discharge telehealth follow-up has been
shown to identify issues promptly, improve medication adherence,
and reduce preventable readmissions under value-based purchasing
programs.
2. In analyzing HCAHPS (Hospital Consumer Assessment of
Healthcare Providers and Systems) data, a unit reports low scores for
“communication with nurses.” According to Donabedian’s model,
which domain is being evaluated?
a. Structure
b. Process
c. Outcome
d. Balancing measure
ANS: b. Process
Rationale: Communication with nurses is a process measure—how
care is delivered—whereas structure refers to staffing and
equipment, and outcome refers to end results like mortality or
readmission.
3. Under CMS’s Value-Based Purchasing program, which metric most
directly affects hospital reimbursement?
a. Unit nurse turnover rate
2
, b. 30-day all-cause readmission rate
c. Number of HCAHPS “cleanliness” complaints
d. Annual profit margin
ANS: b. 30-day all-cause readmission rate
Rationale: CMS penalizes hospitals financially for excessive 30-day
readmissions, making this a key outcome metric in value-based
payment.
4. A nurse leader applies Lean methodology to reduce medication
administration delays. Which Lean tool focuses on workplace
organization to eliminate waste?
a. Fishbone (Ishikawa) diagram
b. PDSA cycle
c. 5S (Sort, Set in order, Shine, Standardize, Sustain)
d. FMEA (Failure Mode and Effects Analysis)
ANS: c. 5S (Sort, Set in order, Shine, Standardize, Sustain)
Rationale: 5S is a Lean tool used to organize and standardize the
workplace to reduce wasted time and motion.
5. A hospital reduces central line–associated bloodstream infections
(CLABSIs) via a bundle approach. Which statement best describes
this strategy?
a. It’s a pay-for-performance penalty applied by CMS.
b. It’s a process standardization to improve outcomes.
c. It’s a structure measure ensuring adequate staffing.
d. It’s an outcome benchmark reported annually.
ANS: b. It’s a process standardization to improve outcomes.
Rationale: Care bundles specify evidence‐based practices
(processes) that, when implemented together, reduce CLABSI rates.
6. During a root‐cause analysis of frequent patient falls, the team
identifies unclear handoff communication as a contributor. Which
3
