These 12 original questions follow the CPHQ style: short clinical or operational scenarios where more than one answer sounds reasonable and you have to pick the best one. Answer each, read the explanation, and check your score at the end.
How to get the most from these
- Commit to an answer before you look at the explanation. Guessing then reading feels productive but builds less.
- Read explanations for questions you got right. You may have been right for the wrong reason.
- Aim for about 75 seconds per question, the real exam pace.
Questions 1–4
A medical unit wants to try a new bedside discharge checklist. The team is unsure whether nurses will use it consistently. What is the best next step?
When you want to learn whether a change works and how people use it, a small-scale PDSA test is the fastest, lowest-risk approach. Results inform the next cycle before spreading. DMAIC is heavier than needed, house-wide rollout skips testing, and FMEA assesses process risk rather than testing a change.
A control chart of monthly patient falls shows the last 8 data points all above the centerline, but all within the control limits. How should this be interpreted?
A run of 8 or more consecutive points on one side of the centerline is a widely used rule for special cause variation, even when every point is inside the limits. (Some rule sets use 7 or 9.) Something has shifted the process and deserves investigation. A point outside the limits is only one of several signals.
A hospital tracks the percentage of sepsis patients who receive antibiotics within one hour. The number of sepsis patients varies each month. Which control chart is most appropriate?
Each patient either did or did not get timely antibiotics, so the data are attribute data counting "defectives," expressed as a proportion. With a varying sample size, the p-chart is correct. The np-chart needs a constant sample size, the c-chart counts defects with a constant area of opportunity, and X-bar and R charts are for continuous measurements.
A hospital is about to introduce new smart infusion pumps. Leadership wants to identify how errors could occur before the pumps go live. Which approach fits best?
FMEA is a proactive (prospective) risk assessment: the team maps the new process, identifies how each step could fail, and prioritizes fixes before harm occurs. RCA is retrospective, used after an event. Pareto and run charts analyze existing data, which doesn't exist yet for the new pumps.
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Questions 5–8
A nurse skips scanning a patient's wristband because the scanner is slow and other nurses on the unit routinely skip it. No harm occurs. Using a Just Culture approach, what is the most appropriate response?
This is at-risk behavior: a choice where the risk was not recognized or was believed justified, often because the shortcut has become normalized. The Just Culture response is coaching, plus fixing the system drivers (the slow scanner, unit norms). Human error calls for consoling; reckless behavior may warrant sanction. The response depends on the behavior, not the outcome.
A new screening tool is tested on 1,000 patients. Results: 90 true positives, 10 false negatives, 30 false positives and 870 true negatives. What is the sensitivity?
Sensitivity = true positives ÷ (true positives + false negatives) = 90 ÷ 100 = 90%. The distractors are other values from the same table: 75% is the positive predictive value (90 ÷ 120), 96.7% is specificity (870 ÷ 900), and 98.9% would be the negative predictive value (870 ÷ 880).
The governing board asks for a way to monitor the organization's quality performance at each meeting. What should the quality director provide?
Boards need concise, strategic information to fulfill their oversight role. A dashboard showing key measures against targets over time lets them see performance at a glance and ask the right questions. Raw data, full incident reports and every RCA are too detailed and operational for governance.
A team has brainstormed dozens of possible causes of delayed lab results. What is the main purpose of placing these causes on a fishbone diagram?
A cause-and-effect (fishbone or Ishikawa) diagram groups potential causes into categories such as people, methods, equipment and environment. It does not rank them; a Pareto chart does that. RPNs belong to FMEA, and variation over time belongs on a run or control chart.
Questions 9–12
A surgeon new to the hospital has just been granted clinical privileges. Which type of practitioner evaluation is required?
The Joint Commission requires focused professional practice evaluation (FPPE) for all practitioners newly granted privileges, as well as when questions arise about a practitioner's performance. Ongoing professional practice evaluation (OPPE) is the continuous monitoring that applies to everyone once privileged.
A review of heart failure readmissions shows many patients never attended a follow-up visit after discharge. Which intervention most directly addresses this gap?
The identified failure is a missed follow-up visit. Booking the appointment before discharge and addressing barriers like transportation targets that exact care transition gap. A longer stay adds cost without fixing follow-up, a clinic list shifts the burden to the patient, and staff education is a weak, indirect fix.
A hospital wants to demonstrate compliance with Medicare Conditions of Participation through accreditation instead of routine state agency surveys. What should it pursue?
CMS grants deeming authority to approved accrediting organizations such as The Joint Commission and DNV. Accreditation by one of them is accepted as meeting the Medicare Conditions of Participation. ISO certification alone, Magnet and Baldrige recognize quality but do not confer deemed status.
A clinic tracks "percentage of patients with diabetes who had an HbA1c test in the past 12 months." Using Donabedian's framework, what type of measure is this?
Process measures capture whether care that should happen actually happened, like testing HbA1c. A structure measure describes capacity (for example, having a diabetes educator on staff), an outcome measure describes the result for the patient (for example, HbA1c below target), and a balancing measure watches for unintended consequences of a change.
What your score means
| Score | What it suggests | Next step |
|---|---|---|
| 10–12 | Strong across categories | Move to full-length timed practice exams |
| 7–9 | On track with gaps | Target the categories you missed with focused question sets |
| 0–6 | Foundation work needed | Start with the study guide and build a weighted plan |
Frequently asked questions
No. These are original practice questions written to match the style and content outline of the exam. Using actual exam items is prohibited by NAHQ, so avoid any source that claims to sell them.
Aim for at least several hundred questions plus at least one full-length, timed 140-question practice exam. Volume matters less than reviewing every explanation, including the ones you got right.
Consistently scoring around 75% or higher on fresh, exam-style questions across all categories is a reasonable signal. Watch your weakest heavy-weight category more than your overall average.
CPHQ Qbank has 500+ scenario-based questions mapped to the NAHQ content outline. The first 50 are free.
Figures are from NAHQ's 2024 CPHQ Detailed Content Outline (Revision 2b) and 2024 Domestic Candidate Handbook unless noted. Fees and policies change; the current handbook on nahq.org is the controlling source.