Certified Obstetric and Neonatal Quality and Safety Practice Test

C-ONQS test Format | Course Contents | Course Outline | test Syllabus | test Objectives

Exam Code: C-ONQS
Certification Name: NCC Certified Obstetric and Neonatal Quality and Safety (C-ONQS)
Issuing Organization: National Certification Corporation (NCC)
Exam Type: Computer-based, multiple-choice questions
Number of Questions: ~150-175 (including unscored pilot questions)
Duration: 3 hours
Passing Score: Scaled score (typically around 70-75% correct)

I. Methods to assess organization, institutional and environmental culture and patient experience
- Healthcare quality improvement goals
- Domains of quality
- Timeliness
- Effectiveness
- Patient centered
- Efficiency
- Safety
- Equitability
- Dimensions of quality (Donabedian)
- Structure
- Process
- Outcome
- System goals
- Population health
- Patient experience
- Healthcare

- Adverse events and event reporting
- Monitoring and procedure surveillance
- Incident/safety reports
- Near misses
- Root cause analysis
- Mortality and morbidity
- Methods of event reporting
- Video
- Direct observation
- Auditing
- Patient reported events
- Institutional processes and priorities
- Regulatory
- Certifications
- Accreditation
- Peer-review
- Assessment strategies
- Defining population
- Assembling teams
- Reviewing literature
- Identifying measures
- Assessing patient/family perspective
- Assess and Strengthen organizational culture
- Culture
- Just culture

II. National Quality and Safety Standards and Clinical Guidelines
- Awareness of legal/statutory and national quality and safety standards and clinical practice guidelines in obstetrical and neonatal care
- Perinatal core measures
- GBS guidelines
- Guidelines to prevent hospital associated infections
- Guidelines for perinatal care current edition
- AWOHNN guidelines Maternal health

III. Quality and Safety metrics to identify state of performance, gaps and opportunities
- General quality and safety principles and terminology
- Quality assurance versus quality improvement
- Quality versus safety
- Metrics
- outcome
- process
- structure
- access
- Risk adjustment
- Benchmarking
- Gap analysis
- Participation and shared decision making
- Systems thinking
- Methodologies of data display
- How to implement and evaluate data collection strategies
- Process tools
- Huddle tools
- Trigger tools
- Chart review

I. Quality and Safety aims, tools, checklists and communication strategies
- Human psychology and cognition
- Situational awareness
- Violations of process/protocols
- Risk taking
- Fear of repercussions
- Cognitive biases
- Attention and distractions
- Stress
- Burn out and fatigue
- Safety climate
- Briefings
- Family involvement councils
- Committees
- Collaborations and effective communication strategies
- Standardized communication
- Handoffs
- SBAR
- I-PASS
- Debriefing
- Care transitions

II. Team function, leadership, empowerment
- Leadership skills
- Self-awareness/management
- Mentoring
- Sustainability
- Succession and transition planning
- Communication and conflict management
- Change management
- Principles and concepts of teams
- Team development
- Structures and function
- Diversity and inclusivity
- Collaboration
- Mutual respect
- Information diffusion
- Team meetings
- Code of conduct

III. Training exercises, learning principles, mock codes and simulation
- Effective learning/teaching principles
- Adult learning principles
- Generational learning styles
- Remote or distance learning methodologies
- Interprofessional
- Use and principles of simulation
- Unit drills
- Simulated care processes

IV. Advocating for ongoing resources, risk management
- Methods for determining human resource needs
- Hours per patient day
- Work hours per unit of service
- Work hours per birth
- Clinician to patient ratio
- Standards for staffing
- Human factors that impact the work environment
- EMR
- Medical devices
- Alarm fatigue
- Distractions
- Interruptions
- Overcrowding
- Noise
- Ergonomics of procedures
- Patient census acuity
- Staffing
- Fatigue
- Work arounds
- Design of systems and processes
- Relevant aspects of structural design standards
- Layout and design
- Resource placement
- Lighting
- Signage and way finding

V. Inform and disseminate outcome data, benchmarking and transparency
- Various methods for educating and disseminating QNS data to various stakeholders
- Annual reports
- Presentations
- Publications
- Public reporting
- Websites
- Social/other medias
- Share data on key quality indicators with colleagues/organizations to improve
- Education campaigns
- Peer
- Benchmarking/accountability

I. Selecting and monitoring key quality metrics
- Prioritize opportunities for improvement
- Relative importance to different stakeholders
- Patient, family, provider, facility, healthcare, system, payor
- Develop goal statements
- Specific
- Measurable
- Achievable
- Relevant
- timebound
- Types of metrics
- Outcome
- Process
- Structure
- Access
- Patient experience
- Patient satisfaction
- Balancing measures and metrics
- Unintended consequences of metrics
- Balancing measure to mitigate unintended consequences
- Outcome, process and structure measures
- Familiarity with common methods for quality and safety improvement initiatives
- Models for improvement
- PDSA/PDCA
- Improve
- Six sigma
- Lean

II. Identify population, measures and data collection
- Project team formation and dynamics
- Identification of stakeholders
- Identification of champions
- Influencer model
- Patient/family perspective
- Appraise and prioritize literature relevant to project
- Randomized trials
- Meta-analysis
- Expert opinion
- Observational studies
- Consensus documents

- Improvement process
- Selection of interventions
- Planning implementation
- Tracking of improvements
- Data definitions
- Data collection
- Data quality assurance
- Graphs and tables
- Analysis
- Interpretation

III. Integration into workflow, error prevention strategies and auditing
- Errors and Risk reduction strategies and use of cognitive aids
- Bundles
- Checklists
- Flow sheets
- Timeouts
- Guidelines
- Structured communication
- Patient identification
- Barcodes
- E-prescribing
- Computerized physician order entry
- Medication administration processes
- Human milk handling processes
- Blood product administration processes
- Food and nutrition safety
- Errors and Risk reduction strategies and use of cognitive aids
- Feedback
- Surveillance

I. Tools of evaluation (Fishbone, flow chart, run chart, control charts)
- Evaluation of outcomes and performance improvement
- Run charts
- Control charts
- Dashboards
- Interpret data
- Role of technology in quality improvements
- Data standardization and retrieval
- Standardization of EMR

II. Evaluate the balance between quality, outcomes and cost
- Understanding the interplay between costs, quality and value from the perspective of various stakeholders
- Monetary
- Non-monetary
- Patient and family experience
- Value equals quality divided by cost
- Identification of waste
- Duplication
- Tools to identify waste
- Wait times

III. Strategies for sustainment and positive change
- Recognition of threats to implementation and sustainability
- Fatigue
- Project fatigue
- Backsliding
- Knowledge exclusivity
- Large scale implementation without testing
- Research models
- Knowledge degradation
- Lack of upper-level support/commitment
- Lack of team integrity
- Lack of personnel
- Competing priorities
- Disruptive behavior
- Hierarchical professional behaviors
- Steps in project sustainability
- Communication
- Reporting
- Ongoing ownership
- Celebration of success
- Modification of data collection and review

I. Adverse events, disclosures, transparency, patient trust and risk mitigation
- Elements of effective disclosure
- Mandatory versus voluntary disclosure
- Disclosure of errors and near misses
- Explanation as to why error occurred
- How effects will be minimized
- Steps to prevent recurrences
- Apology
- Acknowledgement of responsibility
- Distinguishing different types of error including system error, blameless human error (inadvertent), and accountable human error (at risk, reckless, intentional harm)
- Differentiating human error from system error
- Differentiate between human error, at risk behavior, and reckless behavior
- Understanding and mitigating psychological harm experience by the patient and second victims
- Second victims
- Debriefing
- Communication strategies
- Counseling, employee assistance
- Support groups
- Emotional support

II. Professional and ethical issues
- Ethical principles as they apply to patients, families, providers and organizations
- Patient/family access
- Fairness, truthfulness, justice, beneficence, nonmaleficence, autonomy
- Awareness of differences between quality improvement projects and research
- Human subject protections
- IRB or local approval mechanism
- Compare research to quality improvement

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Question: 383
A quality team is identifying measures for a preterm birth reduction initiative. Which measure is most appropriate for assessing program effectiveness?
1. Rate of preterm births before 37 weeks
2. Patient satisfaction with prenatal care
3. Staff compliance with training modules
Answer: A
Explanation: Rate of preterm births before 37 weeks is the most appropriate measure, as it directly evaluates the clinical outcome targeted by the initiative. Patient satisfaction, while important, does not measure clinical effectiveness. Staff compliance with training is an indirect measure that does not directly assess preterm birth rates.
Question: 384
A multidisciplinary team is formed to address high rates of postpartum hemorrhage in a labor and delivery unit. The team includes obstetricians, nurses, and anesthesiologists, but there is resistance from some staff due to unclear roles. Which strategy is most effective in optimizing team dynamics and ensuring project success?
1. Conduct a stakeholder analysis to clarify roles and align expectations
2. Assign roles based on seniority to streamline decision-making
3. Implement a top-down directive to enforce participation
Answer: A
Explanation: Conducting a stakeholder analysis to clarify roles and align expectations is the most effective strategy, as it identifies individual interests, influence, and responsibilities, fostering collaboration and reducing resistance. Assigning roles based on seniority may overlook expertise and create resentment, while a top-down directive risks disengagement by ignoring team input.
Question: 385
A nurse observes a colleague bypassing hand hygiene protocols but does not report it, fearing interpersonal conflict. What psychological factor is most influencing this decision?
1. Cognitive bias
2. Fear of repercussions
3. Situational awareness deficit
Answer: B
Explanation: Fear of repercussions, specifically interpersonal conflict, drives the nurse�s decision not to report the violation, as the scenario explicitly mentions fear of confrontation. Cognitive bias and situational awareness deficit are not indicated, as the nurse is aware of the violation but chooses not to act.
Question: 386
A hospital is implementing the CDC�s 2023 HAI guidelines to reduce surgical site infections (SSIs) post- cesarean. Which intervention is most critical?
1. Routine postoperative antibiotic prophylaxis for 48 hours
2. Administering preoperative antibiotics within 60 minutes of incision
3. Weekly staff education on sterile technique
Answer: B
Explanation: Administering preoperative antibiotics within 60 minutes of incision is most critical, as CDC guidelines emphasize timely prophylaxis to reduce SSI risk. Routine postoperative antibiotics are not recommended, as they increase resistance risk. Weekly staff education is supportive but less impactful than timely antibiotics.
Question: 387
An obstetric unit implements a new protocol for managing shoulder dystocia. The team uses a control chart to monitor the time to delivery after diagnosis. What does this methodology primarily assess?
1. Common versus special cause variation
2. Most frequent causes of delays
3. Performance gaps compared to benchmarks
Answer: A
Explanation: Control charts assess whether variations in a process, such as time to delivery, are due to common causes (inherent) or special causes (specific events). Identifying frequent causes uses Pareto or fishbone diagrams, and performance gaps involve benchmarking or gap analysis.
Question: 388
A hospital�s peer review identifies gaps in neonatal transport safety. Which dissemination method best educates staff on new protocols?
1. Simulation-based training with transport scenarios
2. Annual report with transport data
3. Staff memo with protocol updates
Answer: A
Explanation: Simulation-based training with transport scenarios provides hands-on learning, ensuring staff understand and apply new protocols. Annual reports and memos lack the practical engagement needed for safety training.
Question: 389
During a simulation for eclampsia management, the facilitator aims to align with adult learning principles. Which debriefing technique should be used to enhance learning?
1. Deliver a lecture on correct procedures
2. Facilitate discussions linking actions to outcomes
3. Provide written feedback without dialogue
Answer: B
Explanation: Adult learning principles emphasize reflective, outcome-focused learning. Facilitating discussions linking actions to outcomes allows participants to reflect on their decisions and their impact, enhancing learning. Lectures and written feedback without dialogue are less interactive and reflective.
Question: 390
A quality and safety team is developing a remote training program for neonatal transport. To incorporate effective distance learning methodologies, which approach ensures active engagement and knowledge retention?
1. Live virtual simulations with real-time feedback
2. Asynchronous video lectures with no interaction
3. Self-paced multiple-choice quizzes with delayed feedback
Answer: A
Explanation: Effective distance learning methodologies prioritize active engagement and immediate feedback to enhance retention. Live virtual simulations with real-time feedback allow learners to practice skills in a dynamic, interactive environment, closely mimicking real-world scenarios. Asynchronous video lectures and self-paced quizzes with delayed feedback lack the immediacy and interactivity needed for optimal engagement.
Question: 391
A quality improvement team is planning to implement a new protocol for maternal hemorrhage. What is the most effective way to ensure successful implementation?
1. Implement immediately to address urgency
2. Develop a detailed timeline with stakeholder input
3. Train only senior staff to lead the change
Answer: B
Explanation: Developing a detailed timeline with stakeholder input ensures structured implementation, aligns expectations, and addresses barriers. Immediate implementation risks chaos, and training only senior staff limits engagement and scalability.
Question: 392
A neonatal unit aims to Strengthen inclusivity after feedback about biased decision-making. What is the best approach to promote diversity and inclusivity in team processes?
1. Establish a diversity committee to oversee all decisions
2. Require all decisions to be approved by a diverse panel
3. Implement bias training with follow-up accountability measures
Answer: C
Explanation: Implementing bias training with follow-up accountability measures addresses root causes of bias while fostering inclusivity through actionable steps. A diversity committee may add bureaucracy without ensuring cultural change. Requiring diverse panel approval is impractical and may delay critical decisions.
Question: 393
A postpartum unit is aligning with AWHONN�s 2022 maternal health guidelines for hypertensive disorders. A patient develops severe postpartum hypertension (BP >160/110). Which action best reflects AWHONN recommendations?
1. Administering oral antihypertensives and monitoring for 24 hours
2. Initiating IV antihypertensive therapy immediately
3. Reassessing blood pressure in 4 hours without medication
Answer: B
Explanation: Initiating IV antihypertensive therapy immediately aligns with AWHONN�s guidelines, which recommend prompt treatment for severe hypertension to prevent complications like stroke. Administering oral antihypertensives is slower-acting and less appropriate for severe cases. Reassessing without medication delays critical intervention.
Question: 394
A nurse in the NICU bypasses a safety protocol to expedite a medication administration due to understaffing during a high-acuity shift. This behavior is an example of which human factor impacting safety?
1. Workarounds due to staffing shortages
2. Inadequate ergonomic design
3. Fatigue-related errors
Answer: A
Explanation: Workarounds due to staffing shortages describe the nurse�s decision to bypass a safety protocol to manage workload under time pressure, a common response to understaffing. Fatigue-related errors would involve cognitive lapses, not deliberate protocol bypass. Inadequate ergonomic design pertains to physical workspace issues, not staffing-related behavior.
Question: 395
A NICU team tracks central line maintenance compliance as a process metric. Which metric best evaluates the impact of this process?
1. Structure metric: Number of trained staff
2. Process metric: Frequency of line audits
3. Outcome metric: Rate of CLABSIs
Answer: C
Explanation: The outcome metric, rate of CLABSIs, directly evaluates the impact of central line maintenance compliance, as it measures the clinical outcome (infection rates) tied to the process. Frequency of line audits is another process metric, and the number of trained staff is a structure metric, both less directly tied to patient outcomes.
Question: 396
A NICU�s overcrowding leads to equipment being placed in hallways, delaying access during an emergency. Which human factor is most impacting safety?
1. Alarm fatigue
2. Medical devices
3. Overcrowding
Answer: C
Explanation: Overcrowding, with equipment in hallways, directly delays emergency access. Alarm fatigue and medical devices are not the primary issues.
Question: 397
A quality improvement project aims to Strengthen breastfeeding rates in the postpartum unit. After selecting a bundle of interventions, what is the most effective method to plan implementation?
1. Implement the bundle hospital-wide immediately
2. Conduct a pilot test in one unit before full rollout
3. Survey staff to finalize the intervention bundle
Answer: B
Explanation: Conducting a pilot test in one unit allows the team to assess feasibility, identify barriers, and refine the intervention before hospital-wide implementation. Immediate full rollout risks unforeseen issues, and surveying staff focuses on input rather than testing the intervention�s effectiveness.
Question: 398
A hospital�s perinatal quality team aims to Strengthen population health by reducing neonatal sepsis rates. They implement a hand hygiene campaign but see no change in rates. Which metric best evaluates the campaign�s effectiveness?
1. Neonatal sepsis incidence rate
2. Hand hygiene compliance rate
3. Staff satisfaction with the campaign
Answer: A
Explanation: Effectiveness is measured by the impact on the targeted health outcome. Neonatal sepsis incidence rate directly assesses whether the hand hygiene campaign reduces sepsis, aligning with population health goals. Compliance rate measures process, and satisfaction is unrelated to effectiveness.
Question: 399
A hospital is implementing a sustainability initiative to reduce waste in the obstetric unit. The quality and safety leader notices resistance from staff due to increased workload. What is the most effective approach to ensure long-term sustainability of the initiative?
1. Integrate waste reduction into existing workflows with staff input
2. Enforce mandatory compliance with waste reduction protocols
3. Offer financial incentives for staff who meet waste reduction targets
Answer: A
Explanation: Integrating waste reduction into existing workflows with staff input promotes sustainability by addressing workload concerns and fostering ownership, reducing resistance. Enforcing mandatory compliance may lead to resentment and burnout, undermining long-term adherence. Offering financial incentives may drive short-term compliance but fails to address workflow integration or intrinsic motivation, risking regression when incentives end.
Question: 400
A perinatal quality manager notices increased medication errors since implementing a new electronic medical record (EMR) system. Staff report difficulty navigating the interface during high-pressure situations. Which human factor is most likely contributing?
1. EMR
2. Medical devices
3. Noise
Answer: A
Explanation: A poorly designed EMR interface can increase errors in high-pressure settings due to usability issues, a common human factor in healthcare. Medical devices and noise are unrelated to the EMR-specific navigation challenges described.
Question: 401
A neonatal unit experiences a medication error due to a nurse misinterpreting a handwritten order for phenobarbital. Which technology-based cognitive aid would most effectively reduce this type of error?
1. Computerized physician order entry (CPOE) system
2. Barcoding for medication administration
3. Structured handoff checklist
Answer: A
Explanation: A computerized physician order entry (CPOE) system eliminates handwritten orders, reducing misinterpretation risks by standardizing and clarifying medication orders. Barcoding ensures correct administration but does not address errors originating from order transcription. A structured handoff checklist improves communication but is not directly relevant to preventing errors from handwritten orders.
Question: 402
An interprofessional team is conducting a unit drill for umbilical cord prolapse. Which facilitation technique enhances learning across disciplines?
1. Shared debriefing with role clarification
2. Discipline-specific debriefing sessions
3. Written feedback without discussion
Answer: A
Explanation: Shared debriefing with role clarification fosters interprofessional learning by allowing team members to discuss roles, share perspectives, and Strengthen collaboration. Discipline-specific debriefing isolates learning, and written feedback without discussion limits interactive reflection.
Question: 403
During a unit drill for neonatal sepsis, the facilitator aims to align with adult learning principles. Which debriefing strategy should be prioritized?
1. Deliver a summary of errors with corrections
2. Facilitate reflective discussions on decision-making
3. Provide written feedback only
Answer: B
Explanation: Adult learning principles emphasize reflection and experiential learning. Facilitating reflective discussions on decision-making allows participants to analyze their choices and outcomes, enhancing learning. Delivering a summary of errors is less interactive, and written feedback alone limits reflective dialogue.
Question: 404
A hospital�s neonatal quality team identifies a gap in hand hygiene compliance. Which education campaign strategy is most effective for improving adherence among staff?
1. Display posters with compliance statistics
2. Implement real-time feedback audits with coaching
3. Send monthly email reminders with guidelines
Answer: B
Explanation: Real-time feedback audits with coaching provide immediate, personalized intervention, directly addressing behavior. Posters and emails are less interactive and have limited impact on sustained compliance.

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