# The nurse manager reviews a unit quality-improvement cycle. Which actions require follow-up? Highlight the actions that interfere with a valid Plan-Do-Study-Act test of change.

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> subject: Assignment/Delegation/Supervision  
> category: MOC

## Question

The nurse manager reviews a unit quality-improvement cycle. Which actions require follow-up? Highlight the actions that interfere with a valid Plan-Do-Study-Act test of change.

| Cycle step | Documented team action |
| --- | --- |
| Act | Expands the change hospital-wide before reviewing the first-cycle data |
| Plan | Defines a prediction and one process measure before testing begins |
| Do | Records unexpected workflow observations during the single-shift trial |
| Study | Compares collected results with the prediction written in the plan |
| Do | Changes several workflows together without tracking their separate effects |
| Act | Uses cycle findings to adapt the procedure for a second test |
| Plan | Specifies the test population, responsible staff, and collection period |
| Do | Begins the change with one nurse team during one shift |
| Study | Discards an unsuccessful cycle and leaves the result undocumented |

## Explanation

Hospital-wide rollout before study, changing several processes without tracking them, and discarding an unsuccessful cycle require follow-up. PDSA uses a defined prediction, small test, documented observations, comparison, and adaptation.

## In-depth explanation

Quick answer
Highlight expanding the change before examining the first cycle, altering several workflows without tracking their separate effects, and omitting an unsuccessful cycle from the record. These actions prevent the team from learning what produced the result.

Why this is correct
PDSA begins with a focused plan and prediction, tests a change on a small scale, studies data and unexpected observations, then adapts the next cycle. Transparent results, including disappointing ones, are evidence for the next decision rather than failures to hide.[2]

Easy analogy or mental picture
Think of adjusting a recipe one ingredient at a time and tasting each small batch. Changing the whole kitchen menu at once or throwing away a poor batch without notes hides the cause; the analogy illustrates controlled learning, not clinical outcome measurement by itself.

Memory hook
Predict, test small, study honestly, adapt.

NCLEX decision rule
For a quality-improvement question, prefer a measurable small test with documented observations and an explicit comparison to the prediction before wider implementation.

Why the other choices are wrong
Defining a measure, testing on a single shift, recording surprises, comparing results with the prediction, and planning an adapted second cycle all preserve learning. They are expected PDSA steps, not reasons to stop the project.References

- [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

- [2]AHRQ: Plan-Do-Study-Act WorksheetAgency for Healthcare Research and Quality

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