The correct sequence aligns with the Plan-Do-Check-Act (PDCA) cycle of continuous improvement:
Identify and prioritize opportunities (3).
Take action on those priorities (4).
Evaluate to confirm results (1).
Take further action if goals are not sustained (2).
This matches performance improvement processes emphasized in the CHFM Administration domain.
References: AHA/ASHE CHFM Handbook - Administration domain; Joint Commission Performance Improvement standards.

Comprehensive and Detailed Explanation From Exact Extract:
MRI (Magnetic Resonance Imaging) scanners do not use ionizing radiation; instead, they use powerful magnetic fields and radiofrequency energy. The primary safety hazard is the projectile effect (missile effect), where ferromagnetic objects are pulled violently into the scanner bore. This is one of the most well- documented risks in MRI safety and is a leading cause of MRI accidents.
* Correct Answer (D. missile projection): Strong magnetic fields can accelerate ferromagnetic objects, causing serious patient/staff injury or equipment damage.
* Incorrect Options:
* A. visual impairment: Not a recognized risk from MRI scanning itself.
* B. radiation overexposure: MRI does not use ionizing radiation, unlike CT or X-ray.
* C. permanent hearing loss: While MRI noise can be damaging without ear protection, the most likely injury of those listed is projectile accidents.
Relevance to CHFM: This falls under Compliance and Safety domains. Facility managers must ensure MRI safety zones, access control, ferromagnetic detection systems, and staff training to prevent accidents.
References:
ACR (American College of Radiology): MRI Safety Guidelines - Projectile/missile effect identified as the greatest risk.
NFPA 99: Health Care Facilities Code, Chapter 15 - MRI safety environment requirements.
CHFM Candidate Handbook - Compliance with clinical safety codes and standards.

All construction and renovation projects in healthcare must include Infection Control Risk Assessment (ICRA). Infection Control professionals assess potential risks such as dust, ventilation disruptions, and waterborne hazards during construction. They ensure patient safety through control measures (barriers, negative pressure, monitoring).
D). Infection Control (Correct): Mandatory involvement in construction planning.
A). IT / B. Biomed / C. Patient Services: May participate but are not mandated by TJC and CDC requirements for ICRA.
References:
CDC Guidelines for Environmental Infection Control in Healthcare Facilities.
The Joint Commission, Environment of Care and Infection Prevention Standards.
CHFM Candidate Handbook - Planning, Design, and Construction domain.
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Symptoms of nausea, dizziness, and drowsiness are typical of poor indoor air quality (IAQ), most often due to insufficient outside air ventilation leading to buildup of carbon dioxide or other contaminants.
C). Insufficient outside air (Correct).
A). Mercury spill: Causes neurological issues but less common in general building complaints.
B). Humidity levels: Can cause discomfort but not acute dizziness/nausea.
D). Medical gas leak: Hazardous, but would usually trigger alarms and involve smaller affected areas (not whole wing complaints).
References:
ASHRAE 62.1: Ventilation for Acceptable Indoor Air Quality.
The Joint Commission, EC standards - IAQ and ventilation requirements.
CHFM Candidate Handbook - Maintenance and Operations domain.

A demand spike (kW) can occur when multiple large motors or systems restart simultaneously after a power interruption. Although energy consumption (kWh) over the interval may be less, the instantaneous demand registers higher because of inrush currents during restart. This aligns with CHFM exam energy management principles.
References: NFPA 70; ASHE Energy Management guidelines; CHFM Candidate Handbook - Maintenance and Operations.