Handbook of Informatics for Nurses & Healthcare Professionals, 6th edition Toni L. Hebda Test Bank

Type:

Test Bank

Handbook of Informatics for Resource: Nurses & Healthcare Professionals Edition:

6th Edition

Author(s):

Toni L. Hebda Kathleen Hunter Patricia Czar

Test Bank for Handbook of Informatics for Nurses & Healthcare Professionals

Handbook of Informatics for Nurses & Healthcare Professionals 6th Edition

Hebda, Toni Czar, Patricia Hunter, Kathleen

Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 1 An Overview of Informatics in Healthcare 1) A large healthcare organization is planning to implement a clinical information system. What should be considered when selecting this system?

A) Training on the system should be limited.

B) Nursing staff documentation needs are the priority.

C) The organization needs to meet multiple competing demands.

D) Laboratory data and pharmacy integration is considered nonessential.

Answer: C Explanation: A) No evidence supports limiting training on the system.

B) Every department in a large healthcare organization has an essential role in patient care.

C) The healthcare organization today is a complex system faced with multiple, competing demands.

D) Every department in a large healthcare organization has an essential role in patient care.

Page Ref: 1 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Quality & Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Provide an overview of the current state of healthcare delivery.

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2) The leadership team of a multisystem healthcare organization are analyzing potential clinical documentation systems. Which demands should the team keep in mind when selecting the system? Select all that apply.

A) Adopting new models of care B) Eliminating disparities in care C) Financing the system D) Evolving roles for practitioners E) Ensuring quality, safety, and transparency Answer: A, B, D, E Explanation: A) The healthcare delivery system today is a complex system faced with multiple, competing demands. Among these demands are the need to adopt new models of care.

B) The healthcare delivery system today is a complex system faced with multiple, competing demands. Among these demands are efforts to eliminate disparities in care.

C) The healthcare delivery system today is a complex system faced with multiple, competing demands. Financing the system is not an identified demand.

D) The healthcare delivery system today is a complex system faced with multiple, competing demands. Among these demands are evolving roles for practitioners.

E) The healthcare delivery system today is a complex system faced with multiple, competing demands. Among these demands are the need for quality, safety, and transparency.

Page Ref: 1 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Quality & Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Provide an overview of the current state of healthcare delivery.

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3) The leadership team of a multisystem healthcare organization is hesitant to agree that the current electronic medical record should be replaced with one that would integrate information throughout the entire system. For which reasons should the organization update the system?

Select all that apply.

A) Decrease costs B) Reduce staff turnover C) Improve communication D) Enable the delivery of safe quality care E) Ensure care is provided in an effective, efficient manner Answer: A, C, D, E Explanation: A) Technology is a pervasive part of every aspect of society, including healthcare delivery. Health information technology (HIT) provides the tools to decrease costs.

B) Technology is a pervasive part of every aspect of society, including healthcare delivery.

Health information technology (HIT) is not identified as a mechanism to reduce staff turnover.

C) Technology is a pervasive part of every aspect of society, including healthcare delivery.

Health information technology (HIT) provides the tools to improve communication.

D) Technology is a pervasive part of every aspect of society, including healthcare delivery.

Health information technology (HIT) enables the delivery of safe, quality care.

E) Technology is a pervasive part of every aspect of society, including healthcare delivery.

Health information technology (HIT) ensures care is provided in an effective, efficient manner.

Page Ref: 1 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Quality & Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss the role that technology plays in healthcare.

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4) A healthcare provider practice associated with a multisystem healthcare organization uses paper documentation for patient notes and stores laboratory data in the electronic health record.

What does this process exemplify?

A) Resistance to change B) Insufficient number of electronic devices C) Slow to use technology to its full potential D) Limited time to learn the electronic system Answer: C Explanation: A) The healthcare sector has been slow to adopt and use technology to its full potential. This may or may not be due to resistance to change.

B) The healthcare sector has been slow to adopt and use technology to its full potential. This may or may not be due to an insufficient number of electronic devices.

C) The healthcare sector has been slow to adopt and use technology to its full potential. This is viewed as being due to the complexity of healthcare delivery.

D) The healthcare sector has been slow to adopt and use technology to its full potential. This may or may not be due to the time required to learn the electronic system.

Page Ref: 2 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Quality & Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Discuss the role that technology plays in healthcare.

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5) The informatics nurse is preparing a presentation for new nursing staff. Which definition should the nurse use when explaining informatics to these colleagues?

A) A subspecialty of nursing that focuses on training in the use of computers B) A specific area of medicine that highlights the importance of technology in patient care C) A profession that is seeking an identity separate from medicine, nursing, or other behavioral sciences D) An interdisciplinary field that includes computer, decision, information, management, and cognitive sciences Answer: D Explanation: A) Informatics is not a subspecialty of nursing that focuses on training in the use of computers.

B) Informatics is not a specific area of medicine that highlights the importance of technology in patient care.

C) Informatics is not a profession that is seeking an identity separate from medicine, nursing, or other behavioral sciences.

D) The American Medical Informatics Association states that informatics is an interdisciplinary field that draws from, as well as contributes to, computer science, decision science, information science, management science, and cognitive science.

Page Ref: 2 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Quality & Safety | Nursing/Integrated Concepts: Planning/Teaching/Learning Learning Outcome: Provide a definition for informatics.

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6) The nurse is considering attending a program that focuses on informatics. On which field will the curriculum most likely be based?

A) Clinical informatics B) Public health informatics C) Translational bioinformatics D) Consumer health informatics Answer: A Explanation: A) Clinical informatics focuses on the delivery of timely, safe, efficient, effective, evidence-based, and patient-centered care. Nursing informatics is an example of this field.

B) Public health informatics focuses on surveillance, prevention, health promotion, and preparedness.

C) Translational bioinformatics focuses on the storage, analysis, and interpretation of large volumes of data.

D) Consumer health informatics focuses on the consumer, or patient, view and the structures and processes that enable consumers to manage their own health.

Page Ref: 2 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Quality & Safety | Nursing/Integrated Concepts: Assessment/Teaching/Learning Learning Outcome: Provide a definition for informatics.

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7) The nurse is preparing a white paper, explaining how informatics supports the use of data.

Which example should the nurse include that demonstrates a structure for data use?

A) Care plans B) Concept map C) Nursing process D) Nursing diagnosis Answer: D Explanation: A) Care plans are not identified as a structure to use data.

B) Concept maps are not identified as a structure to use data.

C) The nursing process is a problem-solving approach to provide patient care. It is not a structure to use data.

D) To be useful, data and information must be available when needed and in a form that can be analyzed or used. Improved communication among professionals requires the adoption of standardized languages and terminologies. An example of a standardized language is NANDA, which provides standardized terms for nursing diagnoses.

Page Ref: 4 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Quality & Safety | Nursing/Integrated Concepts: Planning/Teaching/Learning Learning Outcome: Discuss the significance of informatics for healthcare.

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8) The informatics nurse is focusing on the analysis of big data. What would be an expected outcome of this analysis? Select all that apply.

A) Support decisions B) Recommend actions C) Enhance staff satisfaction D) Forecast the likelihood of an event E) Improve patient perception of care providers Answer: A, B, D Explanation: A) Real-time analytics use current data from multiple sources to support decisions.

B) Analysis of big data, or analytics, looks for patterns in data, then uses models to recommend actions.

C) Analysis of big data is not used to enhance staff satisfaction.

D) Analytics can be used to forecast the likelihood of an event.

E) Analytics is not used to improve patient perception of care providers.

Page Ref: 5 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Quality & Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss the significance of informatics for healthcare.

9) The quality improvement committee is analyzing ways to prevent errors. Which approaches should this committee consider? Select all that apply.

A) Checklists B) Automation C) Using big data D) Hand-off tools E) Standardization Answer: A, B, D, E Explanation: A) Steps to prevent errors in healthcare include checklists that can prevent slips and lapses.

B) Steps to prevent errors in healthcare include automation when possible.

C) Big data is not identified as a step to prevent errors in healthcare.

D) Steps to prevent errors in healthcare include using hand-off tools to improve communication.

E) Steps to prevent errors in healthcare include standardization.

Page Ref: 7 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Quality & Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss the significance of informatics for healthcare.

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10) The leadership team of a multisystem healthcare organization is strategizing ways to create a culture that values informatics. On which foundational skills should the team focus? Select all that apply.

A) Health literacy B) Establish policies C) Computer literacy D) Information literacy E) Enforce competencies Answer: A, C, D Explanation: A) Health literacy is a foundational skill required for an information-driven culture and is the ability to understand and act upon basic healthcare information.

B) Policy establishment is a separate action that needs to be developed to create an informationdriven culture.

C) Computer literacy is a foundational skill required for an information-driven culture. It is a term used to refer to the basic understanding and use of computers, software tools, spreadsheets, databases, presentation graphics, social media, and communication via email.

D) Information literacy is a foundational skill required for an information-driven culture. It is defined as the ability to read and understand the written word and numbers as well as the ability to recognize when information is needed.

E) Competency development and enforcement is a separate action that needs to be developed to create an information-driven culture.

Page Ref: 8 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Quality & Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Describe the process required to create an informatics culture.

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11) The committee working on the implementation plan for the clinical information system is finalizing a policy to address responsibilities when safeguarding sensitive information. Which ethical values should the committee emphasize in this policy? Select all that apply.

A) Justice B) Veracity C) Autonomy D) Beneficence E) Non-maleficence Answer: A, C, D, E Explanation: A) Justice refers to the standards practiced by healthcare professionals.

B) Veracity refers to telling the truth; however, it is not identified as a guiding principle for moral action with informatics.

C) Autonomy is the individual's freedom to control interferences by others, retaining a personal capacity for intentional action.

D) Beneficence refers to actions that result in positive outcomes in which benefits and utility are balanced.

E) Non-maleficence is the obligation to do no harm.

Page Ref: 9 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.7. Explore ethical and legal implications of patientcentered care | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality, and clients' right to privacy | NLN Competencies: Personal & Professional Development | Nursing/Integrated Concepts: Planning/Caring Learning Outcome: Describe the process required to create an informatics culture.

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12) The nurse on the clinical information system committee is charged with locating information on technical infrastructure. Which federal agencies should the nurse research before the next committee meeting? Select all that apply.

A) The Joint Commission (TJC) B) National Institutes of Health (NIH) C) Centers for Medicare and Medicaid Services (CMS) D) Agency for Healthcare Research and Quality (AHRQ) E) Office of the National Coordinator for Health Information Technology (ONCHIT) Answer: B, D, E Explanation: A) TJC is not a federal agency that addresses technical infrastructure.

B) The NIH provides funding for research to improve health.

C) The CMS does not address technical infrastructure.

D) The AHRQ is a division of the U.S. Health and Human Services committed to research and evidence to improve the safety and quality of healthcare and to provide education for healthcare professionals that will enable them to improve care.

E) The ONCHIT was funded with a grant from the Public Health Service Act (PHSA) and provides electronic health record certification. Its structure includes multiple offices that are relevant for HIT. Page Ref: 10 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: V.4. Examine legislative and regulatory processes relevant to the provision of health care | NLN Competencies: Quality & Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Describe the process required to create an informatics culture.

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13) The clinical information system committee is finalizing health-information standards to safeguard collected data. Which categories of standards need to be addressed by this committee?

Select all that apply.

A) Process B) Content C) Transport D) Vocabulary E) Privacy/security Answer: B, C, D, E Explanation: A) Process is not a category of health-information data standards.

B) Content standards establish the structure and organization of the content.

C) Transport standards establish the format for exchange.

D) Vocabulary standards improve communication through the use of structured terms and facilitate the organization of data.

E) Privacy standards protect personal health information, whereas security standards provide administrative, physical, and technical actions that provide patient confidentiality as well as the availability and integrity of health information.

Page Ref: 11 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision-making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality & Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss the significance of informatics for healthcare.

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14) The nurse enters the room of a patient whose cardiac monitor alarm is sounding. Which action should the nurse take first?

A) Greet the patient.

B) Turn off the alarm.

C) Look at the monitor.

D) Check for lead placement.

Answer: A Explanation: A) Electronic devices should not be a replacement for compassionate patient care.

B) Turning off the alarm could harm the patient if it is not reset once the reason for the alarm is discovered.

C) Ignoring the patient when entering the room gives the impression that the machine is more important than the patient.

D) Immediately searching for lead placement before talking with the patient gives the impression that the machine is more important than the patient.

Page Ref: 12 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Assessment/Caring Learning Outcome: Examine the relationship between technology, informatics, and caring.

15) While assessing a new patient, the nurse's phone rings. Which action should the nurse take to demonstrate caring?

A) Answer the phone.

B) Leave the patient's room.

C) Place it on the windowsill.

D) Apologize for the interruption.

Answer: D Explanation: A) Limitations to building a trusting, caring relationship come when patients perceive the nurse as not caring or being distracted during interactions, such as answering the phone during a nurse-patient interaction.

B) Leaving the patient's room indicates that the phone call is more important than the patient.

C) Placing the phone on the windowsill is distracting to the nurse and patient.

D) Apologizing for the interruption is the best approach to demonstrate care.

Page Ref: 13 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Assessment/Caring Learning Outcome: Examine the relationship between technology, informatics, and caring.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 2 Informatics Theory and Practice 1) The informatics nurse selects a middle-range theory to support a research study. Which is an advantage of using this type of theory? Select all that apply.

A) Reflects practice B) Crosses different nursing fields C) Focuses on a specific phenomenon D) Differentiates between nursing and medical practice E) Describes the broadest scope of nursing phenomenon Answer: A, B, C Explanation: A) Middle-range theories are more limited in scope and reflect nursing practice.

B) Middle-range theories cross different nursing fields and reflect a wide variety of nursing-care situations.

C) Middle-range theories focus on specific phenomenon and are a good fit for empirical testing.

D) Grand theories are used to differentiate between nursing and medical practice.

E) Grand theories describe the broadest scope of nursing phenomenon and relationships between them.

Page Ref: 21 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Discuss the relevance of theory for informatics research and practice.

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2) The informatics nurse is leading a group of information technologists to study why a group of care providers is having difficulty documenting care provided to patients with chronic back pain.

Which type of theory should the nurse use to guide this study?

A) Grand B) Middle-range C) Situation-specific D) Conceptual framework Answer: C Explanation: A) Grand theories aim to describe the broadest scope of nursing phenomena and relationships between them and do not lend themselves to empirical testing.

B) Middle-range theories are more limited in scope, focus on a specific phenomenon, and reflect practice (teaching, clinical, or administrative). These theories cross different nursing fields and reflect a wide variety of nursing-care situations.

C) Situation-specific theories focus on a specific nursing phenomenon. They are often bound to a specific type of clinical practice and focus on a specific population. This type of theory would be the best to use with the clinical problem.

D) A conceptual framework is another name for a theory.

Page Ref: 22 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Discuss the relevance of theory for informatics research and practice.

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3) The nurse reviews assessed data, determines a nursing diagnosis, and then plans interventions to address a patient's care needs. Which dimension of the theory of wisdom in action for clinical nursing did the nurse implement?

A) Wisdom B) Knowledge C) Person-related factors D) Environment-related factors Answer: B Explanation: A) Wisdom in action requires knowledge mastery when dealing with uncertain or stressful situations. Knowledge impacts, and insight and intuition influence, the clinical judgment in context of the situation. The judgment leads to a care decision. After a care decision is applied, reflection and discovery of meaning occur, which results in learning. Gained knowledge is integrated back into the knowledge dimension.

B) Knowledge is constructed of three different knowledge types, increasing in complexity: rich factual knowledge, rich procedural knowledge, and lifespan contextualism. Factual knowledge refers to the knowledge of nursing process and patient care. This kind of knowledge is often presented in nursing textbooks and then refined and further bolstered by continuous professional development. Procedural knowledge is made up of clinical procedures, processes, and interventions required for care. Procedural knowledge is often acquired in a specific type of setting based on the accepted norms and rules of behavior. Lifespan refers to the understanding of others as well as understanding oneself.

C) Personal factors would include simple concepts, such as nurse and/or patient age, education, marital status, and more complex concepts. Clinical factors include clinical training and experience and mentors and role models.

D) Environment-related factors affecting wisdom include setting-related and information-system factors.

Page Ref: 25 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Apply the DIKW framework to a situation in your lived experience.

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4) The nurse clusters collected data according to who, what, where, and when. Which concept of the data, information, knowledge, and wisdom theory is the nurse completing?

A) Data B) Wisdom C) Knowledge D) Information Answer: D Explanation: A) Data are the most discrete components of the DIKW framework. They are mostly presented as discrete observations with little interpretation. These are the smallest factors describing the patient, disease state, or health environment.

B) Wisdom is an appropriate use of knowledge to manage and solve human problems. Wisdom includes ethics or knowing why certain things or procedures should or should not be implemented in specific cases.

C) Knowledge is information that has been processed and organized so that relations and interactions are identified. Knowledge answers the questions of why and/or how.

D) Information might be described as data plus meaning. A meaningful clinical picture is constructed when different data points are put together and presented in a specific context.

Information is a continuum of progressively developing and clustered data; it answers questions such as who, what, where, and when.

Page Ref: 23 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Apply the DIKW framework to a situation in your lived experience.

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5) The nurse notes that a patient's blood pressure has been trending lower since admission.

Which intervention demonstrates the nurse using information to guide nursing care? Select all that apply.

A) Measuring body temperature B) Measuring intake and output C) Monitoring for blood in stool D) Monitoring for blood in urine E) Monitoring level of consciousness Answer: B, C, D Explanation: A) Body temperature changes would not reflect clinical judgment in this situation.

B) Low blood pressure can be caused by low oral fluid intake or excessive urine output.

Measuring intake and output reflects clinical judgment.

C) Low blood pressure can be caused by bleeding. Monitoring for blood in stool reflects clinical judgment.

D) Low blood pressure can be caused by bleeding. Monitoring for blood in urine reflects clinical judgment.

E) Monitoring level of consciousness would not reflect clinical judgment in this situation.

Page Ref: 26 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Examine ways that informatics may use the wisdom-in-action framework to support clinical care.

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6) The nurse finds a patient unresponsive in bed. After assessing that the patient is breathing and has a pulse, the nurse raises the head of the bed and measure the oxygen saturation level. Which aspect of the wisdom-in-action framework did the nurse demonstrate?

A) Setting B) Environment C) Personal factor D) Insight and intuition Answer: D Explanation: A) The setting is an antecedent to wisdom.

B) The environment is an antecedent to wisdom.

C) Personal factors are antecedents to wisdom.

D) The nurse assessed the patient first for breathing and circulation. Raising the head of the bed reduces intracranial pressure, which could be causing the unresponsiveness. Measuring oxygen saturation helps determine if the unresponsiveness could be caused by a low oxygen level. The nurse is demonstrating problem-solving or using knowledge and previous experience to guide actions.

Page Ref: 26 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Examine ways that informatics may use the wisdom-in-action framework to support clinical care.

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7) A multisystem healthcare organization is adding an informatics department to the main hospital. Which subdiscipline should be added to support clinical care? Select all that apply.

A) Bioinformatics B) Dental informatics C) Nursing informatics D) Medical informatics E) Structural informatics Answer: B, C, D Explanation: A) Bioinformatics is often defined as studying biology by applying informatics skills to understand and organize the information associated with these molecules on a largescale. Bioinformatics is primarily concerned with three types of data from molecular biology: macromolecular structures, genome sequences, and the results of functional genomics experimentation.

B) Dental informatics is a subdiscipline of clinical informatics. It is defined as a multidisciplinary field that seeks to improve healthcare through the application of health-information technology and information science to dental-health delivery, information management, healthcare administration, research, and knowledge sharing.

C) Nursing informatics is a subdiscipline of clinical informatics. Nursing informatics uses nursing knowledge, along with information and communication technology to promote the health of individuals, families, and entire populations.

D) Medical informatics is a subdiscipline of clinical informatics and refers to research and practice in clinical informatics that focuses on disease and predominantly involves the role of physicians.

E) Structural informatics refers to research and practical applications concerned with representing, managing, and using information about the physical organization of the body.

Page Ref: 32 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C. 4. Value nurses' involvement in design, selection, implementation, and evaluation of information technologies to support patient care | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Compare and contrast the different informatics subdisciplines found within healthcare.

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8) A patient asks if the genetic tests being advertised on television can be used to create specific medication to treat a health problem. Which informatics professional should the nurse contact to answer this patient's question?

A) Bioinformatics B) Structural informatics C) Public health informatics D) Translational bioinformatics Answer: D Explanation: A) Bioinformatics is often defined as studying biology by applying informatics skills to understand and organize the information associated with these molecules on a largescale. Bioinformatics is primarily concerned with three types of data from molecular biology: macromolecular structures, genome sequences, and the results of functional genomics experimentation.

B) Structural informatics refers to research and practical applications concerned with representing, managing, and using information about the physical organization of the body.

C) Public-health informatics is the science of application of information technology in areas of public health, including prevention, preparedness, health promotion, and surveillance.

D) Translational bioinformatics combines applications of health informatics, bioinformatics, and structural informatics, to identify genomic and cellular mechanisms to explain and predict clinical phenomena. Translational bioinformatics develops innovative techniques for the integration of biological and clinical data to create a more personalized healthcare. The recent emergence of precision medicine, aimed at providing all individuals with access to personalized information for better health, builds heavily on translational-bioinformatics methods to develop accurate and personalized characterization of patient populations based on molecular, clinical, environmental exposures, lifestyle, and other patient information.

Page Ref: 32 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C. 4. Value nurses' involvement in design, selection, implementation, and evaluation of information technologies to support patient care | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Compare and contrast the different informatics subdisciplines found within healthcare.

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9) The nurse is reviewing information about the TIGER initiative. What does this acronym represent?

A) Technology Information Grants Electronic Records B) Technological Initiative Given Electronic Reform C) Technology Informatics Guiding Education Reform D) Technology Information Guiding Electronic Reports Answer: C Explanation: A) TIGER Initiative (Technology Initiative Guiding Education Reform) was developed in an attempt to bring together stakeholders in healthcare to redesign nursing education.

B) TIGER Initiative (Technology Initiative Guiding Education Reform) focuses on creating a vision for the future of nursing to provide safer, higher-quality care through the use of information technology.

C) TIGER Initiative (Technology Informatics Guiding Education Reform) was formed to advance nurses' competencies related to informatics. TIGER's primary objective was to develop a U.S. nursing workforce capable of using electronic health records to improve the delivery of healthcare. The TIGER initiative brought together nursing stakeholders to develop a shared vision, strategies, and specific actions for improving nursing education, practice, and the delivery of patient care through the use of health-information technology.

D) TIGER Initiative (Technology Informatics Guiding Education Reform) requires informatics competencies for every nurse and active involvement in advancing health information technology.

Page Ref: 36 Cognitive Level: Understanding Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Weigh how the scope of informatics practice determines the types and levels of competencies needed.

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10) The manager is reviewing informatics competencies for each level of staff nurse. Which statement indicates the appropriate level of informatics competencies to the correct nurse?

A) An informatics nurse extrapolates data to develop a best practice model for indwelling catheter care.

B) The novice nurse uses a spreadsheet to document medication reactions.

C) An experienced staff nurse creates databases.

D) A beginning nurse utilizes the Internet to integrate multidisciplinary languages.

Answer: A Explanation: A) An informatics innovator is expected to be educationally prepared to conduct informatics research and generate informatics theory and have advanced understanding and skills in information management and computer technology.

B) A beginning nurse is expected to have fundamental information management and computertechnology skills and use existing information systems and established information-management practices.

C) An experienced nurse is expected to have a specific area of expertise, be skilled in using information management and computer technology, have strong analytic skills to learn from relationships between different data elements, and be able to collaborate with the informatics nurse specialist to suggest improvement to systems. Database creation is beyond the skill level of the experienced nurse.

D) Beginning nurses are comfortable with basic skills and should be able to retrieve information from the system, as well as interpret data. An experienced nurse is prepared to use the Internet to integrate multidisciplinary languages.

Page Ref: 33 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Weigh how the scope of informatics practice determines the types and levels of competencies needed.

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11) The manager plans to hire a new nurse who has just graduated from nursing school. Which informatics activity should this nurse be able to perform?

A) Attain informatics nurse certification within six months of beginning practice.

B) Input vital signs and intake and output data in the electronic medical record.

C) Utilize the Internet to review trends in healthcare information technology.

D) Use an electronic spreadsheet to create staffing rotations.

Answer: B Explanation: A) Inputting data into the electronic medical record is a beginning level competency for nurses entering the profession; the other choices are at higher levels.

B) Inputting data into the electronic medical record is a beginning level competency for nurses entering the profession.

C) Inputting data into the electronic medical record is a beginning level competency for nurses entering the profession. Using the Internet is a higher level of competency.

D) Novice nurses do not have the computer literacy skills to employ a spreadsheet to create schedules. This is a more advanced competency. The novice nurse is beginning to learn to use the system to input data.

Page Ref: 33 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Weigh how the scope of informatics practice determines the types and levels of competencies needed.

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12) The information technology department in a multisystem healthcare organization establishes the goal of improving the use of technology with patient care. Which action item should the departmental members plan to implement? Select all that apply.

A) Practice B) Visibility C) Cost containment D) Quality improvement E) Education and training Answer: A, B, E Explanation: A) Based upon a survey conducted about future trends in nursing informatics, practice is identified as an area in which to advance nursing informatics in the next 5 to 10 years.

B) Based upon a survey conducted about future trends in nursing informatics, visibility is identified as an area in which to advance nursing informatics in the next 5 to 10 years.

C) Based upon a survey conducted about future trends in nursing informatics, cost containment is not identified as an area in which to advance nursing informatics in the next 5 to 10 years.

D) Based upon a survey conducted about future trends in nursing informatics, quality improvement is not identified as an area in which to advance nursing informatics in the next 5 to 10 years.

E) Based upon a survey conducted about future trends in nursing informatics, education and training are identified as areas in which to advance nursing informatics in the next 5 to 10 years.

Page Ref: 37 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss future needs and directions for nursing informatics.

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13) A multisystem healthcare organization placed questionnaires within every patient's personal portal. Which type of data is being collected?

A) Big B) Medical C) Personal D) Situational Answer: A Explanation: A) Big data is a recent term referring to large, unstructured datasets that are becoming increasingly available in health-related domains.

B) These data are not medical in nature.

C) Although the questionnaire is placed in a personal portal, the data are not considered personal.

D) Situational is not a type of data.

Page Ref: 37 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss future needs and directions for nursing informatics.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 3 Effective and Ethical Use of Data and Information 1) At the end of a work shift, the nurse collects vital signs and intake and output measurements from nursing assistive personnel. What are these finding considered to be?

A) Data B) Wisdom C) Knowledge D) Information Answer: A Explanation: A) Data are discrete entities that are described objectively without interpretation.

B) Wisdom is the ability to appropriately use knowledge to recognize and handle complex problems.

C) Knowledge is synthesized information that shows formally recognized relationships.

D) Information is data that have been interpreted, organized, or structured.

Page Ref: 42 Cognitive Level: Understanding Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Distinguish between the metastructures of data, information, knowledge, and wisdom.

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2) A patient recovering from hip replacement surgery develops shortness of breath. Which action should the nurse take to demonstrate wisdom?

A) Apply oxygen.

B) Assess the surgical site.

C) Listen to breath sounds.

D) Measure blood pressure.

Answer: A Explanation: A) Wisdom is the ability to appropriately use knowledge to recognize and handle complex problems. The patient recovering from hip replacement surgery is at risk for either a deep vein thrombosis or fat embolism. The shortness of breath indicates insufficient oxygenation, which can be helped by applying oxygen.

B) Assessing the surgical site is an action to collect data.

C) Listening to breath sounds is an action to collect data.

D) Measuring blood pressure is an action to collect data.

Page Ref: 43 Cognitive Level: Analyzing Client Need & Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Distinguish between the metastructures of data, information, knowledge, and wisdom.

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3) The informatics nurse is designing a spreadsheet to facilitate the collection of data for patients in the post-anesthesia care unit. Which ethical standards should this nurse demonstrate? Select all that apply.

A) Promoting effective workflows B) Informing leadership of ethical issues C) Evaluating factors related to handling data D) Questioning practices that could hinder patient safety E) Serving on an interprofessional team to support patient concerns Answer: A, C, D Explanation: A) Informatics nurses are called upon to promote effective workflows.

B) Informatics nurse specialists inform leadership of ethical issues.

C) Informatics nurses are called upon to evaluate factors related to handling data.

D) Informatics nurses are called upon to question practices as necessary for the purpose of maintaining or promoting safety and quality improvement.

E) Informatics nurse specialists are called upon to serve on interprofessional teams to support patient concerns.

Page Ref: 43 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Caring Learning Outcome: Detail prerequisite conditions for effective and ethical use of data and information.

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4) The informatics nurse is assisting with the analysis of a clinical information system for a multisystem healthcare organization. Which characteristics of data should the nurse ensure are present to support quality patient care? Select all that apply.

A) Absent of bias and current B) Clear, accurate, and available C) Precise and verified by other means D) Documented in more than one place E) Limited use of health information exchange Answer: A, B, C Explanation: A) Data are viewed as a strategic resource and should be free of bias and current.

B) Data are viewed as a strategic resource and should be clear, accurate, and available when needed.

C) Data are viewed as a strategic resource and should be precise and verifiable by other means.

D) Data that are documented in more than one place can lead to errors and redundancies when providing care.

E) Data should be shared through health information exchanges as a means to reduce redundant tests, improve quality of care, and improve public confidence.

Page Ref: 45 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Detail prerequisite conditions for effective and ethical use of data and information.

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5) The nurse manager is reviewing data on patient falls collected over the last month. Where should the manager look to compare the number of falls with other similar organizations?

A) The Joint Commission B) National Institutes of Health C) Centers for Medicare and Medicaid Services D) National database of nursing quality indicators Answer: D Explanation: A) The Joint Commission does not track patient falls.

B) The National Institutes of Health do not track patient falls.

C) The Centers for Medicare and Medicaid Services collect patient survey data and readmission rates.

D) The national database of nursing quality indicators is a database created by the America Nurses Association that tracks patient falls.

Page Ref: 46 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Provide exemplars of effective and ethical use of data and information within healthcare.

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6) The leadership team for a multisystem healthcare organization learns that Medicare reimbursement will be 10% lower for the next quarter. Which data should the team analyze to determine the reason for this decline in reimbursement? Select all that apply.

A) Fall rates B) Staff turnover C) Surgical errors D) CAHPS surveys E) Readmission rates Answer: D, E Explanation: A) Fall rates are tracked through the national database of nursing quality indicators; however, it does not impact reimbursement.

B) Staff turnover is not information that would impact reimbursement.

C) Surgical errors will impact Joint Commission accreditation; however, it is not identified as impacting reimbursement.

D) The hospital Consumer Assessment of Healthcare Providers and Systems (CAHPS) is a survey that collects data on patients' perceptions of care. These surveys are used to provide financial incentives in the form of increased or decreased Medicare reimbursement for hospitals to improve the quality of care provided.

E) The hospital readmission reduction program provides financial incentives to hospitals to reduce patient readmissions within 30 days for Medicare beneficiaries.

Page Ref: 46 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Provide exemplars of effective and ethical use of data and information within healthcare.

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7) A patient takes a copy of care provided during a recent hospitalization to a specialist's office who places the information in the medical record. Who is the owner of the data?

A) The patient B) It is unclear C) The hospital D) The specialist Answer: B Explanation: A) There are issues with who owns the data because ownership of patient data is not clearly addressed from a legal perspective.

B) The data is about the patient, which was collected during a hospitalization, and then shared with a specialist. It is not clear who ultimately owns the data.

C) The hospital collected the data; however, ownership of the data is unclear and not addressed from a legal perspective.

D) The specialist was handed data; however, ownership of the data is unclear and not addressed from a legal perspective.

Page Ref: 52 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Relate issues and concerns for effective and ethical use of healthcare data and information.

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8) A patient who is prescribed an antidepressant receives information in the mail about a mental health clinic and several telephone calls from marketers about support groups and counseling centers. Which issues with this patient's information have occurred? Select all that apply.

A) Data sharing B) Informed consent C) Ownership of data D) Secondary use of data E) Privacy versus confidentiality Answer: A, C, D, E Explanation: A) There are questions about control and implications when the data are shared.

B) Sharing of the information about the patient's medication is not an informed consent issue.

C) Because the ownership of patient data is not clearly addressed from a legal perspective, the information about the patient's medication has been shared.

D) Data should be de-identified before being reused or given as secondary data. Because the patient is receiving mail and telephone calls, it is obvious that the data were not properly deidentified.

E) Data is typically de-identified; however, there are occasions when personal information can be identified and information released that could cause harm and potential social stigma, especially for a mental health issue.

Page Ref: 52 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Relate issues and concerns for effective and ethical use of healthcare data and information.

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9) The finance department in a multisystem healthcare organization wants to know which patient populations are remaining as inpatients beyond the approved reimbursement rates. On which type of data should the department focus?

A) Big data B) Small data C) Data science D) Data modeling Answer: B Explanation: A) The term big data refers to very large data sets that are beyond human capability to analyze or manage without the aid of technology. These large data sets are then used to reveal patterns and discover new learning.

B) Small data, a type of data analytics, refers to limited data sets such as that seen with EHR information for a select patient population at a single hospital or healthcare delivery system. This type of data would be used to determine the care needs for a specific population and time frame for care.

C) Data science is the systematic study of digital data such as analytics, business intelligence, knowledge management, and discovery informatics so that they have context for the time and place in which they practice.

D) Data modeling is a process to define and analyze data requirements to support processes required within an organization. Data modeling is an important step in the design of a database such as an EHR because it establishes what information must be collected and in what format.

Page Ref: 48 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B. 2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Discriminate between the terms big data, data science, data analytics, and data modeling.

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10) A community hospital is identifying characteristics required before implementing an electronic health record. Which type of data should the organization analyze?

A) Big data B) Small data C) Data mining D) Data modeling Answer: D Explanation: A) The term big data refers to very large data sets that are beyond human capability to analyze or manage without the aid of technology. These large data sets are then used to reveal patterns and discover new learning.

B) Small data, a type of data analytics, refers to limited data sets such as that seen with EHR information for a select patient population at a single hospital or healthcare delivery system. This type of data would be used to determine the care needs for a specific population and time frame for care.

C) Data mining or data analytics is a process that uses software to uncover relationships within large data sets using artificial intelligence, statistical computation, and computer technology.

D) Data modeling is a process to define and analyze data requirements to support processes required within an organization. Data modeling is an important step in the design of a database such as an EHR because it establishes what information must be collected and in what format.

Page Ref: 49 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B. 2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Discriminate between the terms big data, data science, data analytics, and data modeling.

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11) The informatics nurse is attending a continuing education program about data science. Which areas should the nurse expect this program to include? Select all that apply.

A) Big data B) Analytics C) Business intelligence D) Discovery informatics E) Knowledge management Answer: B, C, D, E Explanation: A) The term big data refers to very large data sets that are beyond human capability to analyze or manage without the aid of technology. These large data sets are then used to reveal patterns and discover new learning; however, they are not considered a part of data science.

B) Data science is the systematic study of digital data such as analytics to provide context for the time and place in which they practice.

C) Data science is the systematic study of digital data such as business intelligence so that they have context for the time and place in which they practice.

D) Data science is the systematic study of digital data such as discovery informatics so that they have context for the time and place in which they practice.

E) Data science is the systematic study of digital data such as knowledge management so that they have context for the time and place in which they practice.

Page Ref: 51 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B. 2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Discriminate between the terms big data, data science, data analytics, and data modeling.

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12) A multisystem healthcare organization has many types of big data; however, it has been limited in its ability to use the information to improve patient outcomes. What should be done with the data to improve its use?

A) Supply metadata B) Implement discovery informatics C) Hire a business intelligence practitioner D) Apply a knowledge management system Answer: A Explanation: A) Metadata is defined as the data that provides information about how, when, and by whom data are collected, formatted, and stored. Without metadata and data dictionaries, the correct or meaningful reuse of information cannot occur.

B) Discovery informatics uses scientific models and theories to create computer-based discovery of new learning in big data, replacing human cognition with the idea that discovery and learning can be accelerated.

C) Knowledge management systems are sets of information systems that enable organizations to tap into the knowledge, experiences, and creativity of their staff to improve performance.

D) Business intelligence (BI) is the integration of data from different sources for the purpose of optimizing its use and understanding. BI refers to a strategy, processes, and a tool set.

Page Ref: 49 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B. 2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Summarize the current state of big data use within healthcare.

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13) A multisystem healthcare organization is transitioning from an electronic medical record to a clinical information system. What should the informatics nurse recommend to improve nursing's presence and participation in the collection of big data?

A) Improving input screen design B) Including standardized nursing language C) Streamlining entry of routine measurements D) Increasing the number of standardized care plans Answer: B Explanation: A) Improving input screen design will not improve nursing's presence and participation in the collection of big data.

B) Nurses and nurse informaticists are needed to communicate clinician needs to data scientists, and nurses must work with data scientists to advance both nursing knowledge and practice using big data. One visibility issue for nursing relates to the low levels of adoption of standardized nursing language in EHRs, leaving nursing with limited measures of its clinical accomplishments.

C) Streamlining the entry of routine measurements will not improve nursing's presence and participation in the collection of big data.

D) Increasing the number of standardized care plans will not improve nursing's presence and participation in the collection of big data.

Page Ref: 49 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B. 2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.4. Understand the use of CIS (clinical information systems) systems to document interventions related to achieving nurse sensitive outcomes | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Summarize the current state of big data use within healthcare.

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14) The nurse manager is reviewing the importance of using technology when providing patient care. Which action should the manager take to improve the staff's acceptance of big data?

A) Place user manuals for the computer systems throughout the care area.

B) Ask staff to participate in the selection of a clinical information system.

C) Purchase reference materials that explain standardized nursing languages.

D) Subscribe to websites that provide information on evidence-based guidelines Answer: B Explanation: A) Placing user manuals throughout the care area will hot improve the staff's acceptance of big data.

B) Clinicians need to understand the relationship between big data and evidence-informed practice. They also need to have a voice in the selection and use of tools to ensure that the tools provide value for clinicians and patients.

C) Purchasing reference materials about standardized nursing languages will not improve the staff's acceptance of big data.

D) Subscribing to websites that provide information on evidence-based guidelines will not improve the staff's acceptance of big data.

Page Ref: 51 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C. 1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Differentiate between clinician and informatics roles with big data and analytics.

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15) A group of nurses are expressing dissatisfaction with the amount of technology that is being used because it affects time spent with patients at the bedside. Which response should be made to reduce the nurses' dissatisfaction?

A) "Technology reduces the need to hire individuals to collect the data."

B) "The time spent learning new technology should lessen as skills improve."

C) "Learning new skills is important in every industry, including patient care."

D) "Data are used to improve clinical practice by supporting evidence-based practice."

Answer: D Explanation: A) There is no evidence the technology reduces the need to hire individuals to collect the data. The implementation of technology is labor intensive and costly.

B) Although skills may improve over time, technology is always changing, and learning will be continuous.

C) Nurses understand the need for continuing education. Explaining that learning new skills is an expectation for patient care is condescending.

D) Clinicians need to understand the relationship between big data and evidence-informed practice.

Page Ref: 51 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C. 1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Differentiate between clinician and informatics roles with big data and analytics.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 4 Electronic Resources for Healthcare Professionals 1) The nurse desires to find information that justifies changing an approach to wound care.

Which method should the nurse use to obtain this information?

A) Study wound care journals.

B) Complete a search at a library.

C) Search a database over the Internet.

D) Ask a librarian to help find the material.

Answer: C Explanation: A) Studying wound care journals will take a considerable amount of time.

B) Completing a search at a library will take a considerable amount of time.

C) Databases are now easily accessible and available through the Internet as public libraries, colleges and universities, subscriptions, and open access database engines allow the user to access journals, publications, and periodicals quickly and easily from any device with an Internet connection.

D) It will take a librarian a considerable amount of time to find the material.

Page Ref: 59 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Choose methods to locate reliable information online.

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2) The nurse locates an article to support a change in patient care; however, there is a fee to obtain the entire manuscript. What should the nurse consider before purchasing this article?

A) If the content is appropriate to address the issue B) If there are other articles not appearing in the search C) If the organization will reimburse for the cost of the article D) If purchasing the entire magazine might be a better use of resources Answer: B Explanation: A) The only way to determine if the content is appropriate to address the issue is to read the entire article.

B) Some sites provide pay-per-article access to literature; however, these sites may not have the full spectrum of literature found in a scholarly database.

C) Reimbursement for the article should be discussed before the nurse performs the search.

D) Purchasing an entire publication for one article is not cost effective if the article does not fit the need.

Page Ref: 59 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Choose methods to locate reliable information online.

3) A patient reports using information on the Internet to research a health problem. What should the nurse use to determine if the site is providing quality information? Select all that apply.

A) Who is in charge of the website?

B) Where does the information come from?

C) Does the site avoid unbelievable claims?

D) Does the site ask for personal information?

E) Do experts review the information on the site?

Answer: B, C, E Explanation: A) "Who is in charge of the website?" evaluates the provider.

B) "Where does the information come from?" evaluates for quality.

C) "Does the site avoid unbelievable claims?" evaluates for quality.

D) "Does the site ask for personal information?" evaluates for privacy.

E) "Do experts review the information on the site?" evaluates for quality.

Page Ref: 59 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Propose ways to determine the veracity of online information.

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4) The nurse notes that a website has a HONcode. For which designation should the nurse check the site before using the material? Select all that apply.

A) Authority B) Autonomy C) Advertising D) Transparency E) Confidentiality Answer: A, C, D, E Explanation: A) The HONcode for authority is principle 1 and means that the qualifications of the authors are validated.

B) Autonomy is not a HONcode but rather an ethical principle.

C) The HONcode for advertising is principle 8 and means that advertising is removed from editorial content.

D) The HONcode for transparency is principle 6 and means that valid contact details are provided.

E) The HONcode for confidentiality is principle 3 and means that the site respects the privacy of the users.

Page Ref: 60 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Propose ways to determine the veracity of online information.

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5) A patient reports finding information about a health problem on Wikipedia. The nurse should realize that which of the following describes a wiki?

A) A shared online resource B) Social media site C) A pop-up D) SPAM Answer: A Explanation: A) A wiki is a website where users not only read the content but can add to or edit the content.

B) A wiki is not a social media site but a website where users not only read the content but can add to or edit the content.

C) A wiki is not a pop-up but rather is a website where users not only read the content but can add to or edit the content.

D) A wiki is not considered SPAM but rather is a website where users not only read the content but can add to or edit the content.

Page Ref: 62 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Demonstrate responsible use of social media for healthcare professionals.

6) A patient asks to take a picture with the nurse to post on Facebook. Which response should the nurse make?

A) "Great idea. Let me comb my hair first."

B) "I suggest you not do this since this could violate your privacy."

C) "Make sure you 'friend' me after you post it."

D) "Let me get some other nurses to be in the picture, too."

Answer: B Explanation: A) It is inappropriate for the nurse to have a photograph with a patient posted on Facebook. This violates the patient's privacy.

B) The nurse should suggest that the patient not post a picture because it will violate the patient's privacy.

C) Being a Facebook "friend" violates the patient's and the nurse's privacy.

D) It is inappropriate for any nurse to have a photograph with a patient posted on Facebook.

Page Ref: 62 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Demonstrate responsible use of social media for healthcare professionals.

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7) The informatics nurse wants to find information to support a proposed change to the electronic health record. Which action should the nurse take first?

A) Perform a Google search.

B) Search the National Library of Medicine.

C) Enter the search term into the Medline database.

D) Access the Cochrane Database of Systematic Reviews.

Answer: A Explanation: A) Google is the number-one search engine and would be appropriate as a starting point for the nurse.

B) The National Library of Medicine may not have information about electronic health record changes.

C) Medline focuses on health problems and treatments. There would be minimal or no information about electronic health records in this database.

D) The Cochrane Database of Systematic Reviews is a repository for evidence-based practice guidelines and would not have much information about electronic health records.

Page Ref: 62 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Identify reliable resources for health information and services.

8) While conducting an Internet search using different search engines, the nurse notes that the same resources continue to appear. What should the nurse do?

A) Change the search term.

B) Use a different search engine.

C) Try the search again after resources refresh.

D) Assume all available information has been located.

Answer: D Explanation: A) Changing the search term may or may not produce different results.

B) The nurse has already been using different search engines.

C) Resources are constantly refreshed on the Internet.

D) When subsequent Internet searches begin to produce the same information as prior searches, it can be assumed that most of the available information has been located.

Page Ref: 63 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Identify reliable resources for health information and services.

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9) The informatics nurse needs to complete mandatory continuing education hours for relicensure. Which action should the nurse take after locating an online education program?

A) Validate the approval body.

B) Complete the registration form.

C) Review the learning objectives.

D) Pay the fee to access the program.

Answer: A Explanation: A) Many commercial sites on the Internet advertise free continuing education credit courses for nurses. Care should be taken to ensure that the education provided by any of these sites is approved by the appropriate credentialing body for the particular licensure or certification requirements.

B) The registration form is completed only after deciding to purchase the program.

C) The learning objectives would be reviewed while deciding to purchase the program.

D) The fee is paid after deciding to purchase the program.

Page Ref: 64 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss the benefits of online services for healthcare professionals.

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10) The nurse is preparing a presentation for the electronic medical record committee. For which reason should the nurse use online publications as resources for this presentation? Select all that apply.

A) Easy to read B) Easy to print C) Easy to search D) Decreased cost E) Instant availability Answer: B, C, D, E Explanation: A) Readability will depend on the journal selected for the resources.

B) Journal articles may be available in PDF format for printing and sharing.

C) Journal readers can search electronically within or across issues for specific words or phrases and may be able to link to references and other related materials.

D) Although costs for editing and review may remain the same, costs for printing and mailing are eliminated.

E) The most recent journal edition is available immediately to any subscriber with an Internet connection.

Page Ref: 65 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss the benefits of online services for healthcare professionals.

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11) The informatics nurse finds an article to support a change in the clinical information system.

What should the nurse look for to ensure that the information in the article is valid?

A) Current date B) Symbol of validity C) Last reviewed date D) Name of the author Answer: B Explanation: A) The current date does not ensure that the content is valid.

B) Many "watchdog" organizations place a symbol that identifies that the material has been validated for accuracy.

C) The last review date does not ensure that the content is valid.

D) The author's name does not ensure that the content is valid.

Page Ref: 65 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Name specific professional organizations and watchdog groups focused on electronic resources.

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12) The electronic medical record committee is preparing information to share during a major stockholder's meeting. Which should the committee use to ensure that the content is valid? Select all that apply.

A) Perform a general Google search.

B) Look for the URAC symbol of accreditation.

C) Find material supported by manufacturers of health-related software.

D) Use material approved by the Health on the Net Foundation (HON).

E) Search on the Department of Health and Human Services (HSS) website.

Answer: B, D, E Explanation: A) There is a proliferation of material on the Internet, not all of which is valid. A general Google search does not guarantee that material is valid.

B) URAC provides standards for healthcare quality, including accreditation services for healthcare websites. Websites that have been accredited by URAC will display a seal on the web page.

C) Material supported by manufacturers of health-related software will be skewed and not necessarily valid.

D) The Health on the Net Foundation (HON) places a symbol on health content that it deems valid and reliable.

E) The federal Department of Health and Human Services (HHS) provides information for consumers about how to assess the accuracy and validity of online health information through the healthit.gov website.

Page Ref: 65-66 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Name specific professional organizations and watchdog groups focused on electronic resources.

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13) The nurse is considering enrolling in an online program to achieve a baccalaureate degree in nursing. What should the nurse consider as an advantage of taking the program online? Select all that apply.

A) Easy B) Flexible C) Consistent D) Convenient E) Cost effective Answer: B, C, D Explanation: A) Online education programs are not easy. The course work is the same as that required in a live or in-person program.

B) Online programs are flexible to allow the learner to manage time around family and other commitments.

C) Online program content is consistent in that it will not vary according to the instructor's style or preferences.

D) Online programs are convenient in that there is no need to commute to a classroom.

E) Online programs are not necessarily cost effective. Many programs cost the same as live, inperson programs.

Page Ref: 67 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss the benefits and drawbacks to eLearning.

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14) The nurse considers enrolling in an online education program. For which reason should the staff nurse decide to apply to an in-person program instead? Select all that apply.

A) Less expensive B) Lacks motivation C) Desires socialization D) Minimal self-direction E) Limited computer skills Answer: B, C, D, E Explanation: A) The cost for online or in-person programs do not necessarily differ.

B) Successful eLearning depends on the ability of the learner to be motivated.

C) Because the learner is not relating to fellow learners or instructors in real time, the learner can experience feeling of isolation or disconnectedness when first experiencing online learning.

D) Successful eLearning depends on the ability of the learner to be self-directed.

E) The eLearning participant must have a degree of technical skills and ability to be able to navigate and manage the various elements within the course environment.

Page Ref: 67-68 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss the benefits and drawbacks to eLearning.

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15) The leadership team in a multisystem healthcare organization have approved each staff member to have an email address for communication. Which information should the team include when developing the guidelines for email use? Select all that apply.

A) Use a clear subject line.

B) Add exclamation points.

C) Proofread before sending.

D) Use professional language.

E) Avoid the use of "reply all."

Answer: A, C, D, E Explanation: A) A clear subject line allows the recipient to quickly identify important emails for timely review.

B) Exclamation points add emotional drama or immaturity to an email message.

C) Mistakes in spelling and grammar can discredit the sender's reputation; in addition, spellcheck can sometimes substitute very inappropriate words into a professional email.

D) Do not use nicknames, colloquial expressions, or slang when addressing emails in a professional environment.

E) Using the reply-all function can clutter inboxes with information not relevant to a major of the people on the original email thread.

Page Ref: 69 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Teamwork | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Describe technology used to organize and use electronic information.

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16) The director of a home care agency wants to document the names, addresses, diagnoses, healthcare providers, and pharmacy information for all patients. What should the nurse use to organize this information?

A) Database B) Index cards C) Spreadsheet D) Basic document Answer: A Explanation: A) A database is an electronic format for storing, organizing, and retrieving data in an organized manner. Databases provide the backbone for any organizations that need to store, retrieve, and organize data. The most common type of database is the relational database, which provides the ability to sort and retrieve data through its relationship with other data fields, such as linking a name with an address or a gender with a diagnosis.

B) Index cards would be labor intensive and may get lost or misplaced.

C) Spreadsheets are electronic tools that can be used to organize data, such as lists of related data. The row and column format support calculations, but spreadsheet software can also be used to create staff schedules, track information, and make simple reports. A spreadsheet can perform some simple functions of a database but cannot provide the complex relationship linking and reporting that is found in a true database.

D) A basic document can be used to list information; however, it cannot be sorted or easily changed.

Page Ref: 70 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.1. Explain why information and technology skills are essential for safe patient care | AACN Essential Competencies: IV.1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Describe technology used to organize and use electronic information.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 5 Using Informatics to Support Evidence-Based Practice and Research 1) The informatics nurse is using outcomes research to determine the effectiveness of changes made to the electronic health record. On which concepts should the nurse focus? Select all that apply.

A) Accelerating the diffusion of research into practice B) Linking treatments and outcomes data through databases C) Minimizing variations in practice by developing quality guidelines D) Analyzing databases so results can be quickly and easily disseminated E) Providing ways to systematically measure the functioning and well-being of patients Answer: B, C, D, E Explanation: A) Accelerating the diffusion of research into practice is a goal of the Accelerating Change and Transformation in Organizations and Networks (ACTION) program.

B) Linking treatments and outcomes data through databases is a concept of outcomes research.

C) Minimizing variations in practice by developing quality guidelines is a concept of outcomes research.

D) Analyzing databases so results can be quickly and easily disseminated is a concept of outcomes research.

E) Providing ways to systematically measure the functioning and well-being of patients is a concept of outcomes research.

Page Ref: 74 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: III.B.1. Participate effectively in appropriate data collection and other research activities | AACN Essential Competencies: III.2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Identify the role of outcomes research and transformational research in modern healthcare.

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2) The nurse is reviewing the results of a study using outcomes research. Which outcomes should the nurse analyze? Select all that apply.

A) Survival B) Quality of life C) Functional status D) Medication usage E) Patient satisfaction Answer: A, B, C, E Explanation: A) Survival is a measurable outcome of outcomes research.

B) Quality of life is a measurable outcome of outcomes research.

C) Functional status is a measurable outcome of outcomes research.

D) Medication usage is not a measurable outcome of outcomes research.

E) Patient satisfaction is a measurable outcome of outcomes research.

Page Ref: 74 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: III.B.1. Participate effectively in appropriate data collection and other research activities | AACN Essential Competencies: III.2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Evaluation/Communication and Documentation Learning Outcome: Identify the role of outcomes research and transformational research in modern healthcare.

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3) The nurse reviewing several pieces of literature notes the GRADE approach was used to rate the evidence. What should the nurse realize as being the purpose of this approach?

A) Increasing the use of research by nurses B) Reducing the cost associated with grading research C) Focusing on the nursing outcomes when grading research D) Promoting the development of a transparent approach to grade research evidence Answer: D Explanation: A) The GRADE approach was not designed to increase the use of research by nurses.

B) The GRADE approach was not designed to reduce the cost associated with grading research.

C) The GRADE approach was not designed to focus on nursing outcomes when grading research.

D) The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was to get input from many contributors, including representatives of other grading systems. The thought behind this strategy was to bring forward previous work and ideas and promote the development of a transparent approach for grading research evidence.

Page Ref: 76 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: III.B.1. Participate effectively in appropriate data collection and other research activities | AACN Essential Competencies: III.2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Explain the need for defining levels of evidence in healthcare research.

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4) The nurse notes that a research study is graded as a C on the SORT scale. Which organization should the nurse realize created this type of research leveling?

A) World Health Organization (WHO) B) Family Practice Inquiries Network (FPIN) C) Agency for Healthcare Research and Quality (AHRQ) D) American Association of Critical-Care Nurses (AACN) Answer: B Explanation: A) The World Health Organization participated in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

B) The Strength of Recommendation Taxonomy (SORT) was created by a group of primary care physicians to quality evidence-based outcomes from outside sources.

C) The Agency for Healthcare Research and Quality (AHRQ) recognized that healthcare decision-making should be done through systematic reviews. This organization created he Evidence-Based Practice Council (EPC) and The Effective Health Care (EHC) program to establish a comprehensive method of comparative effectiveness reviews.

D) The American Association of Critical-Care Nurses (AACN) taskforce developed an evidence rating scale in 1995. The original rating scale used roman numerals but was revised to use an alphabetical rating scale, using A for the highest level of evidence and moving down through the alphabet to letter E as reliability decreased. The letter M was reserved for evidence that was recommended only by the industry or manufacturer.

Page Ref: 77 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: III.B.1. Participate effectively in appropriate data collection and other research activities | AACN Essential Competencies: III.2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Explain the need for defining levels of evidence in healthcare research.

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5) The nursing leadership team is brainstorming ways to change one aspect of care provided by the clinical staff. Which approach should be used that considers factors that determine the likelihood of adoption of practice?

A) Iowa model B) Stetler model C) ACE star model D) PARIHS framework Answer: C Explanation: A) The Iowa model stresses the importance of prioritizing triggers based on the need for change and the needs of the clinical agency.

B) The original Stetler model was developed in 1976 and was revised specifically to the needs of EBP in 1994 and again in 2001.

C) The Academic Center for Evidence-Based Practice (ACE) developed the ACE star model to address translation and implementation aspects of the evidence-based practice process. The model applies evidence to clinical nursing by considering factors that determine the likelihood of adoption of practice.

D) The PARIHS (Promoting Action on Research Implementation in Health Services) framework is less structured than a true model of practice and provides a theory of practical application.

Page Ref: 79 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: III.B.1. Participate effectively in appropriate data collection and other research activities | AACN Essential Competencies: III.2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Identify existing models of integration for evidence-based practice into clinical practice.

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6) A healthcare organization is planning to use the PARIHS framework to implement evidencedbased practice. Which elements should the organization plan to have for a successful implementation? Select all that apply.

A) Context B) Evidence C) Validation D) Evaluation E) Facilitation Answer: A, B, E Explanation: A) The element of context refers to the quality of the environment that evidencebased practice is to be implemented in the PARIHS model.

B) The element of evidence is the source of knowledge from multiple stakeholders in the PARIHS model.

C) Validation is a phase in the Stetler model.

D) Evaluation is a phase in the Stetler model.

E) The element of facilitation is how the change will be supported in the PARIHS model.

Page Ref: 80 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: III.B.6. Participate in structuring the work environment to facilitate integration of new evidence into standards of practice | AACN Essential Competencies: III.2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Identify existing models of integration for evidence-based practice into clinical practice.

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7) The nurse needs to locate specific information to support a change in clinical practice. Which database should be accessed to locate this information?

A) The National Network of Libraries of Medicine (NN/LM) B) The Academic Center for Evidence-Based Practice (ACE) C) The Agency for Healthcare Research and Quality (AHRQ) D) The American Association of Critical-Care Nurses (AACN) Answer: A Explanation: A) The National Network of Libraries of Medicine (NN/LM) is a program with the goal of improving access to biomedical information by U.S. health professionals and the public's access to information. Access to NN/LM information is by membership, which can include libraries, information centers, or other types of organizations.

B) The Academic Center for Evidence-Based Practice (ACE) is a model to integrate evidencebased practice.

C) The Agency for Healthcare Research and Quality (AHRQ) created a leveling system.

D) The American Association of Critical-Care Nurses (AACN) created a leveling system, Page Ref: 80 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: III.B.6. Participate in structuring the work environment to facilitate integration of new evidence into standards of practice | AACN Essential Competencies: III.2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Define the need for research databases and data repositories related to research.

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8) The nurse notes that a substantial amount of research data are available through search engines and databases. For which reason should the nurse contact the Office of Extramural Research, Education and Priority Populations (OEREP)?

A) Locating an author of a research study B) Identifying where a study was conducted C) Learning what is being done to preserve the research data D) Obtaining the names of the people who were studied in a project Answer: C Explanation: A) The Office of Extramural Research, Education and Priority Populations (OEREP) will not be able to help locate an author of a research study.

B) The Office of Extramural Research, Education and Priority Populations (OEREP) will not be able to identify were a study was conducted.

C) The Office of Extramural Research, Education and Priority Populations (OEREP) is tasked to preserve and ensure the sustainability of data.

D) The Office of Extramural Research, Education and Priority Populations (OEREP) will not be able to provide the names of the people who were studied in a project.

Page Ref: 81 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: III.B.6. Participate in structuring the work environment to facilitate integration of new evidence into standards of practice | AACN Essential Competencies: III.2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Define the need for research databases and data repositories related to research.

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9) The nurse is planning to implement a study to measure the effectiveness of post-operative teaching. For which reason should the nurse obtain informed consent from the study participants?

A) Ensuring that the patient's name remains confidential B) Communicating the patient's participation with the other staff members C) Making sure that the patient does not participate in another research study D) Receiving permission to use information collected while the patient received care Answer: D Explanation: A) Informed consent is not used to ensure that the patient's name remains confidential.

B) Informed consent is not done to communicate the patient's participation with the other staff members.

C) Informed consent is not done to make sure that the patient does not participate in another research study.

D) If the patient, procedure, or any part of the procedure is specifically used in a research project, the patient must be made aware and consent must be obtained.

Page Ref: 83 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.B.12. Facilitate informed patient consent for care | AACN Essential Competencies: III.3. Advocate for the protection of human subjects in the conduct of research | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Identify ethical and legal principles of research related to patient privacy and security.

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10) The nurse questions if an article was written by a healthcare professional because several pieces of data appear to be misinterpreted. Which action should be taken to identify a ghostwriter? Select all that apply.

A) Use peer reviewers with expertise.

B) Notify the publisher that the article is incorrect.

C) Note if interpreted data is in sync with current practice.

D) Monitor the internal and external validity of research data.

E) Contact the listed author and ask questions about the content.

Answer: A, C, D Explanation: A) Actions to isolate a true author from a ghostwriter include using peer reviewers with expertise.

B) Actions to isolate a true author from a ghostwriter do not include notifying the publisher that the article is incorrect.

C) Actions to isolate a true author from a ghostwriter include noting if the interpreted data is in sync with current practice.

D) Actions to isolate a true author from a ghostwriter include monitoring the internal and external validity of the research data.

E) Actions to isolate a true author from a ghostwriter do not include contacting the listed author and asking questions about the content.

Page Ref: 84 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.3. Differentiate clinical opinion from research and evidence summaries | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Identify ethical and legal principles of research related to patient privacy and security.

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11) The nurse needs to locate specific information to support a clinical project. For which reason should the nurse access the Patient Centered Outcomes Research network (PCORnet)?

A) Funded by private sources B) Links all libraries on the Internet C) Contains clinical effective research D) Access limited to healthcare workers Answer: C Explanation: A) PCORnet is publicly funded.

B) PCORnet does not link all libraries on the Internet.

C) PCORnet is a public database of clinical effectiveness research.

D) PCORnet is available to the public and healthcare workers.

Page Ref: 87 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.4. Describe reliable sources for locating evidence reports and clinical practice guidelines | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Identify and discuss methods of research dissemination based on current government funding practices.

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12) A healthcare organization receives funding to study a new medical device to be used during surgery. Which database should the organization access to research similar studies?

A) Patient Centered Outcomes Research network (PCORnet) B) The National Network of Libraries of Medicine (NN/LM) C) The Academic Center for Evidence-Based Practice (ACE) D) The Agency for Healthcare Research and Quality (AHRQ) Answer: A Explanation: A) The Patient Centered Outcomes Research network (PCORnet) aggregates research information from hospitals, health plans, and practice-based networks for funded projects.

B) The National Network of Libraries of Medicine (NN/LM) is a program with the goal of improving access to biomedical information by U.S. health professionals and the public's access to information. Access to NN/LM information is by membership, which can include libraries, information centers, or other types of organizations.

C) The Academic Center for Evidence-Based Practice (ACE) is a model to integrate evidencebased practice.

D) The Agency for Healthcare Research and Quality (AHRQ) created a leveling system.

Page Ref: 87 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.4. Describe reliable sources for locating evidence reports and clinical practice guidelines | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Identify and discuss methods of research dissemination based on current government funding practices.

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13) The research department within a multisystem healthcare organization requires funding to continue an ongoing study. Which sources should the department consider to obtain this funding? Select all that apply.

A) Corporations B) Government grants C) Non-profit agencies D) Individual donations E) Academic institutions Answer: A, B, C, E Explanation: A) Corporate entrepreneurship strategies are identified as a method to obtain funding for research.

B) Many research projects are funded by government grants.

C) Many research projects are funded by non-profit agencies.

D) Individual donations are not identified as a method to obtain funding for research.

E) Many research projects are funded by academic institutions.

Page Ref: 82 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: III.B.1. Participate effectively in appropriate data collection and other research activities | AACN Essential Competencies: V.2. Describe how health care is organized and financed, including the implications of business principles, such as patient and system cost factors | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Identify and discuss methods of research dissemination based on current government funding practices.

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14) The nurse receives a notice about changes in funding for the Patient Centered Outcomes Research Network (PCORnet). Which agencies will be funding this public database in the future? Select all that apply.

A) Private industry B) National Institutes of Health C) The World Health Organization D) The Food and Drug Administration E) The Department of Veterans Affairs Answer: A, B, D Explanation: A) Funding for PCORnet is expected to be shifted to private industry.

B) Funding for PCORnet is expected to be shifted to the National Institutes for Health.

C) The World Health Organization is not a funding source for PCORnet.

D) Funding for PCORnet is expected to be shifted to the Food and Drug Administration.

E) The Department of Veterans Affairs is not a funding source for PCORnet.

Page Ref: 87 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: III.B.1. Participate effectively in appropriate data collection and other research activities | AACN Essential Competencies: V.2. Describe how health care is organized and financed, including the implications of business principles, such as patient and system cost factors | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Identify and discuss methods of research dissemination based on current government funding practices.

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15) The leadership team at a multisystem healthcare organization is noting the contributions that the division of nursing has had through various research projects. Which program has nursing research impacted? Select all that apply.

A) Meaningful use criteria B) Medicare reimbursement C) Clinical quality measures D) National Patient Safety Goals E) CMS conditions of participation Answer: A, C, D Explanation: A) Nursing has changed practice and demonstrated value through meaningful use criteria.

B) Nursing has not impacted Medicare reimbursement through research.

C) Nursing has changed practice and demonstrated value through clinical quality measures.

D) Nursing has changed practice and demonstrated value through the National Patient Safety Goals.

E) Nursing has not impacted the CMS conditions of participation through research.

Page Ref: 88 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Discuss the role of nursing in the future of healthcare research.

16) A healthcare organization is experiencing a drop in revenue that is impacting patient care. In which way can nursing research impact this issue?

A) Provide analytical data B) Change staffing patterns C) Begin a job-sharing program D) Withhold using time-off benefits Answer: A Explanation: A) Nursing research can influence the impact of cost containment by providing solid analytical data that supports patient care issues.

B) There is no evidence to support that changing staffing patterns will impact hospital revenue.

C) There is no evidence to support that a job-sharing program will impact hospital revenue.

D) There is no evidence to support that withholding the use of time-off benefits will impact hospital revenue.

Page Ref: 88 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss the role of nursing in the future of healthcare research.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 6 Policy, Legislation, and Regulation Issues for Informatics Practice 1) Members of a national nursing organization are petitioning a federal congressman to develop a policy to address mandatory drug testing. Which stages will need to be completed as the policy develops? Select all that apply.

A) Budgeting B) Agenda setting C) Program design D) Implementation E) Government response Answer: B, C, D, E Explanation: A) Budgeting is not a component of the policy development process.

B) Agenda setting is the first step in the policy development process.

C) Program design occurs after the government response in the policy development process.

D) Implementation occurs after program design in the policy development process.

E) The government response occurs after the agenda is set in the policy development process.

Page Ref: 96 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.4. Value nurses' involvement in design, selection, implementation, and evaluation of information technologies to support patient care. | AACN Essential Competencies: V.1. Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Differentiate policy, legislation, and regulation through components, processes, outcomes, and relationship to informatics.

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2) A multisystem healthcare organization has a new chief executive officer. Which will this organization leader use to guide policy development for the system going forward?

A) Budget B) Regulations C) Issues D) Values Answer: D Explanation: A) The budget is not identified as being used to guide policy development.

B) Regulations are not identified as being used to guide policy development.

C) Issues are not identified as being used to guide policy development.

D) Policies are written documents that reflect the values of administrators of organizations. They should and ought to express what the chief executive officers (CEOs) and their inner circles and confidantes believe.

Page Ref: 95 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.4. Value nurses' involvement in design, selection, implementation, and evaluation of information technologies to support patient care. | AACN Essential Competencies: V.1. Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Differentiate policy, legislation, and regulation through components, processes, outcomes, and relationship to informatics.

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3) The informatics nurse is reviewing electronic data interchange (EDI) with a group of new nurse colleagues. Which statement best describes the impact of the EDI? A) Supplies proof of recovery B) Eliminates second opinions C) Interacts with multiple databases D) Facilitates the approval of patient claims Answer: D Explanation: A) EDI is not used to supply proof of recovery of charges billed for healthcare services provided.

B) EDI is not used to eliminate second opinions.

C) An EDI is a process that ensures billing is complete and uniform with the Centers for Medicare and Medicaid Services expectations.

D) The Center for Medicare and Medicaid Services (CMS) has mandated that all providers and insurers submit all claims for reimbursement–for any service or for verification or certification of services–in a consistent format. This order compelled all providers to buy or contract with electronic data interchanges (EDIs) so billing is complete and uniform.

Page Ref: 98 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.4. Value nurses' involvement in design, selection, implementation, and evaluation of information technologies to support patient care. | AACN Essential Competencies: V.1. Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Contrast how value-based reimbursement differs from pay-for-performance or volume-based delivery models.

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4) The hospital finance department is reviewing the revenue generated during the last quarter. In which way did the implementation of value-based reimbursement impact this income?

A) Procedures that cost more are being performed.

B) Diagnostic tests that cost more are being performed.

C) Diagnostic tests to rule out problems are prescribed.

D) Procedures that impact patient outcomes are prescribed.

Answer: D Explanation: A) Procedures that cost more are volume-based compensation.

B) Diagnostic tests that cost more are volume-based compensation.

C) Diagnostic tests to rule out problems are not a particular type of compensation.

D) Prescribing procedures that impact patient outcomes is an approach in value-based reimbursement.

Page Ref: 98 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.4. Value nurses' involvement in design, selection, implementation, and evaluation of information technologies to support patient care. | AACN Essential Competencies: V.1. Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Evaluation/Communication and Documentation Learning Outcome: Contrast how value-based reimbursement differs from pay-for-performance or volume-based delivery models.

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5) The informatics nurse is reviewing the International Classification of Diseases (ICD-10) codes identified for a patient's care. For what should the nurse evaluate each code? Select all that apply.

A) Cause B) Severity C) Wounds D) Medications E) Anatomical location Answer: A, B, E Explanation: A) The ICD-10 codes categorize an injury or illness and describe in detail the cause.

B) The ICD-10 codes categorize an injury or illness and describe in detail the severity.

C) The ICD-10 codes are not specific for wounds.

D) The ICD-10 codes are not specific for medications.

E) The ICD-10 codes categorize an injury or illness and describe in detail the anatomical location.

Page Ref: 100 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: V.3. Compare the benefits and limitations of the major forms of reimbursement on the delivery of health care services | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Analyze the implications of health information technology (HIT) and informatics on diagnostic and billing codes.

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6) The director of nursing is reviewing the characteristics of the do-not-pay list published by the Centers for Medicare and Medicaid Services (CMS). Which disease process should the director highlight as being on this list? Select all that apply.

A) Falls B) Pneumonia C) Surgical site infection D) Stage III pressure ulcer E) Deep venous thrombosis Answer: A, C, D, E Explanation: A) The Deficit Reduction Act (DRA) of 2006 required that the CMS oversee the Hospital Acquired Conditions-Present on Admission (HAC-POA) Program. The HAC-POA evaluates payment, based on whether there is documented clinical evidence that a condition was present during the hospitalization and if it was noted to be present on admission to the healthcare facility. If conditions are not properly documented within the EHR as being present on admission, the condition is assumed to be hospital acquired and, therefore, will most likely fall into the do-not-pay category of CMS reimbursement. Examples of the HAC-POA conditions that CMS has placed on a do-not-pay list include falls.

B) Pneumonia is not on the do-not-pay list.

C) The Deficit Reduction Act (DRA) of 2006 required that the CMS oversee the Hospital Acquired Conditions-Present on Admission (HAC-POA) Program. The HAC-POA evaluates payment, based on whether there is documented clinical evidence that a condition was present during the hospitalization and if it was noted to be present on admission to the healthcare facility.

If conditions are not properly documented within the EHR as being present on admission, the condition is assumed to be hospital acquired and, therefore, will most likely fall into the do-notpay category of CMS reimbursement. Examples of the HAC-POA conditions that CMS has placed on a do-not-pay list include surgical site infections.

D) The Deficit Reduction Act (DRA) of 2006 required that the CMS oversee the Hospital Acquired Conditions-Present on Admission (HAC-POA) Program. The HAC-POA evaluates payment, based on whether there is documented clinical evidence that a condition was present during the hospitalization and if it was noted to be present on admission to the healthcare facility.

If conditions are not properly documented within the EHR as being present on admission, the condition is assumed to be hospital acquired and, therefore, will most likely fall into the do-notpay category of CMS reimbursement. Examples of the HAC-POA conditions that CMS has placed on a do-not-pay list include stage III pressure ulcers.

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E) The Deficit Reduction Act (DRA) of 2006 required that the CMS oversee the Hospital Acquired Conditions-Present on Admission (HAC-POA) Program. The HAC-POA evaluates payment, based on whether there is documented clinical evidence that a condition was present during the hospitalization and if it was noted to be present on admission to the healthcare facility.

If conditions are not properly documented within the EHR as being present on admission, the condition is assumed to be hospital acquired and, therefore, will most likely fall into the do-notpay category of CMS reimbursement. Examples of the HAC-POA conditions that CMS has placed on a do-not-pay list include deep venous thrombosis.

Page Ref: 100 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: V.3. Compare the benefits and limitations of the major forms of reimbursement on the delivery of health care services | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Analyze the implications of health information technology (HIT) and informatics on diagnostic and billing codes.

7) The informatics nurse reads a change made in a federal rule that will affect the organization's method for storing data. How should the nurse comment on the change? Select all that apply.

A) Fax B) Letter C) Email D) Telephone call E) Facebook comment Answer: A, B, C, D Explanation: A) Comments from the public about rules are invited in the form of faxes.

B) Comments from the public about rules are invited in the form of letters.

C) Comments from the public about rules are invited in the form of emails.

D) Comments from the public about rules are invited in the form of telephone calls.

E) Facebook comments are not identified as a method to comment about rules.

Page Ref: 101 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.4. Value nurses' involvement in design, selection, implementation, and evaluation of information technologies to support patient care | AACN Essential Competencies: V.4. Examine legislative and regulatory processes relevant to the provision of health care | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Determine points of access for making decisions in the federal rule-making process related to informatics issues.

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8) A final rule about data regulation is published in the Federal Register; however, a flaw is found in the language. What should the informatics nurse expect once the error is reported to the federal agency?

A) Nothing since the rule is final B) A note saying that the error is documented C) A letter saying that an amendment is being drafted D) An email saying that final rules cannot be amended Answer: C Explanation: A) Even after a rule is finalized, all communication about the rule and any changes must be addressed and go through the approval process again.

B) The error will be acted upon and not just documented.

C) There still are opportunities to amend rules, even after the final rule is published. New data, re-interpretation of data, a change in philosophy about a program, or a change in administration can prompt changes in programs. All changes must go through the original process.

D) Final rules can be amended.

Page Ref: 101 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.4. Value nurses' involvement in design, selection, implementation, and evaluation of information technologies to support patient care | AACN Essential Competencies: V.4. Examine legislative and regulatory processes relevant to the provision of health care | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Determine points of access for making decisions in the federal rule-making process related to informatics issues.

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9) A group of healthcare providers are moving into new office space and are reviewing different types of electronic health records. Which legislation should the group review to ensure compliance with meaningful use?

A) Health Information Technology for Economic and Clinical Health Act (HITECH) B) The American Recovery and Reinvestment Act C) Medicare Improvements for Patients and Providers Act (MIPPA) D) The Health Insurance Portability and Accountability Act Answer: A Explanation: A) The Health Information Technology for Economic and Clinical Health (HITECH) Act is a provision of the ARRA, which aimed to ensure that healthcare organizations were not only adopting EHRs but also validating their implementation by showing meaningful use.

B) The American Recovery and Reinvestment Act (ARRA) was enacted in 2009 as an attempt to revive the nation's economy, create jobs, and address widely neglected challenges that impact the future. Many of the provisions to the ARRA were directed toward improving healthcare, such as reducing COBRA health-insurance premiums, a tax credit for health coverage to encourage greater compliance, and federal funding or incentives for healthcare organizations to upgrade HIT systems.

C) In 2008, Congress enacted the Medicare Improvements for Patients and Providers Act (MIPPA), which contained several provisions that changed the Medicare program and allocated federal funding for state-based assistance programs directed at providing outreach to low-income Medicare beneficiaries.

D) The Health Insurance Portability and Accountability Act (HIPAA) of 1996 required the U.S.` Department of Health and Human Services (HHS) to develop regulations protecting the privacy and security of designated health information. HIPAA includes a privacy rule and a security rule.

The privacy rule established national standards for protecting health information, and the security rule established national security standards for protecting health information being held or transferred in electronic form.

Page Ref: 103 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.4. Value nurses' involvement in design, selection, implementation, and evaluation of information technologies to support patient care. | AACN Essential Competencies: V.4. Examine legislative and regulatory processes relevant to the provision of health care | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Identify the impact of informatics on at least three specific federal regulations.

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10) A healthcare provider receives notice that current reimbursement rates from Medicare are going to change. What should the provider keep in mind about reimbursement when reviewing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)?

A) Focused on quantity B) Based on value and quality C) Determined by the number of beneficiaries D) Calculated according to the gross domestic product Answer: B Explanation: A) The goal of MACRA is to drive healthcare reform toward providing improved reimbursement for care, based on value and quality rather than quantity.

B) The goal of MACRA is to drive healthcare reform toward providing improved reimbursement for care, based on value and quality rather than quantity.

C) Before MACRA, healthcare providers were paid according to the number of Medicare beneficiaries served.

D) Before MACRA, healthcare providers were paid according to changes in the real gross domestic product.

Page Ref: 101-102 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.4. Value nurses' involvement in design, selection, implementation, and evaluation of information technologies to support patient care. | AACN Essential Competencies: V.4. Examine legislative and regulatory processes relevant to the provision of health care | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Identify the impact of informatics on at least three specific federal regulations.

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11) An urban hospital has earned Magnet Recognition through the ANCC. Which role did information technology have in earning this recognition?

A) Informatic technology provided aggregate data related to quality improvement.

B) Informatic technology provided individualized data related to quality improvement.

C) Informatic technology provided aggregate data related to combating Joint Commission sanctions.

D) Informatic technology provided encrypted data to prevent breaches in security.

Answer: A Explanation: A) Accreditation cannot be earned without documentation of relevant data. Quality of care depends on healthcare providers making decisions based on evidence, which is often found in integrated data exchanges. Data sharing among providers, organizations, and other relevant and secure entities can contribute to quality care.

B) Although data sharing is a part of the process, individualized data is not a cost-effective approach.

C) Data collection is not focused on addressing Joint Commission sanctions.

D) Although encryption is necessary when sharing information, it would not support the process to achieve Magnet status.

Page Ref: 105-106 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.C.1. Appreciate that continuous quality improvement is an essential part of the daily work of all health professionals | AACN Essential Competencies: II. 9.

Apply quality improvement processes to effectively implement patient safety initiatives and monitor performance measures, including nurse-sensitive indicators in the microsystem of care | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Identify the relationship among accreditation decisions, reimbursement, quality of care, and informatics.

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12) A multisystem healthcare organization is planning to change the clinical information system.

Which professional should be a participant in the planning of this change?

A) Staff nurse B) Nurse manager C) Informatics nurse D) Vice president of nursing Answer: C Explanation: A) A staff nurse does not necessarily need to be involved in the planning stages.

B) A nurse manager is not identified as needing to be involved in the planning stages.

C) Informatics specialists must be at the table as decisions are made about computer- and electronic-related systems. These specialists can offer insight, expertise, and wisdom so that information systems are developed, implemented, and evaluated in a useful manner.

D) The vice president of nursing is most likely involved in the planning stages but will not be able to address the development, implementation, or evaluation of electronic systems.

Page Ref: 106 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.10. Advocate for the use of new patient care technologies for safe, quality care | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Identify the relationship among accreditation decisions, reimbursement, quality of care, and informatics.

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13) An urban hospital is implementing interprofessional teams to address patient care issues.

Which should be considered regarding supplying the teams with the necessary data?

A) Supplying each team member with a smart phone B) Banning the use of smart wristwatches to obtain data C) Expecting all data to be retrieved through computers D) Drafting a policy that explains the teams' use of patient information Answer: D Explanation: A) Although smartphones are used to retrieve data, there are other devices such as computers and smart wristwatches.

B) Smart wristwatches are a viable method to retrieve data.

C) Computers are not the only devices to retrieve data. Smart phones and smart wristwatches are available for use.

D) Organizations must have policies in place that direct or restrict how current information technology is used. Security and privacy continue to be central to any discussion.

Page Ref: 107 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: II.C.5. Respect the unique attributes that members bring to a team, including variations in professional orientations and accountabilities | AACN Essential Competencies: VI. 2. Use inter-and intraprofessional communication and collaborative skills to deliver evidence-based, patient-centered care | NLN Competencies: Teamwork | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss the pros and cons of working in interprofessional teams related to informatics and public policy-making.

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14) The staff development department is preparing a lecture series on interprofessional teams.

How should this training benefit the organization? Select all that apply.

A) Improve patient care B) Reduce the cost for care C) Increase public recognition D) Form a strong clinical team E) Build respect between disciplines Answer: A, C, D, E Explanation: A) A benefit of interprofessional education is an improvement in patient care through collaborative practice that attends to the whole patient, family, and community.

B) Interprofessional education is not identified as reducing the cost for care.

C) A benefit of interprofessional education is an increase in public recognition of a caring provider community.

D) A benefit of interprofessional education is the formation of a strong clinical team whose members use tested competencies.

E) A benefit of interprofessional education is the building of an environment where all providers demonstrate respect for each other's education and experience.

Page Ref: 107 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: II.C.5. Respect the unique attributes that members bring to a team, including variations in professional orientations and accountabilities | AACN Essential Competencies: VI. 2. Use inter-and intraprofessional communication and collaborative skills to deliver evidence-based, patient-centered care | NLN Competencies: Teamwork | Nursing/Integrated Concepts: Evaluation/Communication and Documentation Learning Outcome: Discuss the pros and cons of working in interprofessional teams related to informatics and public policy-making.

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15) The informatics nurse is informed that a healthcare provider is using patient data to create a mailing list to sell vitamins. Which outcome could occur because of this provider's handling of confidential information?

A) Nothing B) Civil action C) Criminal action D) Establish a client base Answer: B Explanation: A) Intentional misuse of data is unethical and could lead to civil action.

B) Intentional misuse of data is unethical and could lead to civil action.

C) Intentional misuse of data is unethical and could lead to civil action, not criminal action.

D) Intentional misuse of data is unethical and could lead to civil action. The provider was planning to create a client base by using the patient information; however, if reported, that will not occur.

Page Ref: 108 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.7. Explore ethical and legal implications of patientcentered care | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Evaluation/Communication and Documentation Learning Outcome: Discuss ethical issues that impact healthcare providers and organizations in the electronic age.

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16) The informatics nurse learns that a close friend is admitted to the organization. What should the nurse do demonstrate ethical behavior?

A) Refrain from accessing the medical record.

B) Access at the friend's medical record at the bedside.

C) Look at the friend's medical record in a secure area.

D) Ask a nurse on the care area about the friend's health problem.

Answer: A Explanation: A) The informatics nurse should be a role model in the proper attention to and use of health information technology. The friend's medical record should not be accessed.

B) Accessing the medical record at the bedside is a clear violation and should not be done.

C) Looking at the medical record anywhere is a clear violation and should not be done because the informatics nurse should serve as a role model.

D) Asking about the friend's health problem is a clear violation of privacy and should not be done since the informatics nurse is a role model.

Page Ref: 108 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.7. Explore ethical and legal implications of patientcentered care | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss ethical issues that impact healthcare providers and organizations in the electronic age.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 7 Electronic Health Record Systems 1) The informatics nurse is preparing a teaching tool about the different types of electronic communication. Which of the following should the nurse use to describe the electronic medical record (EMR)?

A) Method to identify outcomes B) Legal record created by vendors C) An electronic stand-alone database D) Legal record created in a practitioner's office Answer: D Explanation: A) The EMR is not a method to develop outcomes.

B) The EMR is not created by vendors.

C) The EMR is not considered a stand-alone database.

D) The EMR is described as an early form of the EHR, in which the focus was on bringing together the diagnostic and treatment information for an individual patient within a specific healthcare setting, such as a hospital or an office practice.

Page Ref: 113 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.10. Advocate for the use of new patient care technologies for safe, quality care | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Differentiate between electronic health record (EHR), electronic medical record (EMR), and personal health record (PHR).

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2) The informatics nurse reviews an approach for patients to enter personal information that can be accessed by the patient and provider. Which type of record is the nurse reviewing?

A) Best practice model B) Clinical data network C) Personal health record D) Online scheduling database Answer: C Explanation: A) The best practice model is not an approach for personal health information.

B) A clinical data network is not an approach to enter personal health information.

C) An approach to increasing patient engagement is the personal health record (PHR), which is a collection of patient data controlled by the patient and accessible by patient and providers.

D) An online scheduling database would not be used by patients.

Page Ref: 113 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.10. Advocate for the use of new patient care technologies for safe, quality care | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Differentiate between electronic health record (EHR), electronic medical record (EMR), and personal health record (PHR).

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3) The nurse accesses the computer software to locate information about laboratory studies completed and the nurse's notes during the last hospitalization. Which type of system is the nurse accessing?

A) Electronic health record (EHR) B) Electronic medical record (EMR) C) Shared electronic health record (SEHS) D) Electronic health record system (EHRS) Answer: D Explanation: A) An EHR is a database of an individual's healthcare data during healthcare encounters.

B) An EMR is an early form of the EHR, in which data is stored about a patient within a specific healthcare setting.

C) An SEHR is an electronic record system that allows clinicians to access a patient's data and information from the patient's EHRs at different facilities.

D) An EHRS is the database management software enabling the functions needed to create and maintain an EHR. The EHRS usually includes software to manage: a data repository (the EHR database), practitioner order entry (POE)–also known as computerized practitioner order entry (CPOE)–clinical decision support (CDS), and practitioner documentation.

Page Ref: 113 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.10. Advocate for the use of new patient care technologies for safe, quality care | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Explain the relationship between an EHR and an electronic health record system (EHRS).

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4) A healthcare organization is considering implementing an electronic health record system (EHRS). Which software should be included within this system? Select all that apply.

A) Practitioner order entry (POE) B) Clinical decision support (CDS) C) Evidence-based practice guidelines D) Online medical and nursing journals E) Electronic health record (EHR) database Answer: A, B, E Explanation: A) The EHRS usually includes software to manage practitioner order entry (POE).

B) The EHRS usually includes software to manage clinical decision support (CDS).

C) Evidence-based practice guidelines are not included in an EHRS. D) Online medical and nursing journals are not included in an EHRS. E) The EHRS usually includes software to manage the EHR database.

Page Ref: 113 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.10. Advocate for the use of new patient care technologies for safe, quality care | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Explain the relationship between an EHR and an electronic health record system (EHRS).

5) The informatics nurse prepares a seminar about meaningful use. Which statement should the nurse include?

A) It is an ongoing process and not an issue associated with the EHR. B) It is an issue that must be addressed before implementing any upgrade.

C) It provides invaluable information that will define the numbers of staff members needed at the bedside.

D) It requires that use of an EHRS results in improved quality, safety, and efficiency while reducing inconsistencies in healthcare.

Answer: D Explanation: A) Meaningful use is associated with the use of the EHR. B) Meaningful use is an ongoing process that will be implemented over three stages.

C) Meaningful use is not used to make staffing decisions.

D) Meaningful use requires that use of an EHRS results in improved quality, safety, and efficiency while reducing inconsistencies in healthcare.

Page Ref: 114 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.3. Navigate the electronic health record | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Describe the relationship between meaningful use and the adoption and use of the EHR in hospitals, practitioner offices, and other settings.

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6) The informatics nurse is working with a group of family practice healthcare providers on achieving meaningful use with an electronic health record system (EHRS). Which of the following should the nurse emphasize as outcomes of using the system? Select all that apply.

A) Improving efficacy B) Decreasing spending C) Improving the quality of care D) Improving scheduling of tests E) Increasing communication with patients Answer: A, B, C Explanation: A) Electronic systems that meet meaningful use criteria improve efficacy by eliminating redundancies and automating tasks.

B) Electronic systems that meet meaningful use criteria decrease spending in areas where information can be accessed instead of having to repeat diagnostic tests and procedures.

C) Electronic systems that meet meaningful use criteria improve the quality of care in patient population.

D) Scheduling of tests is not identified as an outcome of electronic systems that meet meaningful use criteria.

E) Patient communication is not identified as an outcome of electronic systems that meet meaningful use criteria.

Page Ref: 118-119 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.3. Navigate the electronic health record | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Describe the relationship between meaningful use and the adoption and use of the EHR in hospitals, practitioner offices, and other settings.

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7) A patient asks why all information is being entered into a computer instead of the paper chart.

Which response should the nurse make about the electronic health record (EHR)? Select all that apply.

A) Improved billing processes B) Reduced amount of co-pays for office visits.

C) Record available when and where needed.

D) Increased control over personal health information E) Access by more than one person at any given time.

Answer: A, C, D, E Explanation: A) The EHR improves the efficiency of billing by automated charge capture.

B) The EHR does not affect the amount of co-pays for office visits.

C) The EHR supports caregivers' ability to access client information whenever it is needed and at multiple convenient locations.

D) The EHR improves access and control over health information.

E) The EHR supports simultaneous access by multiple users and promotion of interdisciplinary care.

Page Ref: 119 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.3. Navigate the electronic health record | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss benefits associated with an EHRS.

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8) The informatics nurse is preparing a presentation for healthcare providers on the benefits of an electronic health record (EHR). Which information should be included? Select all that apply.

A) Faster chart access B) Limited access to trends and graphics C) Improved eligibility for reimbursement D) Easier access to previous documented encounters E) Reduced liabilities through accurate documentation Answer: A, C, D, E Explanation: A) One benefit of an EHR to healthcare providers is fast chart access, eliminating waiting for old paper records to be located and delivered from the medical records department.

B) An EHR has better reporting tools where trends and clinical graphs are available upon demand.

C) One benefit of an EHR to healthcare providers is improved eligibility for reimbursement.

D) One benefit of an EHR to healthcare providers is easy access to previous encounters.

E) One benefit of an EHR to healthcare providers is reduced liability through better decisionmaking and documentation.

Page Ref: 120 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.3. Navigate the electronic health record | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss benefits associated with an EHRS.

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9) A community hospital is considering implementing an electronic health record (EHR). Which is considered an impediment to the development and implementation of this electronic communication? Select all that apply.

A) Cost B) Confidentiality C) Information system vendors D) Lack of a common vocabulary E) Development of an electronic infrastructure Answer: A, B, D, E Explanation: A) One impediment to an EHRS is cost. Financial considerations include vendor fees, capital availability, and lack of or limited incentive eligibility. Initial and ongoing costs for deploying and maintaining IT systems were cited as the greatest barrier to IT. B) Security and confidentiality concerns are critical considerations in EHR development and use.

Preservation of the client's privacy is one of the most basic and important duties of the healthcare provider. Because one of the key attributes of an EHR is the ease of data sharing, the client's privacy rights must be guarded by all who have access to the record.

C) Information system vendors are not identified as being an impediment to the implementation of an EHR. D) Standardization of clinical terms used in patient records facilitates interoperability as it ensures a common understanding of terms. Standardized languages make it possible to generalize research findings across settings, countries, and cultures; compare patient outcomes; facilitate communication with other disciplines and delivery systems; and showcase nursing's contributions to healthcare. Despite these clear advantages, adoption of standard nomenclature has been slow.

E) Healthcare facilities, payers, physicians, and nurses all need the ability to access and update the client's longitudinal record. This ability requires linkage of the various information systems that support these stakeholders via a network infrastructure. Agreement must be reached regarding the nature and format of client data to be stored, as well as the mechanisms for data exchange, storage, and retrieval. This means that all participants use common data communication standards. The lack of standards has been a key barrier to establishing this type of electronic connectivity.

Page Ref: 123 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Review the current status of EHRSs.

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10) A multisystem healthcare organization is implementing an electronic health record (EHR).

Which situation could affect the integrity of the data?

A) Data mining B) Data analysis C) System failure D) Data downloading Answer: C Explanation: A) Data mining does not affect the integrity of the data.

B) Data analysis does not affect the integrity of the data.

C) Data integrity can be compromised in three ways: incorrect entry, data tampering, or system failure. In general, data integrity can be improved by implementing security measures, including the use of audit trails, as well as the development of detailed procedures and policies.

D) Data downloading does not affect the integrity of the data.

Page Ref: 126 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Review the current status of EHRSs.

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11) The vendor of the electronic health record system (EHRS) in a multisystem healthcare organization plans a meeting to discuss new updates to the current software. Which changes should elevate the level of the current EHRS? Select all that apply.

A) Cutting costs B) Fostering innovation C) Refocusing regulation D) Simplifying and increasing speed of documentation E) Increasing transparency and streamlining certification Answer: B, C, D, E Explanation: A) Cutting costs is not a recommendation to raise the EHRS to a higher level.

B) A recommendation to raise the EHRS to a higher level includes the ability to foster innovation.

C) A recommendation to raise the EHRS to a higher level includes refocusing regulation.

D) A recommendation to raise the EHRS to a higher level includes simplifying and increasing the speed of documentation.

E) A recommendation to raise the EHRS to a higher level includes increasing transparency and streamlining certification.

Page Ref: 128 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss future directions for EHRSs

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12) The vendor of an electronic health record system (EHRS) implements changes to refocus the regulating of the system. Which changes should the healthcare organization using the system expect? Select all that apply.

A) Reduce the need for re-entering data.

B) Separate data entry from data reporting.

C) Improve data exchange and interoperability.

D) Prioritize patient outcomes over new functional measures.

E) Clarify and simplify certification procedures and meaningful use regulations.

Answer: A, C, D, E Explanation: A) Reducing the need for re-entering data is a change to refocus the regulation of the EHRS. B) Separating data entry from data reporting is an action to simplify and increase the speed of documentation.

C) Improving data exchange and interoperability is a change to refocus the regulation of the EHRS. D) Prioritizing patient outcomes over new functional measures is a change to refocus the regulation of the EHRS. E) Clarifying and simplifying certification procedures and meaningful use regulations is a change to refocus the regulation of the EHRS. Page Ref: 128 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Evaluation/Communication and Documentation Learning Outcome: Discuss future directions for EHRSs.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 8 Healthcare Information Systems 1) The informatics nurse is reviewing potential clinical information systems. Which is the best example of a monitoring system?

A) The automatic blood pressure machine takes one reading of 164/104 and is turned off.

B) Manual blood pressure of 132/82 is entered into the vital sign section of the graphic sheet.

C) A temperature probe is connected to the pulmonary artery catheter to continuously monitor core temperature.

D) Blood glucose readings of 162 for 7:30 a.m. and 198 for 11:30 a.m. are obtained and entered into the computer system.

Answer: C Explanation: A) Devices not directly integrated usually have mechanisms for uploading data into a CIS. One blood pressure reading is not a good example of a monitoring system.

B) Devices not directly integrated usually have mechanisms for uploading data into a CIS. Manually entering data is not a good example of a monitoring system.

C) Physiological monitoring systems are applications that obtain and store real-time data about various physiological (versus anatomical) aspects of a patient. Monitoring is done to track changes in the monitored parameter from a baseline. Aspects that can be monitored today include basic vital signs. Because these applications usually are integrated with a CIS, the data are collected automatically and stored for review and decision making by healthcare professionals. Monitoring systems are devices that automatically monitor biometric measurements. The best monitoring systems, such as the temperature probe, obtain data electronically and transmit the data to be stored in the client's electronic medical record. Manual inputs are possible but are not the best way to record data.

D) Devices not directly integrated usually have mechanisms for uploading data into a CIS. Entering blood glucose readings after measurement is not a good example of a monitoring system.

Page Ref: 137-138 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Describe two or more applications for each type of system: CIS and AIS.

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2) The leadership team is deciding which clinical decision support system to implement in a large healthcare organization. Which should the team consider?

A) A system used to schedule client visits for follow-up care after extensive abdominal surgery B) A system used to register clients who are admitted to an acute healthcare facility for surgery C) A system used by emergency room administration to bill clients once their diagnoses are verified D) A system used by nurses to provide alerts for drug allergy, drug-drug interaction, and druglaboratory interactions Answer: D Explanation: A) A system to schedule patients is an example of an administrative information system application.

B) A system to register patients is an example of an administrative information system application.

C) A system for billing is an example of an administrative information system application.

D) Clinical decision support systems (CDSSs) are applications that support healthcare practitioners in making patient-care decisions. Results of CDSS action include alerts for drug allergy, drug-drug interaction, and drug-laboratory interactions.

Page Ref: 138 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.7. Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Knowledge and Science | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Describe two or more applications for each type of system: CIS and AIS.

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3) The informatics nurse suggests a clinical information system with computerized provider order entry (CPOE). Which is an advantage of having a CPOE? A) Can use electronic entry or hand-written orders B) Each department is notified simultaneously as orders are processed through the system C) Eliminates standing orders D) Reduces the need to validate telephone orders Answer: B Explanation: A) A CPOE means orders are entered electronically, eliminating the need to handwrite orders.

B) CPOE facilitates the process of selecting scripted orders that include precise start-and-stop times, timing of orders, and much more detail. The CPOE applications support the prescribers' decisions to enter orders and immediately share the orders with appropriate health professionals who execute the orders and the departments that need to dispense, schedule, or immediately deliver services to patients.

C) Scripted orders are a part of CPOE. D) All orders need to be validated by the healthcare provider. CPOE does not eliminate the need to validate telephone orders.

Page Ref: 138 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Describe two or more applications for each type of system: CIS and AIS.

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4) The informatics nurse is preparing a presentation on clinical information systems. Which should the nurse explain as a characteristic of an automated radiology information system (RIS)?

A) Once a test is completed, the film is scanned to an optical imaging disc.

B) As each test is ordered, the user is prompted to answer patient-focused information.

C) Images may be faxed to other institutions for timely consultations.

D) As soon as the test is performed, the system interprets the results and sends an electronic report.

Answer: B Explanation: A) Picture archiving and communication system (PACS) applications support the widespread use of digitized medical imaging for x-rays, magnetic resonance imaging (MRI), computerized tomography, and ultrasound.

B) Radiology-information systems (RISs) have functionality to receive requests; schedule imaging, including people, rooms, and equipment; provide patient-focused information that helps patients prepare for scheduled diagnostic imaging; manage image storage; and store and report the radiologists' interpretations.

C) Only the report can be faxed. Images cannot be faxed; however, images can be transmitted electronically to remote locations.

D) Healthcare providers must still review the films and interpret the images.

Page Ref: 137 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Describe two or more applications for each type of system: CIS and AIS.

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5) The informatics nurse is meeting with the pharmacy director to review possible automated pharmacy systems. Which should the nurse highlight as a feature of these systems? Select all that apply.

A) Pulls in client information from the HIS more quickly to identify potential interactions B) Controls inventory C) Prepares patient profiles and medication labels D) Limits the use to pharmacists E) Suggests patient education based upon clinical information Answer: A, B, C, E Explanation: A) Pharmacy information systems (PISs) combine administrative and patient-care functions. Clinical functions alert practitioners and pharmacists of prescription errors and potential interactions.

B) Pharmacy information systems (PISs) combine administrative and patient-care functions. On the administrative side, functions may include inventory control.

C) Pharmacy information systems (PISs) combine administrative and patient-care functions. On the administrative side, functions may patient profiles and medication labels.

D) Pharmacy information systems (PISs) combine administrative and patient-care functions.

These systems can be used by a variety of health care professionals who perform activities related to the ordering, dispensing, and administration of medications.

E) Pharmacy information systems (PISs) combine administrative and patient-care functions.

Clinical functions suggest patient education through access to clinical information.

Page Ref: 137 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Describe two or more applications for each type of system: CIS and AIS.

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6) The informatics nurse is helping the leadership team select a health information system.

Which system should the nurse identify that supports the use and documentation of nursing processes and activities and provides tools for managing the delivery of nursing care?

A) Administrative information system B) Nursing information system C) Computerized provider order entry (CPOE) D) Clinical information system Answer: B Explanation: A) Administrative information systems support client care by managing financial and demographic information and providing reporting capabilities. This category includes client management, financial, payroll, and human resources, and quality assurance systems. Coding systems use clinical information to generate charges for care.

B) Nursing information system supports the use and documentation of nursing processes and activities and provides tools for managing the delivery of nursing care.

C) CPOE is the electronic entry of patient orders directly into the system.

D) Clinical information systems (CISs) are large, computerized database management systems that support several types of activities that may include provider order entry, result retrieval, documentation, and decision support across distributed locations.

Page Ref: 136 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Differentiate between clinical information systems (CIS) and administrative information systems (AIS).

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7) The informatics nurse is highlighting how the health information system supports knowledge.

Which standardized nomenclature is an example of textual knowledge for concepts in nursing?

A) HIS B) CMS C) NIH D) NIC Answer: A Explanation: A) HIS is an acronym for health information systems.

B) CMS is an acronym for the Center for Medicare and Medicaid.

C) NIH is an acronym for the National Institutes of Health.

D) Formalized, systematic methods for representing knowledge facilitate communication, reasoning, and decision making. Standardized nomenclatures, such as Nursing Interventions Classification (NIC), is an example of textual knowledge representing concepts nursing.

Page Ref: 138-139 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: State one format for representing healthcare knowledge.

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8) The informatics nurse is preparing material to explain the client registration and scheduling system. Which aspect of this system tracks a patient's activities throughout the healthcare system?

A) Admission system B) Admission/discharge/transfer system C) Transfer system D) Discharge system Answer: B Explanation: A) The client registration and scheduling system includes an admission/discharge/transfer (ADT) system. This does more than track patient admissions.

B) An admission/discharge/transfer (ADT) system is used in healthcare organizations to support the process of providing client care. This system is integrated with other administrative and clinical systems and tracks a patient's activities and location from hospital or clinic admission through any and all transfers within the facility and, finally, through discharge.

C) The client registration and scheduling system includes an admission/discharge/transfer (ADT) system. This does more than track patient transfers.

D) The client registration and scheduling system includes an admission/discharge/transfer (ADT) system. This does more than track patient discharges.

Page Ref: 139 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Describe two or more applications for each type of system: CIS and AIS.

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9) The informatics nurse is explaining smart technology to a group of staff nurses. Which statement suggests that the use of mobile devices in the healthcare setting can enhance patient care?

A) Personal access to patient's home address B) A finite amount of space on portable devices to receive instantaneous lab results C) The elimination of paper copies of lab reports D) The elimination of a unit secretary position because all data are housed on the mobile device Answer: C Explanation: A) The nurse does not need access to a patient's address to improve nursing care.

B) Space issues on handheld devices should be addressed before loading too many files and data on it.

C) The ability to send results directly to secure mobile devices helps to ensure the privacy of health information because it eliminates the need for large numbers of printouts and the need to fax sensitive information.

D) The unit secretary has additional duties besides delegated retrieval of lab results.

Page Ref: 141 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Discuss the definition and potential benefits for practitioners or patients of smart technology.

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10) The leadership team is evaluating the types of technology to integrate with the health information system. Which term should be used to explain the entry and retrieval of information at the point of care or wherever it is needed by the healthcare professional?

A) Smart technology B) Computerized order entry C) Bar coding systems D) Monitoring systems Answer: A Explanation: A) Smart technology is the functionality behind the scenes that provides the capability of the electronic system to send real-time messages to all of the various areas required during a patient visit, where providers document the visit, order the medications while also checking alerts for errors, schedule appointments, and generate bills. All of this is done because the different systems are tied or interfaced together so the electronic messages can cross systems.

B) Computerized order entry is a part of the clinical information system.

C) Bar coding systems are one type of smart technology.

D) Monitoring systems are a type of smart technology.

Page Ref: 141 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss the definition and potential benefits for practitioners or patients of smart technology.

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11) The informatics nurse is reviewing health information systems. Which clinical system function allows the nurse to provide more efficient patient care?

A) Electronic presentations B) Order entry C) Identification coding D) Help desk Answer: B Explanation: A) Electronic presentations can be useful in the education process but are not necessarily helpful in improving patient care.

B) Clinical information systems (CISs) are large, computerized database management systems that support several types of healthcare activities, including provider/practitioner order entry, results retrieval, documentation, and decision support, across locations.

C) Identification coding is not a part of a CIS. D) The Help Desk is not a part of a CIS. Page Ref: 135 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Differentiate between clinical information systems (CIS) and administrative information systems (AIS).

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12) The informatics nurse is heading a committee to enhance the sharing of knowledge within a large healthcare organization. Which characteristics should the committee members possess?

Select all that apply.

A) Understand the science B) Understand the research evidence C) Able to assist others with comprehension D) Possess an upper level educational degree E) Able to present information for interpretation Answer: A, B, C, E Explanation: A) The development of health-related knowledge representations is a formal process that includes clinical experts representing specialties and healthcare professionals who understand the science.

B) The development of health-related knowledge representations is a formal process that includes clinical experts representing specialties and healthcare professionals who understand the research evidence.

C) The development of health-related knowledge representations is a formal process that includes clinical experts representing specialties and healthcare professionals who are able to assist others with comprehension.

D) The development of health-related knowledge representations is a formal process; however, it is not contingent upon a specific educational degree.

E) The development of health-related knowledge representations is a formal process that includes clinical experts representing specialties and healthcare professionals who understand the information for interpretation.

Page Ref: 139 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: IV.9. Apply patient-care technologies as appropriate to address the needs of a diverse patient population | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: State one format for representing healthcare knowledge.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 9 Strategic Planning, Project Management, and Health Information Technology Selection 1) The informatics nurse is preparing a presentation to support planning for an upgraded clinical information system. Which should the nurse use as an example of strategic planning in an acute care facility?

A) Team members of an organization take on a project to develop policies and procedures one year prior to the Joint Commission accreditation visit.

B) Upon acquiring a new facility, team members are selected to identify goals and strategies to develop policies fitting the newly revised mission statement.

C) A project team from a marketing firm is hired to develop an advertising campaign for the specialized health-promotion services of the acute-care facility.

D) Team members from administration meet as a group to rewrite their one-year-old acute care institution's mission statement.

Answer: B Explanation: A) The development or revision of policies, advertising campaigns, and mission statements prior to a Joint Commission accreditation visit is incomplete.

B) Project planning and strategic planning for the management of information is a critical first step in any planning process to determine what an organization wants in the future, in order to plan how and where to collect and utilize health data; when the guidelines and framework are followed, it increases potential for the project to succeed. Strategic planning is a long-term process that begins by identifying the long-range mission, goals, and strategies of an organization. Ideally, this is done in the beginning when a new institution opens, or before the facility opens. The development or revision of policies, advertising campaigns, mission statements, and so on, by themselves, is incomplete.

C) Developing an advertising campaign is not a complete example of a strategic plan.

D) Rewriting the mission statement is not strategic planning.

Page Ref: 150 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.A.2. Recognize that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families | AACN Essential Competencies: II.4. Demonstrate a basic understanding of organizational structure, mission, vision, philosophy and values | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Define strategic planning. Discuss the value of strategic planning in health information technology (HIT), and explain why it is important.

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2) The leadership team is contemplating a change in the clinical information system. Which definition of strategic planning should this team follow?

A) A chaotic approach to organizational change B) A series of sequential steps leading to individualized goals C) A plan devoid of a mission and goals D) Process of determining what an organization wants to be in the future and planning how it will get there Answer: D Explanation: A) Strategic planning is not a chaotic approach to organizational change. It is a planned approach to change.

B) Strategic planning is not used to achieve individualized goals.

C) Strategic planning is based upon the organization's missions and goals.

D) Strategic planning provides the focus for how a vision will be achieved. Successful strategic plans require the identification of a single vision, and a single mission that fits within that vision, with all activities designed to meet the identified mission.

Page Ref: 150 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.A.2. Recognize that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families | AACN Essential Competencies: II.4. Demonstrate a basic understanding of organizational structure, mission, vision, philosophy and values | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Define strategic planning. Discuss the value of strategic planning in health information technology (HIT), and explain why it is important.

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3) The leadership team of a large healthcare organization is designing a new strategic plan for an electronic health record system. Which has been most instrumental in mandating strategic planning to achieve organization and population healthcare goals?

A) Internal stakeholders B) Community members C) Healthcare reform D) Nursing informatics specialist Answer: C Explanation: A) Internal stakeholders are an essential component of strategic planning; however, they are not the reason why strategic planning has been mandated.

B) Community members are an essential component of strategic planning; however, they are not the reason why strategic planning has been mandated.

C) In 2009, the $787 billion American Recovery and Reinvestment Act (ARRA) included $19.2 billion to increase the use of the electronic health record systems (EHRS) by providers and hospitals through the Health Information Technology for Economic and Clinical Health Act (HITECH) through Medicare and Medicaid incentives. This has spurred tremendous energy toward the implementation of these information systems, requiring extensive planning and reworking of many healthcare organizations and their strategic plans.

D) The nursing informatics specialist is a member of the leadership team; however, this is not the reason why strategic planning has been mandated.

Page Ref: 150 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.A.2. Recognize that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families | AACN Essential Competencies: II.4. Demonstrate a basic understanding of organizational structure, mission, vision, philosophy and values | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Define strategic planning. Discuss the value of strategic planning in health information technology (HIT), and explain why it is important.

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4) The leadership team is beginning the strategic planning process for an electronic health record system. Which should this team use as a goal for this plan?

A) Enhance the organization's website image within six months.

B) Clinical decision-making in the emergency department will be supported by additional funds for personnel training during the fall.

C) The scope of home care services will be maintained with the same budget for the next fiscal year, during which an audit will be conducted.

D) Make effective use of emerging technologies.

Answer: D Explanation: A) This is an example of an objective because it provides a date for completion.

B) This is an example of an objective because it explains how a goal will be achieved with the addition of funds for training.

C) This is an example of an objective because it explains how an audit will be completed in a year.

D) New technologies can create administrative efficiencies and attract providers and clients. A perfect example of this can be seen with the use of handheld and other wireless devices to collect, view, and transmit patient information from the point of care. The Internet and eHealth represent other developments that have changed access to and delivery of healthcare. Because patient results can be made available online from any location, patients can become more connected to their healthcare, patient questions can be addressed, and decision making can be informed. These developments must be included in the strategic planning process as they can change familiar processes from a known system to an unknown workflow, which may cause anxiety and confusion.

Page Ref: 152 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.4. Describe examples of how technology and information management are related to the quality and safety of patient care | AACN Essential Competencies: II.4. Demonstrate a basic understanding of organizational structure, mission, vision, philosophy and values | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Describe how strategic planning is related to an organization's mission, scope, vision, goals, and objectives.

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5) The leadership team is updating the mission statement for a large healthcare organization.

Which phrase should the team consider?

A) Develop wellness service clinics in an urban area in the Midwest.

B) Promote educational activities related to caring for the sick and injured.

C) Build a unit for clients with chronic obstructive pulmonary disease.

D) Expand home care services in the rural area in the Southeast.

Answer: B Explanation: A) Developing wellness clinics could be a strategy to achieve the organization's mission.

B) The mission is the purpose or reason for the organization's existence and represents the fundamental and unique aspirations of the organization that differentiates it from others. The mission is often conveyed in the form of a mission statement that broadly declares what a business aspires to be by telling the organization's personnel and customers who they are and what they do. The mission statement should incorporate meaningful and measurable criteria. The mission statement is an important tool when used to guide the planning process and should resonate with those involved with the organization, including key stakeholders. The mission statement should be one of the first things considered when evaluating a strategic decision.

C) Building a specific type of care area could be a strategy to achieve the organization's mission.

D) Expanding home care services could be a strategy to achieve the organization's mission.

Page Ref: 158 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.C.4. Value measurement and its role in good patient care | AACN Essential Competencies: II.4. Demonstrate a basic understanding of organizational structure, mission, vision, philosophy and values | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Describe how strategic planning is related to an organization's mission, scope, vision, goals, and objectives.

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6) The leadership team is creating a strategic plan to upgrade the current health information system. Which goal would be useful in this plan? Select all that apply.

A) Support business and clinical decisions.

B) Make effective use of emerging technologies.

C) Enhance the organization's image.

D) Spend whatever is necessary to create a state of the art system.

E) Provide a safer environment for clients.

Answer: A, B, C, E Explanation: A) Data management supports better decision making by providing timely and accurate information.

B) New technologies can create administrative efficiencies and attract providers and clients.

These developments must be included in the strategic planning process as they can change familiar processes from a known system to an unknown workflow, which may cause anxiety and confusion.

C) The effective use of information technologies enhances how the organization is perceived by providers, clients, the community, and other external groups. This is especially critical in these times of competitive healthcare.

D) Spending whatever is necessary to create a state of the art system is not an appropriate goal because the system should be cost effective. Cost effectiveness is achieved when redundancies are eliminated.

E) There is a strong initiative for patient safety at this time. A number of organizations, including government agencies, regulatory bodies, consumer groups, and professional organizations, are looking into ways to improve patient safety.

Page Ref: 152 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.C.4. Value measurement and its role in good patient care | AACN Essential Competencies: II.4. Demonstrate a basic understanding of organizational structure, mission, vision, philosophy and values | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Describe how strategic planning is related to an organization's mission, scope, vision, goals, and objectives.

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7) The planning committee collects data during the internal and external environmental scans.

Which should be the committee's next step?

A) Review the budget for a technology line.

B) Complete a gap analysis.

C) Write the pros and cons of the proposed upgrades.

D) Contact the vendors for price comparisons.

Answer: B Explanation: A) Budget considerations occur later in the process.

B) A gap analysis of the existing information management methods should be conducted, which helps to define and support the rationales for the project.

C) Analysis of the upgrades occurs as a separate process.

D) Price comparisons of the upgrades occur as a separate process.

Page Ref: 159 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.C.4. Value measurement and its role in good patient care | AACN Essential Competencies: II.4. Demonstrate a basic understanding of organizational structure, mission, vision, philosophy and values | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Describe how strategic planning is related to an organization's mission, scope, vision, goals, and objectives.

8) The leadership team is meeting to determine the vision for the future of the organization.

Which is the very first step in any strategic planning process?

A) Realization of the need for change B) Review of the mission C) Gather key stakeholders D) Assess the budget Answer: A Explanation: A) The planning process starts after leadership and stakeholders make a decision that the current system must be upgraded or built new, fully replacing the legacy or old system.

B) Reviewing the mission occurs when preparing the scope document.

C) Stakeholders are gathered once the decision to make a change is made.

D) The budget is assessed as a part of strategic thinking.

Page Ref: 150 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.C. 4. Value measurement and its role in good patient care | AACN Essential Competencies: II.4. Demonstrate a basic understanding of organizational structure, mission, vision, philosophy and values | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Understand the relationship between strategic planning for information systems and planning for the overall organization.

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9) The informatics nurse is invited to attend a leadership meeting to discuss an upgrade to the current health information system. Which should the nurse keep in mind during this meeting?

A) Altering the mission of the organization B) Representing the staff of the patient care areas C) Using as much of the current system as possible D) Ensuring the organization's place in the industry Answer: A Explanation: A) The strategic plan should support the organization's mission.

B) The informatics nurse is a member or the leader of the project team. Staff input should be provided throughout the entire planning and implementation process.

C) The current system may not meet the organization's goals and mission which is the reason for the upgrade.

D) Strategic planning is an outcome of strategic thinking. To think strategically requires continual assessment and application of new business acumens. The goal is to use these insights to reinforce a company's place in the industry. Thinking strategically must come before the team can move on to strategic planning.

Page Ref: 151 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.C.4. Value measurement and its role in good patient care | AACN Essential Competencies: II.4. Demonstrate a basic understanding of organizational structure, mission, vision, philosophy and values | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Understand the relationship between strategic planning for information systems and planning for the overall organization.

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10) The project planning committee for an outpatient center is planning to conduct a needs assessment prior to implementing wireless technology to enhance their computer system. Which source should the committee identify as most valuable to assess?

A) Interviews with the director and unit managers of outpatient services and the chief executive officer B) Guidelines provided by the Joint Commission C) Health Insurance Portability and Accountability Act (HIPAA) regulations D) Interviews with administrators and representative employees from all of the outpatient services Answer: D Explanation: A) Although interviews with administrators provide valuable information, they may be unacquainted with daily workflow and information needs.

B) Regulations from accrediting bodies must be followed but do not reflect the work process and needs in specific settings.

C) Regulations from federal bodies must be followed but do not reflect the work process and needs in specific settings.

D) Most valuable would be interviews with administrators and representative employees from all of the outpatient services. Stakeholders are those who have a vested interest in the new project.

Because it will impact them in some way, they are involved at some level in the decision-making process.

Page Ref: 150 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.C.2. Value own and others' contributions to outcomes of care in local care settings | AACN Essential Competencies: II.12. Participate in the development and implementation of imaginative and creative strategies to enable systems to change | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Explain the importance of assessing the internal and external environments during the planning process.

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11) A healthcare organization invites a stakeholder to be a part of the strategic planning process.

Which are considered stakeholders? Select all that apply.

A) Internal customers B) Unions C) Government bodies D) Community members E) External customers Answer: A, C, D, E Explanation: A) Stakeholders are those who have a vested interest in the new project; because it will impact them in some way, they are involved at some level in the decision-making process.

B) Unions are not considered stakeholders.

C) Stakeholders are those who have a vested interest in the new project. Because it will impact them in some way, they are involved at some level in the decision-making process.

D) Stakeholders are those who have a vested interest in the new project. Because it will impact them in some way, they are involved at some level in the decision-making process.

E) Stakeholders are those who have a vested interest in the new project. Because it will impact them in some way, they are involved at some level in the decision-making process.

Page Ref: 150 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.C.2.Value own and others' contributions to outcomes of care in local care settings | AACN Essential Competencies: II.12. Participate in the development and implementation of imaginative and creative strategies to enable systems to change | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Explain the importance of assessing the internal and external environments during the planning process.

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12) Scanning the environment is part of the planning process. Which should the informatics nurse consider as part of the external environment?

A) Published reports B) Interviews from managers C) Questionnaires from managers and end users D) Observations of current technology Answer: A Explanation: A) Strategic planning involves scanning the external and environment. Published reports would be part of the external environment.

B) Interviews from managers would be a part of the internal environment.

C) Questionnaires from managers and end users would be a part of the internal environment.

D) Observing current technology would be a part of the internal environment.

Page Ref: 164 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.C.2. Value own and others' contributions to outcomes of care in local care settings | AACN Essential Competencies: II.12. Participate in the development and implementation of imaginative and creative strategies to enable systems to change | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Explain the importance of assessing the internal and external environments during the planning process.

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13) The strategic planning committee is developing the project plan for the implementation of a health information system. For which reason is a timeline developed?

A) Achievement of the mission B) The completion of all tasks C) Review of the scope and objectives D) Define the length of the vendor's availability Answer: B Explanation: A) The goals and objectives of the project plan should be developed to be aligned with the organization's mission.

B) During phase one, the timeline for the project start and its projected finish is developed. This document is designed to provide a quick overview of due dates, week-by-week and month-bymonth, with tasks to be completed and major milestones outlined. This is also a great way to communicate projected deadlines to the team.

C) The scope and objectives cannot be held to a timeline.

D) A timeline is not used to define the length of the vendor's availability.

Page Ref: 159 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Understand the importance of developing a timeline during the planning phase of strategic planning.

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14) The informatics nurse meets with the health information system implementation team to review which tasks are to be completed in the week ahead. Which document should the nurse use as a reference for this information?

A) Timeline B) Project scope C) Project charter D) Functionality checklist Answer: D Explanation: A) The timeline is a document that provides a quick overview of due dates, weekby-week and month-by-month with tasks to be completed and major milestones outlined.

B) The project scope includes the organization name, title of project, scope document, name/number/priority level, project manager, sponsor, mission statement, vision, measurable project objectives, justification of project, implementation strategy, project resources, completion date, measures of success, assumptions, constraints, approvals: sponsor, project manager, and owner, final approved and signed off by executives.

C) A project charter identifies the title of project, objective of project, population to be served, services to be provided, justification of project, scope statement summary, and project participants.

D) A functionality checklist is used when evaluating if a system will meet the organization's needs.

Page Ref: 159 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Understand the importance of developing a timeline during the planning phase of strategic planning.

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15) The leadership team is in the request for proposal phase of the information system planning process. Which would enhance the decision making process at this time?

A) Use of a lottery system B) Hiring a consultant to make the decision C) Time off to reflect on decisions D) Weighted scoring tool Answer: D Explanation: A) A lottery system does not guarantee that the appropriate vendors will be contacted to submit proposals.

B) A consultant would not have sufficient information to determine the best vendor to meet the organization's needs.

C) Taking time away from the project is not the best way to stay on track to meet the organization's mission and goals.

D) There are tools, such as the Vendor Evaluation Matrix Tool, which consists of 58 assessment questions that should provide answers from evaluation by functionality/usability and prioritizing vendors. Each vendor is scored on a scale from 1 (poor) to 5 (excellent) on each of the prioritized items, and then ratings are tallied at the end for a total score.

Page Ref: 155 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Evaluation/Communication and Documentation Learning Outcome: List tools or processes that may be used to evaluate the outcome of and provide feedback about the planning process.

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16) The informatics nurse reviews the implementation plan for the new health information system. When should the nurse expect the strategic planning process to end?

A) System implementation.

B) Review of lessons learned.

C) Purchase of the equipment.

D) Hiring of the IT support staff.

Answer: B Explanation: A) Implementing the system is just one part of the project implementation plan.

B) The final three steps or phases for project management include implementing the plan, monitoring outcomes, and the final evaluation and lessons learned with knowledge transfer.

C) Equipment purchase occurs early in the implementation of the plan.

D) Hiring support personnel occurs early in the implementation of the plan.

Page Ref: 161 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: List tools or processes that may be used to evaluate the outcome of and provide feedback about the planning process.

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17) A large healthcare organization is reviewing the health information systems being used in the various facilities. Which facility would benefit the most from a complete computer system upgrade?

A) Mid-sized facility using a mainframe legacy system B) A small clinic that has an electronic record system in place C) Merging two smaller facilities that use similar mainframe systems D) Merging three large facilities that use similar Windows-based operating systems Answer: A Explanation: A) A legacy or older system may not easily interface with newer technology.

B) An electronic record system would meet the needs of the clinic and the population and most likely would not need to be replaced.

C) Facilities that are able to merge their systems would not need to be upgraded or replaced.

D) Facilities using a Windows-based operating system are at the most current level of operation and would not need to be upgraded or replaced.

Page Ref: 159 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Describe two functions in the project management process that must be considered during the HIT selection activity.

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18) The leadership team of a large healthcare organization is developing a five-year strategic plan for the health information system. Which should the team plan to address in the coming years?

A) Creating standardized languages B) Bar code medication administration C) Identification of Microsoft's new product line D) Hiring an appropriate chief executive officer Answer: B Explanation: A) It is not the responsibility of a healthcare system to create a standardized language.

B) The American Nurses Credentialing Center (ANCC) describes important tasks to know when selecting a clinical system. Knowledge of hardware, such as smart devices, tablets, laptops, small-footprint computers, and multifunction devices is important to understand. Other essential skills include knowledge of software appropriate to device type as it is used in different clinical scenarios such as barcoding C) It is not the responsibility of a healthcare organization to identify a vendor's product line.

D) Hiring a chief executive officer would be beyond the scope of the leadership team within a healthcare organization.

Page Ref: 153 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Describe two functions in the project management process that must be considered during the HIT selection activity.

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19) The board of directors is appointing a colleague to head the implementation of a new health information system. Which employee would be the most appropriate leader?

A) Resident emergency department physician who was recently hired B) Nurse manager of a 16-bed coronary-care unit who has been employed at the institution for one year C) Chief nursing information officer (CINO) appointed two years ago D) Nurse supervisor of the medical-surgical units, encompassing 130 beds Answer: C Explanation: A) A physician may support the team's efforts but does not possess adequate knowledge to lead the team.

B) Those lower level managers, such as nurse managers, may support the team effort but typically do not take as much of a leadership role.

C) The key responsibility of CNIOs is to capitalize on their nursing informatics knowledge and project management skills. The role encompasses an understanding and integration of multiple computer, information, analytical, and nursing science skills in order to manage, as well as strategically and operationally lead, stakeholders of the interprofessional healthcare team in decision making to achieve organizational outcomes. The CNIO uses these skills when focused on the design, planning, and implementation of health information systems, and when managing the adoption of other supporting clinical initiatives.

D) Those in lower-level management, such as supervisors, may support the team effort but typically do not take as much of a leadership role.

Page Ref: 164 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: II.C.5. Respect the unique attributes that members bring to a team, including variations in professional orientations and accountabilities | AACN Essential Competencies: IV.10. Advocate for the use of new patient care technologies for safe, quality care | NLN Competencies: Teamwork | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: List two skills a nurse informaticist must possess in order to apply best practices in HIT selection.

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20) The informatics nurse (NI) is assigned as the project manager for the implementation of an upgraded health information system. Which actions should the nurse take to raise the likelihood of success during this project? Select all that apply.

A) Defines the scope and results of the project B) Defines who is responsible for each task C) Establishes timeline for task completion D) Establishes how project decisions will be made E) Partners with similar institutions to achieve project's goals Answer: A, B, C, D Explanation: A) The NI in the role of project manager (PM) follows a process that is very similar to the nursing process. The steps of the nursing process and phases of project management both include the first step of assessment, in which analysis of what is and what is needed occurs. Step two/phase two, developing the care plan and the project plan, are completed similarly as well. The final three steps/phases for both the nursing process and project management include implementing the plan, monitoring outcomes, and the final evaluation and lessons learned with knowledge transfer.

B) The NI in the role of project manager (PM) follows a process that is very similar to the nursing process. The steps of the nursing process and phases of project management both include the first step of assessment, in which analysis of what is and what is needed occurs. Step two/phase two, developing the care plan and the project plan, are completed similarly as well.

The final three steps/phases for both the nursing process and project management include implementing the plan, monitoring outcomes, and the final evaluation and lessons learned with knowledge transfer.

C) The NI in the role of project manager (PM) follows a process that is very similar to the nursing process. The steps of the nursing process and phases of project management both include the first step of assessment, in which analysis of what is and what is needed occurs. Step two/phase two, developing the care plan and the project plan, are completed similarly as well.

The final three steps/phases for both the nursing process and project management include implementing the plan, monitoring outcomes, and the final evaluation and lessons learned with knowledge transfer.

D) The NI in the role of project manager (PM) follows a process that is very similar to the nursing process. The steps of the nursing process and phases of project management both include the first step of assessment, in which analysis of what is and what is needed occurs. Step two/phase two, developing the care plan and the project plan, are completed similarly as well.

The final three steps/phases for both the nursing process and project management include implementing the plan, monitoring outcomes, and the final evaluation and lessons learned with knowledge transfer.

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E) It is beyond the scope of the NI to partner with other organizations to achieve the project's goals.

Page Ref: 161 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: II.C.5. Respect the unique attributes that members bring to a team, including variations in professional orientations and accountabilities | AACN Essential Competencies: IV.10. Advocate for the use of new patient care technologies for safe, quality care | NLN Competencies: Teamwork | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: List two skills a nurse informaticist must possess in order to apply best practices in HIT selection.

21) After attending a preliminary planning meeting for the implementation of a health information system, the manager holds a staff meeting to share the exciting features of the proposed system. Which action is the manager taking to support the change process?

A) Instilling fear B) Initiating chaos C) Creating urgency D) Establishing expectations Answer: C Explanation: A) The manager is not instilling fear.

B) Explaining the features of the proposed system is not creating chaos.

C) A key first step to managing change well is to bring staff together and explain the new workflows and how these workflows will affect and improve their day-to-day practice. Creating a sense of urgency begins to motivate people so that they understand the need for a new or upgraded system.

D) Explaining the features of the new system is not establishing expectations.

Page Ref: 160 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: II.C.5. Respect the unique attributes that members bring to a team, including variations in professional orientations and accountabilities | AACN Essential Competencies: IV.10. Advocate for the use of new patient care technologies for safe, quality care | NLN Competencies: Teamwork | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: List two methods used to manage change–using change theory–when planning a new project.

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22) A group of nurse managers are brainstorming ways to ensure staff buy-in with the implementation of a new health information system. Which principle should the managers focus on first?

A) Determine where the resistance is.

B) Assess computer skills of the staff.

C) Suggest disciplinary actions for resisters.

D) Identify those who might voluntarily terminate.

Answer: A Explanation: A) To manage change at the staff level, it is important to put a framework and guidelines in place that will add structure and consistency to the change process and, thereby, reduce anxiety. Two key principles when implementing change are first determine where the resistance is and then engage all levels of employees.

B) Assessing computer skills is not an action to ensure staff buy-in with the implementation of a new health information system.

C) Suggesting disciplinary action is not an action to ensure staff buy-in with the implementation of a new health information system.

D) Identifying those who might voluntarily terminate is not an action to ensure staff buy-in with the implementation of a new health information system.

Page Ref: 161 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: II.C.5. Respect the unique attributes that members bring to a team, including variations in professional orientations and accountabilities | AACN Essential Competencies: IV.10. Advocate for the use of new patient care technologies for safe, quality care | NLN Competencies: Teamwork | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: List two methods used to manage change–using change theory–when planning a new project.

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23) The nurse desires to become more involved with the clinical information system and asks the informatics nurse for direction. Which skills should the informatics nurse identify as important?

Select all that apply.

A) Problem solving B) Communication C) Time management D) Change management E) Human resource management Answer: A, B, C, D Explanation: A) Problem solving is identified as a skill needed by those involved with project management.

B) Communication skills are identified as being needed by those involved with project management.

C) Time management is identified as a skill needed by those involved with project management.

D) Change management is identified as a skill needed by those involved with project management.

E) Management of human resources is not identified as a skill needed by those involved with project management.

Page Ref: 163 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: II.C.5. Respect the unique attributes that members bring to a team, including variations in professional orientations and accountabilities | AACN Essential Competencies: VI.3. Incorporate effective communication techniques, including negotiation and conflict resolution to produce positive professional working relationships | NLN Competencies: Teamwork | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss one consideration for the future of project management.

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24) The Board of Directors for a major large healthcare organization are seeking federal funds for expansion of facilities and the associated health information system. What should the directors review prior to submitting the request for funding to the federal government?

A) Affordable Care Act B) Healthy People 2020 C) Federal Health IT Strategic Plan D) Health Insurance Portability and Accountability Act Answer: C Explanation: A) The Affordable Care Act does not address information technology goals at the federal level.

B) Healthy People 2020 does not address IT goals.

C) The health IT goals within the Federal Health IT Strategic Plan include apply the effective use of information and technology to help the nation achieve high-quality care, lower costs, a healthy population, and engaged individuals. This Plan focuses on advancing health IT innovation to modernize the U.S. healthcare IT infrastructure.

D) HIPAA does not address IT goals at the federal level.

Page Ref: 164 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.C.2. Value technologies that support clinical decisionmaking, error prevention, and care coordination | AACN Essential Competencies: V.1.

Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Discuss one consideration for the future of project management.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 10 Improving the Usability of Health Informatics Applications 1) The informatics nurse reviews the scientific study of the interaction between people, machines, and their work environments. On which topic is the nurse focusing?

A) Ergonomics B) Human—computer interaction (HCI) C) Human factors D) Usability Answer: C Explanation: A) Ergonomics focuses on the physical design and implementation of equipment, tools, and machines related to human safety, comfort, and convenience.

B) HCI is the study of how people design, implement, evaluate, and use interactive computer systems.

C) The term human factors is the scientific study of the interaction between people, machines, and their work environments.

D) Usability addresses specific issues of human performance in achieving specific goals during computer interactions within a particular context.

Page Ref: 169 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Distinguish among the terms user experience, human factors, ergonomics, human— computer interaction, and usability.

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2) The informatics nurse is concerned that staff members will develop health-related issues from computer work. What should the nurse explain about ergonomics to the staff?

A) It is the ability of the nurse to complete computer processing.

B) It focuses on correct posture while keyboarding.

C) It establishes protocols for benchmarking.

D) It is the physical design for safety, comfort, and convenience.

Answer: D Explanation: A) Ergonomics is not the ability of the nurse to complete computer processing.

B) One aspect of ergonomics is correct posture when keyboarding however it encompasses much more.

C) Ergonomics does not establish protocols for benchmarking.

D) Ergonomics is concerned with human performance as it relates to the physical characteristics of tools, systems and machines. Ergonomics focuses on designs for safety, comfort, and convenience.

Page Ref: 169 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Distinguish among the terms user experience, human factors, ergonomics, human— computer interaction, and usability.

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3) Usability is a subset of human-computer interaction (HCI) and one of its major components.

Which topics should the informatics nurse include when discussing usability? Select all that apply.

A) Using an application B) Learning to use a system C) User satisfaction D) Cost-effectiveness E) Error-free/error-forgiving interactions Answer: A, B, C, E Explanation: A) Usability is multidimensional and includes the use of an application.

B) Usability is multidimensional and includes the effort it takes to learn a system.

C) Usability is multidimensional and includes user satisfaction with any product.

D) Usability is multidimensional; however, it does not address cost.

E) Usability is multidimensional and includes how to design error-free/error-forgiveness interactions.

Page Ref: 170 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Distinguish among the terms user experience, human factors, ergonomics, human— computer interaction, and usability.

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4) The information technology department is focusing on the broad goals of usability during the analysis of a computer system. What should cause a user interface to disappear?

A) The system is designed well.

B) The system has multiple partners.

C) The system has a comprehensive set of instructions.

D) The system has little to no downtime.

Answer: A Explanation: A) A user interface can effectively disappear if a system is designed well. This allows users to focus only on the task at hand rather than tending to the technology itself.

B) A user interface will not disappear if the system has multiple partners.

C) A user interface will not disappear if the system has a comprehensive set of instructions.

D) A user interface will not disappear if the system has little to no downtime.

Page Ref: 171 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Describe the goals of usability and its three axioms.

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5) The informatics nurse reviews the goals of usability and human—computer interaction (HCI).

Which should the nurse identify as being absent as a goal?

A) Effectiveness B) Efficiency C) Replication D) User satisfaction Answer: C Explanation: A) Effectiveness is related to the usefulness of technology in completing desired goals.

B) The efficiency of systems deals with the expenditures of resources, where resources are time, productivity, error rates of users, the costs of the system to the organization in terms of value of the product compared to the purchase price, little used options, or redesign of applications.

C) Replication is not a goal with usability.

D) User satisfaction can be assessed by measuring perceptions about the efficiency or effectiveness of interactions with the system.

Page Ref: 171 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Describe the goals of usability and its three axioms.

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6) The leadership team of a large healthcare organization is evaluating the success of a new clinical information system. Which finding suggests that usability of the system is poor? Select all that apply.

A) Increased errors B) Increased use of email C) Decreased productivity D) Increased user frustration E) Delayed treatment decisions Answer: A, C, D, E Explanation: A) Usability issues can result in errors.

B) The use of email is not identified as a usability issue.

C) Usability issues can result in decreased productivity D) Usability issues can result in extreme user frustration.

E) Usability issues can result in treatment and decision delays.

Page Ref: 168 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Evaluation/Communication and Documentation Learning Outcome: Analyze the impacts of poor usability on clinicians' work.

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7) The informatics nurse is requested to help the same staff members access and complete documentation on the new computer system. Which should be considered as a reason for the ongoing problems?

A) Usability B) Ergonomics C) Learning curve D) Human—computer interaction (HCI) Answer: A Explanation: A) Issues with usability can lead to extreme user frustration and decreased productivity.

B) Ergonomics focuses on the design of systems for safety, comfort, and convenience.

C) There is no information to support that the staff are having problems because of a learning curve.

D) HCI is the study of how people design, implement, and evaluate interactive computer systems in the context of users' tasks and work.

Page Ref: 168 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Analyze the impacts of poor usability on clinicians' work.

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8) The informatics nurse is seeking information about human—computer interaction (HCI) frameworks that are based on work-centered research and distributed cognition. On which framework should the nurse focus?

A) CoCom (Contextual Control Model) B) UFuRT (User, Function, Representation, and Task analysis) framework C) SEIPS 2.0 (Systems Engineering Initiative for Patient Safety) D) The Staggers Human—Computer Interaction Framework Answer: B Explanation: A) The contextual control model, or CoCom is based upon users' planning and action with feedback and feedforward loops. Users are part of the whole model, and the influence of a context is direct. The distinctions of the CoCom model compared to others include that humans anticipate actions, and human behavior is seen as a plan versus single actions. Joint cognitive systems and the CoCom model imply that information is shared or distributed among humans and technology.

B) TURF was originally called UFuRT for user, function, representation, and task analyses. The model asserts that system knowledge is distributed across multiple users who have differences in expertise and cognitive characteristics. TURF includes a task-analysis portion to describe steps in tasks and interactions. However, how interactions mature is not considered a part of this framework.

C) SEIPS 2.0, or systems engineering initiative for patient safety, incorporates human factors using three higher level concepts: configuration, engagement, and adaptation. This model is useful for thinking about work systems and the performance of work in a sociotechnical environment. It is constructed at a much higher level of abstraction than typical HCI frameworks.

D) The Staggers Human—Computer Interaction Framework outlines the interaction between the computer and the individual.

Page Ref: 172 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Identify the major components of human—computer interaction models.

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9) The leadership team is reviewing a computer application that will send a text message to the healthcare provider when a laboratory or diagnostic test result is available to review. Which is this application demonstrating?

A) Usability test B) Ergonomic enhancement C) User interface programming D) Information technology-initiated interaction Answer: D Explanation: A) This application is not an example of a usability test.

B) This application is not an example of an ergonomic enhancement.

C) This application is not an example of an interface created by user programming.

D) Humans or information technologies can initiate interactions. The initiator sends information to the user interface for viewing. From the interface, the information is processed through either the technology according to its characteristics (software and hardware) or humans according to their characteristics (expertise, age, and cognitive characteristics). The recipient then reacts to the information. Technologies or humans receive the new information and process it according to their characteristics.

Page Ref: 173 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Identify the major components of human—computer interaction models.

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10) The informatics nurse is reviewing types of usability studies. Which study consists of a detailed review of a sequence of real or proposed actions to complete a task in a system?

A) Simplified usability tests using early prototypes B) Cognitive walkthrough C) Heuristic evaluations or heuristic inspection methods D) Exploratory test Answer: B Explanation: A) Simplified usability tests using early prototypes includes the use of small numbers of users, typically an early prototype (even paper), and a specific method called "think aloud" protocols.

B) Cognitive walkthrough consists of a detailed review of a sequence of real or proposed actions to complete a task in a system. It compares a developed user interface design (which is actually the designer's model of the tasks) to the users' understanding or model of the work to be done).

The method uses think-aloud techniques to elicit users' thought processes while using an actual product.

C) Heuristic evaluations or heuristic inspection methods compare applications against accepted guidelines or published usability principles.

D) An exploratory test is conducted early during development or redesign after very basic or preliminary designs are created.

Page Ref: 177 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Compare and contrast methods employed in usability studies.

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11) The informatics nurse is reviewing how ethnographic studies have been incorporated within healthcare settings to glean data at the point of care. On which statement about ethnography should the nurse focus?

A) Ethnography is a quantitative method from anthropology and sociology that includes fieldwork and analysis of people in cultural, social settings.

B) In ethnography, researchers describe the person-of-interest's point of view focusing on experience and interactions in social settings rather than the actions themselves.

C) Ethnography is an outdated method of inquiry.

D) The use of ethnography is criticized as a method to determine HCI effectiveness.

Answer: B Explanation: A) Ethnography is a qualitative method from anthropology and sociology that includes fieldwork and analysis of people in cultural, social settings.

B) In ethnography, researchers describe the person-of-interest's point of view focusing on experience and interactions in social settings rather than the actions themselves. Data are extrapolated in a systematic manner to determine the effectiveness of an initiative from the person's perspective.

C) Ethnographers review data from the participants perspective in a nonbiased manner and is an acceptable research methodology.

D) In ethnography, researchers describe the person-of-interest's point of view focusing on experience and interactions in social settings rather than the actions themselves.

Page Ref: 178 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Compare and contrast methods employed in usability studies.

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12) The informatics nurse is reviewing usability tests to examine the effectiveness, efficiency, or satisfaction of components and interactions in the human—computer interaction framework.

Which usability test should the nurse use?

A) Identifying appropriate hours to offer patients sleep medication B) Completing a longitudinal study of nursing effectiveness during lunch hours C) Exploring time management strategies in central supply D) Describing the satisfaction with a new computerized provider order entry (CPOE) application.

Answer: D Explanation: A) Usability studies can be simple or complex. Usability studies can be done at any point in the expanded systems life cycle, from clarifying users' requirements, to initial design or redesign using paper prototypes or simple computerized applications, to iterative prototype development, system selection, product customization, or evaluating the impact of a system during and after installation. Identifying hours to offer sleep medication is not a usability test.

B) Usability studies can be simple or complex. Usability studies can be done at any point in the expanded systems life cycle, from clarifying users' requirements, to initial design or redesign using paper prototypes or simple computerized applications, to iterative prototype development, system selection, product customization, or evaluating the impact of a system during and after installation. Studying nursing effectiveness during lunch hours is not a usability test.

C) Usability studies can be simple or complex. Usability studies can be done at any point in the expanded systems life cycle, from clarifying users' requirements, to initial design or redesign using paper prototypes or simple computerized applications, to iterative prototype development, system selection, product customization, or evaluating the impact of a system during and after installation. Exploring time management strategies is not a usability test.

D) Usability studies are considered methods to identify efficiency and effectiveness of the system.

Page Ref: 179 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Construct basic usability tests for health informatics applications.

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13) The information technology department is reviewing usability studies. For which reason should this type of study be completed in the healthcare setting? Select all that apply.

A) Assesses the adequacy of a design or redesign early in the systems life cycle B) Helps determine or clarify users' requirements determination C) Creates an interest in learning the new system D) Determines the actual price of the system E) Supports infrastructure Answer: A, B Explanation: A) Usability studies help to assess the adequacy of a design or redesign early in the systems life cycle.

B) Usability studies conducted early in the life cycle help to determine or clarify the user's requirements.

C) Creating an interest in the new system is not a reason for completing a usability study.

D) The price of the system is not linked to usability studies.

E) The usability study does not have anything to do with supporting the infrastructure.

Page Ref: 179 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Construct basic usability tests for health informatics applications.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 11 System Implementation, Maintenance, and Evaluation 1) The planning committee for the implementation of the clinical information system is using a work breakdown structure (WBS). What is the purpose of this structure?

A) A project planning software program is selected for use by the steering committee to assist in planning needed changes.

B) The implementation committee learns about the capabilities of a new wireless system.

C) A timeline is developed to determine who will do necessary tasks for the implementation of each project phase.

D) A committee is formed to guide the implementation of a new wireless system.

Answer: C Explanation: A) Project planning software is used mainly to manage timelines and schedule tasks.

B) At this point in the project cycle, the committee has already been selected and has an understanding of the new system.

C) A WBS is needed to clearly address all necessary tasks required to implement a new system and includes a timeline for implementation of the project.

D) At this point in the project cycle the committee has already been selected.

Page Ref: 195 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss the significance of change in a culture.

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2) The informatics nurse is working with the planning committee on the implementation of the new computer documentation system. Which steps should be considered when planning for the computer changes to be accepted by the clinical staff? Select: all that apply.

A) Laggard B) Decision C) Persuasion D) Knowledge E) Confirmation Answer: B, C, D, E Explanation: A) Laggard is a term used to describe the level at which a staff member accepts a new innovation or technology.

B) Diffusion is a process in which an innovation is communicated within an environment over time. Decision is the third step in the process.

C) Diffusion is a process in which an innovation is communicated within an environment over time. Persuasion is the second step in the process.

D) Diffusion is a process in which an innovation is communicated within an environment over time. Knowledge is the first step in the process.

E) Diffusion is a process in which an innovation is communicated within an environment over time. Confirmation is the last step in the process.

Page Ref: 192 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss the significance of change in a culture.

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3) The leadership team desires to change the culture of the work environment. Which action should the nurse leader take to promote innovation and minimize resistance?

A) Demanding staff listen to rationale behind the changes B) Planning a strategy to support people and process changes C) Asking staff to trust their colleagues D) Understanding that the change is for their benefit Answer: B Explanation: A) Demanding the staff to do anything does not support the change process.

B) Implementation of information technology is a very political process, particularly in the costcontrolled healthcare delivery systems of today. The realization of a successful system for nursing requires a strong nurse leader who is politically savvy and technologically competent. To begin this process of change, it is important to realize that obstacles may impede the forward progress of the strategies. Clinical operation disruption is minimized using the identification of the processes and their changes, which are then included in user training and implemented by the management team. The implementation plan should include a strategy to support people and process changes.

C) Trust is earned and the staff need proof before placing trust in another person.

D) Change is difficult, and staff may not realize that the change will improve the work flow and benefit them. This approach will not minimize resistance.

Page Ref: 192 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Describe the barriers to implementation.

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4) The informatics nurse is leading the team for the implementation of the clinical information system. Which is a key element for a successful system implementation?

A) Effective training B) Incorporating data dictionaries at every terminal C) Providing a help desk during the day shift D) Finding an ancillary staff member to assist in troubleshooting the new system Answer: A Explanation: A) Unless staff members are adequately trained and understand the usefulness and nuances of a system upgrade, the technology is not fully utilized.

B) Data dictionaries at every terminal will not guarantee successful implementation.

C) A help desk needs to be available on all shifts.

D) Specific super users should be trained and identified to assist with the implementation.

Page Ref: 204 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Describe the barriers to implementation.

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5) The leadership team is selecting the project leader for the implementation of the clinical information system. Which strategy should be used? Select all that apply.

A) Because this will be a complex implementation, focus on the candidate's technical skills and less on communication and leadership skills.

B) Restrict the selection to someone who is a member of the planning committee because of their understanding of the vision, goals, and expectations for the system.

C) Select the consultant that has been assigned to the project from the beginning as the leader.

D) Delay the selection of a leader until after the committee members are selected and then, with the help of the members, select one of the members as leader.

E) Select the chief information officer because of the position of authority and knowledge of the organization's information needs.

Answer: B, C, E Explanation: A) It is important that the project leader possess strong leadership and communication skills.

B) The planning committee chairperson or another member of the planning committee may serve as the implementation project leader. The project leader should have a firm understanding of the vision, goals, and expectations for the system.

C) The consultant experienced in this area may serve as the leader.

D) It is important that the project leader be involved in the entire selection and implementation process.

E) The chief information officer may serve as the leader.

Page Ref: 193 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.4. Value nurses' involvement in design, selection, implementation, and evaluation of information technologies to support patient care | AACN Essential Competencies: IV.1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Illustrate ways that implementation-committee members are selected.

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6) A hospital is implementing a new electronic nurse charting system. When selecting members for the implementation committee, which colleague should be given priority?

A) Informatics nurse specialist B) Experienced consultant C) Planning committee chairperson D) Chief information officer Answer: A Explanation: A) Any effort that involves the implementation of a system for nurses or that will be used by nurses should include an informatics nurse specialist or informatics nurse, because these individuals are uniquely qualified to communicate the needs of clinical staff to information services personnel and have a working knowledge of regulatory and system requirements, strategic plans, and budgetary constraints.

B) An experienced consultant may be considered if no one else is qualified for the role.

C) The planning committee chairperson may be considered if no one else is qualified for the role.

D) The chief information officer may be considered if no one else is qualified for the role.

Page Ref: 193 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.4. Value nurses' involvement in design, selection, implementation, and evaluation of information technologies to support patient care | AACN Essential Competencies: IV.1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Illustrate ways that implementation-committee members are selected.

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7) The implementation committee members analyze the base system as delivered from the vendor before the system is installed in the event that clarification or changes are necessary.

Which should be analyzed throughout this process? Select all that apply.

A) Technology B) Vendor standing C) Vendor compliance with regulatory requirements D) Integration with other systems E) Cost effectiveness Answer: A, B, C, D Explanation: A) The technology should be addressed during system selection but should be considered by the implementation committee before the system is installed, in the event that clarification or changes are necessary.

B) Vendor standing should be addressed during system selection, but it should be considered by the implementation committee before the system is installed, in the event that clarification or changes are necessary.

C) Vendor compliance with regulatory requirements should be addressed during system selection but should be considered by the implementation committee before the system is installed, in the event that clarification or changes are necessary.

D) Integration with other systems should be addressed during system selection but should be considered by the implementation committee before the system is installed, in the event that clarification or changes are necessary.

E) Cost effectiveness is not something that is to be addressed before the system is installed.

Page Ref: 195 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.4. Value nurses' involvement in design, selection, implementation, and evaluation of information technologies to support patient care | AACN Essential Competencies: IV.1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Illustrate ways that implementation-committee members are selected.

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8) To be effective users of a new documentation system, the staff must be trained. Which approach demonstrates the most effective use of training for a new computer system?

A) A training environment is set up off site.

B) Training is scheduled during the normal workday.

C) Training is provided with actual live software.

D) Actual client data are stored in the training system.

Answer: A Explanation: A) Training environments should be set up off site.

B) Employees should be scheduled for sessions separately from other work commitments.

C) A mirror system should be used for training.

D) Fictitious clients are used on separate training programs.

Page Ref: 200 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.4. Value nurses' involvement in design, selection, implementation, and evaluation of information technologies to support patient care | AACN Essential Competencies: IV.1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Review the importance of establishing a project timeline or schedule.

9) The implementation team is planning the implementation of a clinical information system.

Which critical element should be addressed when developing the timeline? Select all that apply.

A) Necessary tasks B) Scope of each task C) The members' roles and responsibilities in accomplishing the tasks D) Driving forces of the market E) Development of crib sheets Answer: A, B, C Explanation: A) All necessary tasks leading to implementation need to be addressed during the development of the timeline.

B) The scope and nature of each task should be identified by the committee before beginning implementation.

C) Each committee member has a distinctive role in the accomplishment of committee goals. All roles and tasks should be identified in the planning phase.

D) The driving forces of the market are not critical elements in the development of the timeline.

E) There is no need for a crib sheet.

Page Ref: 194-195 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.4. Value nurses' involvement in design, selection, implementation, and evaluation of information technologies to support patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Review the importance of establishing a project timeline or schedule.

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10) The team is planning the implementation of a clinical information system. Which are recommended for developing system procedures and documentation? Select all that apply.

A) Create backup procedures to be used in the event that the system is not running, either because of scheduled maintenance or unforeseen circumstances.

B) If major modifications were made to the base system, use the vendor's system user guides.

C) Develop a data dictionary containing system terms and terms for mapping from one system to another.

D) During the training process, develop procedures for how the system will be used to support client care and associated administrative activities.

E) Create separate documentation that includes the downtime procedures and manual requisition forms and locate in an easily identifiable and accessible location.

Answer: A, C, E Explanation: A) Comprehensive procedures for how the system will be used to support client care and associated administrative activities should be developed before the training process is begun.

B) User guides provided by the vendor may be adequate if a limited number of modifications were made to the base system. However, if significant modifications have been made, it may be necessary to customize documentation to reflect the system as the users will see it.

C) A data dictionary is recommended. This ensures that everyone has a clear definition of terms and uses them in the same way. Data dictionaries do not contain actual data, but they rather list and define all terms used and provide bookkeeping information for managing data. Data dictionaries help to ensure that data are of high quality.

D) Procedures for how the system will be used to support client care and administrative activities should be developed before the training begins.

E) System user guides should include downtime processes. These documents explain how to use the system and the printouts that the system produces.

Page Ref: 199 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: List the decisions that must be addressed when performing an analysis of hardware requirements.

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11) A group of tasks related to the analysis of hardware requirements must be addressed during the implementation phase. Which are considered specific tasks for the implementation team to address? Select all that apply.

A) Network infrastructure analysis B) Review of workstation types C) Input applications review D) Printer decisions E) Hardware location requirements Answer: A, B, D, E Explanation: A) The determination of network requirements, cable installation, wiring and access points, and technical standards should be initiated early in the implementation phase.

B) The system may be accessed via a number of different devices. These may include a networked personal computer, thin client, or a wireless or handheld device, such as a smartphone or laptop. The committee must investigate the advantages of each option and make recommendations regarding the types of hardware for purchase and installation.

C) Input applications review is not a specific task to complete.

D) Printer options should be examined, although print needs have decreased. The de facto standard is laser-printer technology, although dot-matrix technology is still used, and ink-jet printers may suffice in low-traffic locations. Other decisions focus on features, such as the number of paper trays and fonts. Printed output requires the same considerations for protecting privacy and confidentiality of information.

E) The areas where the equipment is to be placed or used must be evaluated as to the adequacy of electrical receptacles, cabling constraints, or reception-and-transmission capabilities. In addition, work areas may require modifications to accommodate the selected hardware. Another major consideration is the need to protect health information from casual viewing, while facilitating caregiver-patient communication.

Page Ref: 198 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: List the decisions that must be addressed when performing an analysis of hardware requirements.

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12) The implementation team is aware that backloading of some pre-existing data must be completed for the system to create accurate medication administration records and billing charges. How is this best accomplished?

A) Selected data from client records are loaded into the system by data entry specialists.

B) Each staff member is responsible for inputting medications for each patient for the 24 hours prior to going live.

C) When the system goes live, data from clients' medication administration records since admission are inputted for all clients.

D) A pharmacist selects needed data from client medication administration records and inputs the data immediately prior to going live.

Answer: D Explanation: A) The data to be backloaded need to be consistent.

B) Staff members are not responsible for backloading data.

C) Backloading data occurs before the system goes live.

D) Backloading means some information must be preloaded into the system immediately prior to going live. Decisions are made for who is to input the data, which data are necessary, and how the data will be verified once they have been entered.

Page Ref: 202 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss the "go-live" process and identify the components involved in planning for it.

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13) Once the go-live date of the system has been established, the production environment is in effect. Which planning is most necessary at this time? Select all that apply.

A) A newly released software upgrade will be performed so the new system provides users with the latest technology.

B) A website is constructed so employees may answer questionnaires relating to system satisfaction and ask questions as needed.

C) A 24/7 support schedule is initiated to answer questions when necessary.

D) Information backloading is scheduled the day that the system is to go live.

E) The implementation of the system will begin in the emergency department and will move to other units when they signal that they are ready.

Answer: B, C, D, E Explanation: A) Major changes such as software upgrades should not be attempted at this time.

B) Planning for going live includes 24/7 support, which could include a website for staff to ask questions and receive answers.

C) Planning for going live includes 24/7 support.

D) Planning for going live includes backloading performed prior to actual going live.

E) Planning for going live includes an implementation strategy.

Page Ref: 203 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss the "go-live" process and identify the components involved in planning for it.

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14) An implementation is to go live in a limited number of client units but in all ancillary departments. The remaining client units would be scheduled to go live in groups, staggered over a specified time frame. What implementation strategy is being used?

A) Roll out B) Modular C) Occur all at once D) Direct Answer: A Explanation: A) It must be determined how implementation will occur. The term rollout is sometimes used to refer to a staggered, or rolling, implementation.

B) Modular is not a term used to describe the implementation of the system.

C) An option for implementation is a big-bang implementation, also known as an all-at-once implementation. This occurs when a complete system goes live across an entire organization on a specific date and time.

D) Direct is not a term used to describe the implementation of the system.

Page Ref: 202 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss the "go-live" process and identify the components involved in planning for it.

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15) Considerable planning must be done before the go-live event. Which should the implementation plan before this occurs? Select all that apply.

A) Implementation strategy is determined.

B) Decisions must be made regarding what information will be backloaded or preloaded.

C) Support schedule is developed.

D) Evaluation procedures are addressed.

E) Procedures must be initiated to approve all mandatory overtime.

Answer: A, B, C, D, E Explanation: A) It must be determined whether implementation will be staggered, modular, or occur all at once.

B) Decisions must be made regarding what information will be backloaded or preloaded into the system before the go-live date.

C) On-site support is often necessary around the clock during the initial go-live or conversion phase. Support personnel may include vendor representatives, information system staff, and other members of the implementation committee.

D) Satisfaction questionnaires and a method for communicating and answering questions during the go-live conversion should be provided.

E) Approving mandatory overtime is not an activity to be addressed before the go-live event.

Page Ref: 206 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss the "go-live" process and identify the components involved in planning for it.

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16) The implementation team is discussing the test environment. What should be kept in mind when planning this environment?

A) The findings of the system test always indicate how well the system will perform in the live environment.

B) The test environment is not exactly the same as the live environment because the live environment is much larger and more complex.

C) The test environment is unnecessary with the progress made in technology.

D) The test environment is done for training purposes.

Answer: B Explanation: A) The test environment is not exactly the same as the live environment because the live environment is much larger and more complex. As a result, the findings of the system test may not always indicate how well the system will perform in the live environment.

B) The test environment is not exactly the same as the live environment because the live environment is much larger and more complex.

C) The test environment is necessary because of potential issues with the hardware and software.

D) The test environment is not used for training.

Page Ref: 197 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Identify variables that must be considered in the testing process.

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17) The implementation team is scheduling events to support system testing. Which actions should be taken to maximize the success of this testing? Select: all that apply.

A) Plan ahead.

B) Construct detailed test scripts.

C) Determine what will be tested.

D) Identify how testing will be managed.

E) Identify committee members to run the tests.

Answer: A, B, C, D Explanation: A) Thorough testing requires sufficient time, human input, and, sometimes, dedicated space and equipment.

B) With healthcare scenario-based, step-by-step test scripts, ensure that the system is used as designed and provide precise documentation in the event that issues occur.

C) Determining what will be tested helps identify necessary human resources, levels of testing, and expected deliverables.

D) Some organizations contract for consultant expertise, especially if there is a lack of experience with any part of the testing process.

E) Testing should be done with end-users and not the members of the implementation committee.

Page Ref: 198 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: IV.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Identify variables that must be considered in the testing process.

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18) The implementation team is reviewing the upcoming plans for the information system.

Which strategy might cause problems during implementation?

A) Once the committee has given information to the vendor regarding system needs, a small addition is requested.

B) An open system is set up so that software upgrades can be implemented quickly and easily.

C) The vendor is asked to fully customize the information system for a specialty organization.

D) The committee verifies that the vendor provides annual maintenance with an additional contract.

Answer: C Explanation: A) Including a small addition will not hinder the implementation process.

B) A system that supports software upgrades will not cause problems during implementation.

C) For implementation to move smoothly, the organization must consider maintenance fees and ease of system upgrades, after enough research so that few changes are needed. A customized system may be time consuming and costly and may not interface easily with other systems.

D) Annual maintenance will not hinder the implementation process.

Page Ref: 204 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Summarize several common implementation pitfalls.

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19) The implementation team is concerned about feature creep. Which best describes this occurrence?

A) When an additional feature must be added to the system, the implementation committee approves the change after investigating its cost.

B) The system is totally customized for an individual organization to reflect the current workflow.

C) Staff nurses expect the new system will cut their workload relating to documentation in half.

D) The emergency department and intensive care unit supervisors meet and come up with a list of new features to be added to the system.

Answer: D Explanation: A) Approving a change after determining the cost is not feature creep.

B) Completing customizing a system is not feature creep.

C) Expecting a system to cut the workload is not feature creep.

D) "Feature creep" occurs when features are added to previously agreed-upon system requirements without regard for budget or timelines. An example of "scope creep" is when the staff expects more out the system than can be delivered.

Page Ref: 203 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Summarize several common implementation pitfalls.

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20) A group of staff nurses working on the hospice unit have notoriously been opposed to technology use. They assert technology is not essential for the care of people who are actively dying and have decided not to participate in the training process. What can be done by committee members to decrease resistance in this setting?

A) Data can be collected and stored electronically to develop evidence-based practice models that would be useful in alleviating the suffering of the dying.

B) Have the head nurse document the resistance in each person's file.

C) Have the director of human resources attend the next staff meeting to review position descriptions.

D) Terminate staff that refuse to participate in training.

Answer: A Explanation: A) By appealing to the reasons for the resistance, which are unfounded, the staff can be educated to understand that data are the foundation of best practice models, thereby, improving care.

B) Resistance can be decreased by threatening the staff member's job security; however, the outcome of the threat can be counterproductive.

C) Position descriptions guide the nurse's daily activities. Having an administrative official review the aforementioned descriptions pressures the staff to accommodate the changes but does not address their reasons for resistance.

D) Terminating a person who has reservations about a change in culture is not an effective way of decreasing resistance. Working with the resistors and their reluctance can help to identify areas in need of improvement.

Page Ref: 204 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.2. Identify essential information that must be available in a common database to support patient care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Summarize several common implementation pitfalls.

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21) The leadership team is considering unforeseen issues that may occur during the implementation phase of the life cycle. Which issues should be considered a barrier?

A) Staff training B) Poor communication C) Employing a qualified nurse informatics specialist to lead the change D) Incorporating the suggestions of point-of-care staff Answer: B Explanation: A) Staff training is part of the implementation phase and not necessarily considered a barrier. Training is a planned activity.

B) Poor communication can pose as a barrier to any phase of the life cycle. Good communication skills can decrease resistance and promote the change.

C) A qualified nurse informatics specialist understands the leadership process and change theory.

D) Point-of-care staff members offer excellent suggestions to ensuring the product meets the needs of the end-users.

Page Ref: 204 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Summarize several common implementation pitfalls.

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22) Communication during the maintenance phase of the system's life cycle is crucial. Which is most beneficial to the organization during the maintenance phase?

A) A newsletter for users is posted yearly on accessible sites for new information.

B) A help desk provides 24/7 telephone user support for employees.

C) Users are given Internet access and procedure manual to troubleshoot problems.

D) A list of frequently asked questions (FAQs) is posted on a password-protected site.

Answer: B Explanation: A) A yearly newsletter is not published enough to support the organization.

B) During maintenance, the help desk personnel should be available 24/7. Other ways of providing information and answering questions should also be implemented.

C) A manual can be more user friendly than users searching the Internet for answers to questions.

D) An FAQ on a password-protected site might be time consuming to access and read through to find an answer for an issue.

Page Ref: 205 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Explain the significance of providing ongoing system and technical maintenance.

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23) The implementation team is creating a list of ongoing system technical maintenance issues.

Which should the team include? Select all that apply.

A) Problem solving and debugging B) Performing a file backup C) Maintaining a backup supply of hardware D) Maintaining and updating the disaster recovery plan E) Scheduling staff to perform testing Answer: A, B, C, D, E Explanation: A) Problem solving and debugging is a system technical maintenance issue.

B) Performing file backup is a system technical maintenance issue.

C) Maintaining a backup supply of hardware is a system technical maintenance issue.

D) Maintaining and updating the disaster recovery plan is a system technical maintenance issue.

E) Scheduling staff to perform testing is not a system technical maintenance issue.

Page Ref: 206 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Explain the significance of providing ongoing system and technical maintenance.

24) The implementation team is reviewing the roles and responsibilities after the system is implemented. Which department is responsible for ongoing maintenance of technical issues?

A) Nursing B) Information services department C) Computer programmers D) Vice president of technology Answer: B Explanation: A) The role of nursing is to identify the technological needs of the patient care.

B) This maintenance is the responsibility of the information services department. The role of this department is to oversee the steadiness and functions of the system.

C) Programmers design and create but do not maintain systems.

D) If an agency has a vice president of technology, the role would be more administrative and not technological supportive.

Page Ref: 206 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Explain the significance of providing ongoing system and technical maintenance.

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25) The implementation team is considering the life cycle of the new system. Which should be considered as impacting the life cycle the most?

A) The life cycle is an ongoing process that never ends.

B) The life cycle and information system are unrelated.

C) The life cycle stops to upgrade the system.

D) The life cycle is altered with any upgrade.

Answer: A Explanation: A) As systems develop problems and deficiencies, they need to be upgraded or replaced, illustrating the cyclical nature of the information system's life cycle. Phase 1, the needs assessment phase, is initiated again, and the life cycle continues. In other words, the life cycle is an ongoing process that never ends.

B) The life cycle and information system are closely related.

C) Upgrades occur as a part of the life cycle process.

D) The life cycle begins again after a system upgrade.

Page Ref: 209 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Provide examples that show the cyclical nature of the information system life cycle.

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26) Any significant change in the workplace can lead to discomfort and resistance. Which statement can decrease staff resistance to the implementation of a new system?

A) "Give it time; you will like it."

B) "Perhaps you need more staff development programs."

C) "We know what we are doing. The committee has worked on this project for months."

D) "If you find that its functions are not user-friendly, the committee can make the appropriate changes."

Answer: D Explanation: A) This statement can seem patronizing to staff. Staff members who resist change often have important suggestions that may not be heard by the committee. To minimize resistance, committee members should identify the resistors and understand the reasons for the reluctance to accept the change.

B) This statement does not allow the staff member to communicate the reasons for the reluctance to change. Allow each person an opportunity to voice concerns and respond accordingly.

C) This statement does not decrease resistance. Resistors to change can be emotional, and therefore, this statement can be construed as condescending.

D) Because the life cycle of an information system is ongoing and cyclical, feedback from users such as staff nurses is important. Data from the feedback can assist in the changes of the system that can fully support the staff. When individuals feel that they are part of the change process, there is generally less resistance to the actual change.

Page Ref: 205 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.11. Recognize that redesign of workflow and care processes should precede implementation of care technology to facilitate nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Provide examples that show the cyclical nature of the information system life cycle.

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27) The leadership team is selecting the chair of the technology committee who will be charged with leading the committee members and decision making regarding implementation of the new system. Which person is best suited for this role?

A) The vice president of nursing B) Informatics nurse specialist C) Information technology programmer D) Staff nurses affected by the system implementation Answer: B Explanation: A) The vice president of nursing has a number of important hospital roles; however, this person may not have the skills or knowledge of system implementation to be an effective leader on this committee.

B) The informatics nurse specialist understands the needs of the point-of-care staff and the ability to work and collaborate with multidisciplinary personnel.

C) A programmer does not need to be part of the selection and implementation committee.

D) Staff nurses who are affected by the system's use and changes are important stakeholders in the actual implementation of the system but are not essential in the actual leading of the process.

The staff nurse should be included on the committee as a consultant for point-of-care impact of technology changes.

Page Ref: 207 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: IV.1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Explain the role of the nurse informaticist in the implementation and evaluation processes.

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28) The leadership team is selecting the leaders for the implementation of a clinical information system. Which skill does the informatics nurse possess that supports the implementation process?

A) Communication B) Time management C) Conflict resolution D) Usability principles Answer: D Explanation: A) The informatics nurse needs to have more than communication skills.

B) The informatics nurse needs to have more than time management skills.

C) The informatics nurse needs to have more than conflict resolution skills.

D) As technology and software become more sophisticated, usability principles must be used under the guidance of the informatics nurse specialist to provide a relevant, robust, and welldesigned electronic health record to address the needs of the busy clinician.

Page Ref: 207 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: IV.1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Explain the role of the nurse informaticist in the implementation and evaluation processes.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 12 Workforce Development 1) An organization is uploading client information into the database to use for training on the health information system. What must be done with this information before training begins?

A) Categorize according to health problem.

B) Delete all client-identifying information.

C) Ensure for a wide selection of treatments.

D) Subdivide according to healthcare provider.

Answer: B Explanation: A) It is not necessary to categorize the client information according to health problem in the training database.

B) The training environment should contain realistic patient-and-practice scenarios that mimic the real patient-care setting. However, privacy and security of protected health information must be considered during training development and delivery, and care must be taken to disassociate any patient scenarios from information that could link the episode back to an actual patient. A well-designed computer-training environment will comply with organizational confidentiality and privacy policies and ensure that no identifiable patient information is included during training.

C) It is not necessary to ensure for a wide selection of treatments when creating the training for the database.

D) The clients in the training database need to have all personal health information deleted. The healthcare providers should not be listed.

Page Ref: 214 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.1. Seek education about how information is managed in care settings before providing care | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Discuss privacy and confidentiality issues related to health information technology training.

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2) The instructor is beginning an instructor-lead training (ILT) session on the upcoming clinical information system. What should the instructor say prior to having the participants access the practice clients?

A) "All of the information in the database are from real patients."

B) "Information used to create this database cannot be linked to any actual patients."

C) "Let me know if you recognize any of the patients in the database, and I'll see if you are right."

D) "Don't talk to anyone about the patients in the database. No one should have an unfair advantage."

Answer: B Explanation: A) The instructor should inform the participants that all personal identifying information has been removed.

B) During instructor-led training, the instructors may be familiar with some of the patients or scenarios used in the training environment. Care must be taken to ensure that no actual patient information is revealed during the training process and that no actual patient scenarios that can identify a real patient are discussed within the training room; learners should clearly understand that information used to create a training database cannot be linked to an actual patient, and students are able to integrate the privacy and confidentiality safeguards and principles into their own practice following training.

C) The identity of the patients in the training database should never be revealed.

D) The information in the database should be scrubbed of all identifying information.

Page Ref: 215 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.1. Seek education about how information is managed in care settings before providing care | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Teaching and Learning Learning Outcome: Discuss privacy and confidentiality issues related to health information technology training.

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3) The instructor is preparing information to include during training on the new computer information system. Which policies should be included in the content? Select all that apply.

A) Patient privacy and security B) Password security C) Computer literacy D) System-error correction E) System idiosyncrasies Answer: A, B, D, E Explanation: A) A chart-access policy addresses the user ability to access a patient's healthcare record on a need-to-know basis, such that only persons directly involved in the care of a patient may access this information. Many health information systems are able to block a caregiver's access to patient records that have not been assigned to that particular caregiver, without that caregiver documenting the reason for the access. In addition, a patient-focused, privacy-andsecurity policy should address proper storage and disposal of paper-and-electronic documents containing protected patient information.

B) The lack of password protection can produce unauthorized access into secured health information and the potential for user fraud if one user is able to access a system, patient chart, and functionality of a role through password theft. Password policies not only stipulate protection of personal passwords but also may define the length and complexity of a password and the frequency of password changes.

C) Computer literacy is not a policy to include during training.

D) Errors can be made during electronic charting, and error mitigation and correction is covered by policy, which may include the proper methods to change erroneous information, the time frame allowed for correction, and the error-correction escalation process.

E) System idiosyncrasies is not a policy to include during training.

Page Ref: 215-216 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.1. Seek education about how information is managed in care settings before providing care | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Teaching and Learning Learning Outcome: Provide the rationale for introducing information policies during training.

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4) The instructor addresses a policy that explains the paper forms to complete if the clinical information system is not available. Which policy is the instructor addressing?

A) Email B) Downtime C) Screen security D) Information uploading Answer: B Explanation: A) Email is a valuable time-saving tool for communication that can also provide opportunities for breaches of patient privacy and security. Email policies should include indications and encryption requirements for outgoing email containing patient information, or alternate procedures for sharing patient information with approved recipients.

B) The downtime policy addresses the procedures to follow during planned and unplanned information-system downtime and may include the specific paper forms to be completed during this time or the alternate electronic database that must be used. The policy may also specify time frames for when certain actions must be completed or when forms should be used or not used.

Downtime procedures should be introduced at the time of training and reviewed on a routine basis with end users.

C) Computers used for patient care are often located in areas where patients, families, and others can view protected patient information if the screen is not secured from view. Screen security policies address the timing of screen lock, the use of screen guards, and other aspects.

D) Uploading information into the computer systems of an organization represent a security risk that includes misuse of patient information and violation of patient privacy, as well as the opportunity for malicious applications to infect the organizational system. Although many organizations have configured individual computers so that universal serial bus (USB) devices and disk drives cannot be accessed, a policy provides an additional level of safeguard.

Page Ref: 215 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.1. Seek education about how information is managed in care settings before providing care | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Teaching and Learning Learning Outcome: Provide the rationale for introducing information policies during training.

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5) It has been determined from previous experience that eight hours is the minimum time necessary for staff nurses to obtain initial training on the new system. Which of the following is the best way to schedule this training?

A) One eight-hour session is offered six weeks prior to the go-live date, where employees drop in when they are caught up with work assignments.

B) Eight one-hour sessions are scheduled one month prior to going live, starting immediately after the employee's shift has ended.

C) Four two-hour sessions are scheduled three months prior to going live during nonscheduled work time.

D) Two four-hour sessions are offered one month before going live during nonscheduled work time.

Answer: D Explanation: A) For eight hours of training, two four-hour sessions are preferred.

B) Scheduling eight one-hour sessions of training is not cost effective.

C) Training should occur within one month of going live on the system.

D) Two four-hour sessions are offered one month before going live, during nonscheduled work time. Training is best when done within one month of going live and offered at times when the employees are off work. Otherwise, they may be too tired or stressed to obtain the information.

For eight hours of training, two four-hour sessions are preferred.

Page Ref: 220 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.1. Seek education about how information is managed in care settings before providing care | AACN Essential Competencies: IV.1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Recognize the factors that would lead to selection of a specific trainingdelivery method.

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6) The instructor is working with the informatics nurse to plan training for the new clinical information system. Which approach provides the most effective end-user learning experience?

A) Real client data are utilized for realistic practice.

B) The equipment used for training is the same used in the clinical setting.

C) Two employees share each workstation for mutual encouragement.

D) The live system is used with simulated client data.

Answer: B Explanation: A) Client data must be scrubbed before using in a practice environment.

B) Ideally, individual user training should be done on the same equipment that will be seen in the clinical setting.

C) Each person should have their own workstation.

D) If the live system is used, data may be altered, and confidentiality of client information may be compromised.

Page Ref: 221 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.1. Seek education about how information is managed in care settings before providing care | AACN Essential Competencies: IV.1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Recognize the factors that would lead to selection of a specific trainingdelivery method.

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7) The leadership team identifies a lead instructor to conduct all of the training on the new clinical information system. Which should the instructor consider when selecting an appropriate training method? Select all that apply.

A) Time required to develop program B) Cost of development and training C) Information retention strategies D) Learning styles of instructor E) Scheduling for day shift sessions Answer: A, B, C Explanation: A) The time required to develop and present using each instructional approach varies.

B) Initial content development time and subsequent revisions can be lengthy for computer-based training, running up the expense.

C) Active participation through scenarios, case studies, practice exercises, and repetition provide opportunities for learning, applying job skills, and retaining knowledge.

D) The learning styles of the users and not the instructor needs to be taken into consideration.

E) Scheduling should be flexible to meet all of the needs of the end-users.

Page Ref: 219 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.1. Seek education about how information is managed in care settings before providing care | AACN Essential Competencies: IV.1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Recognize the factors that would lead to selection of a specific trainingdelivery method.

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8) The instructor is considering blended learning when training on the new clinical information system. Which should the instructor keep in mind about this teaching strategy?

A) Blended learning maximizes learning and minimizes cost.

B) The use of blended learning is not appropriate for super user training.

C) Blended learning is too complicated for training sessions.

D) Blended learning should only be used for point-of-care staff.

Answer: A Explanation: A) Blended learning combines elements of several different training-delivery methods in order to maximize learning and application, while minimizing expensive time spent in a classroom.

B) Blended learning can be used for all levels of users.

C) Blended learning is an appropriate method to train on a clinical information system.

D) Blended learning can be used for all levels of users.

Page Ref: 224 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.1. Seek education about how information is managed in care settings before providing care | AACN Essential Competencies: IV.1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Recognize the factors that would lead to selection of a specific trainingdelivery method.

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9) The instructor is interested in learning the best approaches to use when training staff on a clinical information system. Which organization should the instructor contact?

A) Association for Talent Development (ATD) B) Department of Health and Human Services (HHS) C) International Society for Performance Improvement (ISPI) D) Association for Nursing Professional Development (ANPD) Answer: A Explanation: A) ATD is focused on research and education that supports trainers, instructional designers, and talent-development practitioners with the latest evidence and resources that guide and support best practices for instructional development and delivery.

B) The Department of Health and Human Services, in collaboration with the Office of the National Coordinator, has developed a complete set of curricula designed to facilitate growth of the HIT workforce C) The International Society for Performance Improvement (ISPI) focuses primarily on human performance improvement by examining the most cost-effective interventions that influence human behavior, including training.

D) The Association for Nursing Professional Development (ANPD) focuses on the specialty of nursing professional development in order to enhance healthcare outcomes. ANPD provides rich experiential resources, links to additional resources, and the opportunity to communicate and collaborate with other clinical educators.

Page Ref: 225 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.1. Seek education about how information is managed in care settings before providing care | AACN Essential Competencies: IV.1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Teaching and Learning Learning Outcome: Examine resources for health information technology training.

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10) The vendor providing the clinical information system being implemented in a healthcare organization invites the instructor and several other leadership colleagues to a training session so that these individuals can then train the end-users. Which type of training support is being provided by the vendor?

A) Blended B) Just-in-time C) Train the trainer D) Instructor-led training Answer: C Explanation: A) Blended learning combines elements of several different training-delivery methods in order to maximize learning and application, while minimizing expensive time spent in a classroom.

B) Just-in-time training is a method often preferred by physicians and other providers who are reluctant to spend time in a training classroom or viewing eLearning that is perceived as not relevant to their job function, preferring to incorporate their learning into daily practice.

C) An HIT or EHRS vendor may offer training for a client organization through a train-thetrainer method. Using this training method, the vendor trains select internal trainers, who then provide training for all of the end-users. The vendor may provide the instructional curriculum, the organization may customize content provided by the vendor, or the organization may develop all of the content internally.

D) Classroom or instructor-led training (ILT) is delivered by an instructor to an audience of learners who are present in the classroom or connected using audiovisual technology.

Page Ref: 226 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.1. Seek education about how information is managed in care settings before providing care | AACN Essential Competencies: IV.1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Teaching and Learning Learning Outcome: Examine resources for health information technology training.

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11) The instructor is determining which type of evaluation to conduct after training on the use of the clinical information system. What should the instructor keep in mind as the end goal of the training?

A) Training should be evaluated after the fifth session.

B) Training evaluation is necessary after the class.

C) Training assumes proficiency will occur over time with use.

D) All super users have the opportunity to evaluate the training process.

Answer: C Explanation: A) Evaluation can occur throughout the training sessions.

B) Evaluation can occur throughout the training sessions.

C) HIT training should focus on producing end-users who are competent in using selected information technology, with the assumption that proficiency will occur over time with use.

D) All personnel, whether professional or paraprofessional, need to attain the competencies set by the training objectives. However the goal is to produce staff members who are competent in using the system.

Page Ref: 226 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.1. Seek education about how information is managed in care settings before providing care | AACN Essential Competencies: IV.1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Evaluation/Teaching and Learning Learning Outcome: Weigh models used to evaluate training.

12) The cost of a new or upgraded system can be burdensome on an organization from a budgetary perspective. Which statement explains the return on investment?

A) Employees express satisfaction with their jobs and turnover rate is low.

B) Staff members with IT skills are more marketable and have greater job flexibility.

C) The newly trained individual can be granted work release time to train new staff members.

D) After the training, the objectives have not been met.

Answer: A Explanation: A) A well-trained workforce can be considered a return on investment when job satisfaction and retention are outcomes.

B) Staff members who leave the organization after training add an additional cost burden to the budget because their replacements must be trained.

C) This method incurs cost of a replacement for the staff member granted work release time.

D) To be considered effective, the objectives determined by the trainer should be achieved.

Page Ref: 228 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.1. Seek education about how information is managed in care settings before providing care | AACN Essential Competencies: IV.1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Evaluation/Teaching and Learning Learning Outcome: Weigh models used to evaluate training.

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13) The informatics nurse is reviewing the training plan on downtown procedures. Which information should be an integral part of this plan?

A) Length of time to expect the system to be down B) When to enter data back into the computer system C) Location to store the patient information until the system is available D) Identify the person responsible for protecting the personal health information Answer: B Explanation: A) There is no way to predict how long a system will be down.

B) Education on downtime procedures is necessary so staff can continue providing safe patient care and other clinical operations without access to HIT systems. Downtime procedures must include parameters for when data are to be entered back into the computer system.

C) Downtime procedures do not include locations to store data until the system is available.

D) Downtime procedures do not identify people responsible for protecting personal health information.

Page Ref: 228 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Describe the rationale for training on backup procedures.

14) The staff within the information technology department is reviewing a draft of a downtime policy. Which should be included in this policy? Select all that apply.

A) Communication processes B) Methods for storing backup data C) Forms for alternate documentation D) Schedule for routine downtime drills E) Approval for staff to document overtime Answer: A, B, C, D Explanation: A) Downtime planning should include communication processes.

B) Downtime planning should include methods for storing backup data.

C) Downtime planning should include forms for alternate documentation.

D) Downtime planning should include a schedule for routine downtime drills.

E) Downtime planning does not include approval for staff to document overtime.

Page Ref: 228-229 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Describe the rationale for training on backup procedures.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 13 Information Security and Confidentiality 1) During the course of client care, a client reports having an abortion but no one else in the family knows. Which term best describes this situation?

A) Information consent B) Privacy C) Information security D) Confidentiality Answer: D Explanation: A) Information consent occurs when an individual authorizes healthcare personnel to use and share his or her information based on an informed understanding of how this information will be shared and used for treatment purposes.

B) Privacy is the right to control access and disclosure or nondisclosure of information pertaining to oneself and to control the circumstances, timing, and extent to which information may be disclosed. Privacy includes the right to determine what information is collected or shared, how it is used, and the ability to access collected personal information to review its security and accuracy.

C) Information security occurs with the realization that information has value and requires protection. This includes the protection of information against threats to its integrity, inadvertent disclosure, or availability.

D) Confidentiality refers to a situation in which a relationship has been established, and private information is shared but not disclosed.

Page Ref: 240 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: State the differences between privacy, confidentiality, information privacy, information security, and information consent.

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2) The informatics nurse is updating the policy about breaches. For which reason do must breaches of confidentiality occur?

A) Malicious behavior B) System hacking C) Intent D) Carelessness Answer: D Explanation: A) Malicious behavior is not the reason for most breaches to occur.

B) System hacking is not the reason for most breaches to occur.

C) Intent is not the reason for most breaches to occur.

D) Carelessness is the most common cause for breaches in confidentiality.

Page Ref: 240 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: State the differences between privacy, confidentiality, information privacy, information security, and information consent.

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3) The informatics nurse is preparing a training sheet to be used in orientation. Which should the nurse describe as the protection of information against threats to its integrity, inadvertent disclosure, or availability?

A) Information security B) Survivability C) Confidentiality D) Privacy Answer: A Explanation: A) Information security is the protection of information against threats to its integrity, inadvertent disclosure, or availability.

B) Survivability is the capability of a system as a whole to fulfill its mission, in a timely manner, in the presence of attacks, failures, or accidents. The primary goals of healthcare information system security are the protection of client confidentiality and information integrity and ready availability of information when it is needed. Availability is necessary in today's informationdriven world, and it is dependent upon survivability.

C) Confidentiality refers to a situation in which a relationship has been established, and private information is shared but not disclosed.

D) Privacy is the right to control access and disclosure or nondisclosure of information pertaining to oneself and to control the circumstances, timing, and extent to which information may be disclosed. Privacy includes the right to determine what information is collected or shared, how it is used, and the ability to access collected personal information to review its security and accuracy.

Page Ref: 241 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: State the differences between privacy, confidentiality, information privacy, information security, and information consent.

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4) A nurse receives a needlestick but is unaware that the client is positive for HIV. The nurse manager asks the client to sign a form granting permission to share the diagnosis with the nurse so treatment can begin. What is this situation considered?

A) Informed consent B) Information consent C) HIPAA violation D) Breech of privacy Answer: B Explanation: A) Informed consent is giving permission for a procedure, test, medication, blood product, or surgical procedure to be performed.

B) Information consent occurs when an individual authorizes healthcare personnel to use and share personal information based on an informed understanding of how this information will be shared and used for treatment purposes.

C) Because the client was asked for permission, no HIPAA violation occurred.

D) Because the client was asked for permission, no breach of privacy occurred.

Page Ref: 241 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: State the differences between privacy, confidentiality, information privacy, information security, and information consent.

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5) The information technology department is reviewing the healthcare-information-security system in place. Which should be kept in mind when reviewing the purpose of this security system? Select all that apply.

A) Enhanced overtime B) Saving time and money C) Guarding against cybercrime D) Preventing breaches in confidentiality E) Regarded as a form of insurance against downtime Answer: B, C, D, E Explanation: A) A healthcare-information-security system prevents lost productivity.

B) A healthcare-information-security system saves time and money.

C) A healthcare-information-security system guards against cybercrime.

D) A healthcare-information-security system prevents breaches in confidentiality.

E) A healthcare-information-security system should be regarded as a form of insurance against downtime.

Page Ref: 242 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Describe the processes required to attain security in a computer network.

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6) The leadership team is working with the information technology department in the planning of a new computerized information system. Which steps need to be done to ensure the system has the best possible amount of security? Select all that apply.

A) Prepare a security policy.

B) Draft a well-crafted security plan.

C) Ensure a sufficient number of computer workstations are in place.

D) Ensure adequate number of staff members for support.

E) Thoroughly assess assets, risk, and necessary resources.

Answer: A, B, D, E Explanation: A) Effective security includes a security policy.

B) Effective security includes a well-crafted security plan.

C) The number of computer workstations is not a part of an effective security plan.

D) Effective security includes ensuring an adequate amount of staff members to provide support.

E) Effective security begins with a thorough assessment of assets, risk, and necessary resources.

Page Ref: 242 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Describe the processes required to attain security in a computer network.

7) A healthcare facility has discovered that data from one patient's chart was placed in another patient's chart, causing both charts to have invalid data. Which information security area does this breach affect?

A) Survivability B) Integrity C) Availability D) Inadvertent disclosure Answer: B Explanation: A) Survivability addresses accessing information in a timely manner.

B) Integrity is concerned with the accuracy of information. Because information was misplaced in another patient's chart, accuracy is in question.

C) Availability addresses accessing information in a timely manner.

D) Inadvertent disclosure is part of confidentiality.

Page Ref: 241 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Discuss the significance of security for information integrity.

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8) A large healthcare organization is reviewing their information security plan. Which indicates that survivability has been addressed in the plan? Select all that apply.

A) One hospital in each regional area has multiple sources of communication with central processing.

B) Emergency power generators for all associated hospitals are tested and serviced each week C) The system at central processing is backed up each night, and the data are stored at a remote location.

D) One hospital in each regional area has an emergency protocol in place for communicating directly with the Department of Homeland Security.

E) One hospital in each regional area is especially prepared to maintain information system functionality for the emergency, operating room, lab, and pharmacy units.

Answer: A, D, E Explanation: A) Survivability is the ability of the information system to continue its mission even in the presence of damage. Having multiple sources of communication indicates survivability was addressed in the plan.

B) Emergency power generators are important general security issues but do not specifically address survivability during a catastrophic event.

C) System backup is an important general security issue but does not specifically address survivability during a catastrophic event.

D) Survivability is the ability of the information system to continue its mission even in the presence of damage. Having an emergency protocol in place to communicate directly with Homeland Security indicates survivability was addressed in the plan.

E) Survivability is the ability of the information system to continue its mission even in the presence of damage. Having a plan to maintain system function indicates that survivability was addressed in the plan.

Page Ref: 242 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss the significance of security for information integrity.

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9) The information technology system is concerned that spyware has infected a group of computers. Which is least likely to be found when searching for spyware on a computer?

A) Ability to Skype B) Appearance of pop-ups C) Random error messages D) Poor system performance Answer: A Explanation: A) The ability to Skype indicates that the system has not been infected with spyware.

B) Clues that spyware has infected a computer include the presence of pop-up ads.

C) Clues that spyware has infected a computer include the presence of random error messages.

D) Clues that spyware has infected a computer include poor system performance.

Page Ref: 255 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Recognize potential threats to system security and information.

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10) The information technology department is updating the procedures to handle threats to the computer system. For which type of invaders should a procedure be written to support? Select all that apply.

A) Malware B) Scareware C) Telehealth D) Ransomware E) Social networking sites Answer: A, B, D, E Explanation: A) Common sources of threats to information and information-system security include malware attacks. Cybercriminals are using more creative means to package and deliver malware (viruses, worms, and Trojan horses), especially in emails.

B) Common sources of threats to information and information-system security include scareware. Attackers and fraudsters use online pop-ups designed to look like messages from the operating system, warning of a problem or virus infection to coerce users to download a program to correct the problem.

C) Telehealth is not a common threat to information and information-system security.

D) Common sources of threats to information and information-system security include ransomware. Perpetrators render a system, or needed information, unavailable until their demands are met.

E) Common sources of threats to information and information-system security include social networking sites. Sites, such as Facebook, Twitter, and Instagram, provide cybercriminals new opportunities to target unsuspecting users.

Page Ref: 243 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Recognize potential threats to system security and information.

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11) The Health Insurance Portability and Accountability Act (HIPAA) requires organizations to determine threats and appropriate protective measures for information, not only in electronic formats, but in all formats. Which measure is least likely to be incorporated by an organization to secure all data?

A) Creation of authentication policies B) Specific software C) Spyware D) Firewall Answer: C Explanation: A) Authentication is the process of determining whether an individual has access to information. The process is enhanced by passwords, a username, smart card, retina scan, voice recognition, or fingerprints.

B) Software has been created to form a barrier between systems, or different parts of a single system, to protect those systems from unauthorized access.

C) Spyware is a data collection mechanism that installs itself without the user's permission.

D) A firewall is a component of a computer system or network that is designed to block unauthorized access while permitting authorized communications. It is a device or set of devices that is configured to permit or deny network transmissions based upon a set of rules and other criteria.

Page Ref: 255 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Analyze processes to prevent threats to network security, and how to anticipate the threats.

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12) The informatics nurse is working with the information technology department to update the procedure and policies for system security. Which information should be included to prevent the introduction of malicious software into the system? Select all that apply.

A) Disable the Internet firewall.

B) Only use licensed software on the computers.

C) Never open any file attachment from an unfamiliar source.

D) Download software patches to eliminate security problems.

E) Retain backup copies of original software, work files, and directory structure for each computer.

Answer: B, C, D, E Explanation: A) Tips to avoid malicious programs include using an Internet firewall. This firewall should not be disabled.

B) Tips to avoid malicious programs include using only licensed software on the computers.

C) Tips to avoid malicious programs include never opening any file attachment from an unfamiliar source.

D) Tips to avoid malicious programs include downloading software patches that eliminate security problems.

E) Tips to avoid malicious programs include retaining backup copies of original software, work files, and directory structure for each computer.

Page Ref: 246 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Analyze processes to prevent threats to network security, and how to anticipate the threats.

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13) The home care agency provides all nursing staff with laptop computers so they can document immediately after providing care in the patients' homes. Which action should be taken when assigning a laptop to a staff member?

A) Disable all functions except for the online documentation system.

B) Expect the laptop to be returned to the agency at the end of every work day.

C) Install tracking software so every keystroke can be recorded for later evaluation.

D) Have the employees sign a confidentiality-and-privacy agreement and complete HIPAA training.

Answer: D Explanation: A) Disabling functions could negatively impact the software's ability to function.

B) Turning in the laptops at the end of every work day is neither time nor cost effective.

C) Tracking every keystroke for later analysis is not necessary and would create labor-intensive work to analyze the data.

D) Employees should sign a confidentiality-and-privacy agreement and complete HIPAA training.

Page Ref: 250 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss the responsibility that nurses have to protect patient information and privacy.

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14) The nurse is preparing to send patient health information to the main computer system from an off-site facility. What should the nurse do before sending this information?

A) Spell check the information.

B) Ensure it will be sent over an encrypted network.

C) Telephone the recipient to inform him or her that the information is being sent.

D) Validate the patient demographic information over a public network.

Answer: B Explanation: A) Spell checking is good to do; however, it is not something that must be done before sending patient health information over a network.

B) Public Internet access should not be provided on the same network that is used to transmit secure health data unless extensive measures are used to maintain the security of that data.

C) Electronically transmitted information arrives immediately. There is no need to contact anyone to alert them that the information is being sent.

D) Only an encrypted network should be used for patient health information.

Page Ref: 250 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss the responsibility that nurses have to protect patient information and privacy.

15) The informatics nurse is reviewing tips to create effective passwords. Which password provides the most information and system security?

A) StJohns3821 B) p#3J24q7 C) p#5N24p7#hN5 D) p#3J24q7?hN5 Answer: D Explanation: A) This answer uses a common word and would be easy to guess.

B) This password is too short and would be easy to figure out.

C) This password repeats numbers and letters, which should be avoided.

D) The best passwords contain twelve characters, avoid repeated numbers or letters, and have combinations of uppercase and lowercase letters, numbers, punctuation marks, and symbols.

Page Ref: 251 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Evaluation/Communication and Documentation Learning Outcome: Review best practices for secure authentication.

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16) A healthcare provider slides a smart card through a card reader and then place a finger on a scanner before being permitted access to a computer terminal in a healthcare organization.

Which authentication measures were used to verify authorization to access client data? Select all that apply.

A) Appearance of the user's name on a screen B) Biometric authentication C) Picture authentication package D) Proximity radio authentication E) Encrypted pass key authentication Answer: B, E Explanation: A) The appearance of the user's name on a screen is not indicated in this scenario.

B) Biometric authentication is based on unique biological traits; thus, the fingerprint identification is biometric.

C) The appearance of a picture authentication package is not indicated in this scenario.

D) Proximity radio authentication requires the radio device be close to the sensing unit, but there is nothing in the scenario to suggest this method was used.

E) Encrypted passkey authentication uses a secret number verified against a registered digital certificate, which would be kept on the smart card.

Page Ref: 253 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Review best practices for secure authentication.

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17) A certified nursing assistant (CNA) at a local nursing home logs on to the facility's clinical information system and can only see information about assigned clients except for financial data.

Which type of security is applied to this system?

A) Password protection B) Computer forensics C) Access levels D) User authentication Answer: C Explanation: A) More than password protection is provided on this system.

B) Computer forensics is the collection of electronic evidence and is not related to this situation.

C) Based on an individual's access level, information will be restricted on a need-to-know basis.

The CNA is limited to information regarding assigned clients and is restricted from all financial data.

D) The employee has to log into the system, which authenticates the person; however, additional security has been applied.

Page Ref: 257 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Review best practices for secure authentication.

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18) Passwords are a common means to authenticate access to automated records. Which recommendation should the informatics nurse suggest for password selection and use? Select all that apply.

A) Using software to test and eliminate easily compromised passwords B) Using the browser "password save" feature C) Deleting and replacing all system user passwords when employment is terminated D) Storing passwords in a file on the computer E) Using the same password for access to all sites or systems Answer: A, C Explanation: A) Using software to test and eliminate easily compromised passwords is recommended.

B) Using the browser "password save" feature is not recommended.

C) Deleting and replacing all system user passwords when employment is terminated is recommended.

D) Storing passwords in a file on the computer is not recommended.

E) Using the same password for access to all sites or systems is not recommended.

Page Ref: 252 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Review best practices for secure authentication.

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19) The information technology department is reviewing the policy and procedure for disposing of confidential patient information. Which should be listed as appropriate actions to destroy this material? Select all that apply.

A) Ensure shredders are installed on each care area.

B) Mark all patient information with CONFIDENTIAL. C) Download patient data onto thumb drives for later use.

D) Place locked receptacles in the laboratory and pharmacy.

E) Erase all patient confidential information from hard drives.

Answer: A, B, D, E Explanation: A) Installing shredders on each care area encourages paper with personal health information to be destroyed.

B) Marking patient information with CONFIDENTIAL serves as a reminder to destroy the information if no longer needs to be used.

C) Patient data should not be downloaded onto a portable drive for later use. This encourages a breach.

D) Locked receptacles are appropriate for later shredding and incineration.

E) Erasing confidential patient information from hard drives should be done daily for some areas, such as the surgical suite or procedure areas.

Page Ref: 261 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Identify proper disposal techniques for common examples of confidential forms and communication seen in healthcare settings.

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20) A large healthcare organization experienced a breach of confidential information through an email attachment and is now reviewing the process for sending this type of information electronically. Which should be an expectation when using email for electronic transfer of information? Select all that apply.

A) Disabling activated firewalls B) Destroying dormant email accounts C) Destroying unauthorized email accounts D) Ensuring the email program is encrypted E) Using software to monitor network traffic Answer: B, C, D, E Explanation: A) Firewalls should be installed and enabled to prevent cyberattacks through email.

B) Dormant email accounts should be destroyed to reduce the risk of inadvertently sharing personal health information.

C) Unauthorized email accounts should be destroyed to reduce the risk of inadvertently sharing personal health information.

D) Email programs should be encrypted.

E) Software can be used to monitor network traffic for patterns that represent client information, such as lists or Social Security numbers.

Page Ref: 261 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Identify proper disposal techniques for common examples of confidential forms and communication seen in healthcare settings.

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21) The informatics nurse is working with the information technology department to enhance information security. Which measure should be recommended? Select all that apply.

A) Use file deletion software to overwrite hard disk files and leave meaningless information.

B) Dispose of erased storage media in the dumpster.

C) Individuals should routinely witness and record the destruction of records.

D) Papers such as prescriptions, laboratory specimen labels, and identification bracelets should be disposed of in the dumpster.

E) Assign each page of output assigned a serial number, and record the numbers when documents are destroyed.

Answer: A, C, E Explanation: A) File deletion software overwrites files with meaningless information so that sensitive information cannot be accessed.

B) Storage media should be destroyed to ensure that no information can be retrieved from them.

C) For tracking purposes, the identity of individuals witnessing the destruction should be documented.

D) All papers containing personal health information (PHI) such as prescriptions, laboratory specimen labels, identification bracelets, meal descriptions, addressograph plates, or any other items that carry a client's name, address, Social Security number, date of birth, or age must be destroyed.

E) For tracking purposes, each page of output should have a serial number or other means of identification so that an audit trail is maintained that identifies what each paper record is as well as the date and method for destruction.

Page Ref: 262 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Appraise strategies to ensure that the use of information technology protects the privacy and security of patient information.

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22) The informatics nurse is preparing material for new employee orientation about Internet technology. Which information should the nurse include that best depicts the impact that Internet technology has on the security of health-related information?

A) Health information on the Internet requires the same types of safeguards provided for information found in private offices and information systems.

B) Health information on the Internet does not require the same types of safeguards provided for information found in private offices and information systems.

C) Health information on the Internet requires more types of safeguards than what are provided for information found in private offices and information systems.

D) Health information on the Internet requires fewer safeguards than what are provided for information found in private offices and information systems.

Answer: A Explanation: A) Health information on the Internet requires the same types of safeguards provided for information found in private offices and information systems.

B) Any server with Internet access is at risk for a number of security breaches.

C) Health information on the Internet requires the same types of safeguards, not more safeguards.

D) Health information on the Internet requires the same types of safeguards, not fewer safeguards.

Page Ref: 267 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Appraise strategies to ensure that the use of information technology protects the privacy and security of patient information.

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23) The informatics nurse is updating the policy on the use of email to send information to include the HIPAA regulations. When should it be identified that personal health information can be sent through email?

A) Client's consent was obtained to send information via email.

B) Recipient is known to the sender.

C) Email is sent encrypted.

D) Organization's email system has appropriate firewalls.

Answer: C Explanation: A) Although having the client's consent is necessary to share information, it does not protect confidentiality during transmission.

B) Knowing the recipient does not guarantee that the email will not be intercepted by others.

C) Encryption is used so that only the intended recipient can access the information.

D) Firewalls protect a system from unwanted access by allowing only approved transactions to pass through them.

Page Ref: 261 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Describe privacy and confidentiality issues with email and social media.

24) A healthcare organization is concerned because several staff members have posted confidential patient information on their Facebook pages. Which should be communicated to all staff regarding the use of social media?

A) Used to post results of diagnostic tests B) Seen as an avenue to report laboratory results C) Used for education and empowerment of consumers D) Encouraged as a way to promote relationships with patients Answer: C Explanation: A) Personal health information, such as the results of diagnostic tests, should not be posted on social media.

B) Personal health information, such as laboratory results, should not be posted on social media.

C) Social media is appropriate for education and empowerment of patients and other consumers.

D) Those with social media accounts should establish boundaries to protect personal privacy.

Page Ref: 261 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/ Communication and Documentation Learning Outcome: Describe privacy and confidentiality issues with email and social media.

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25) The informatics nurse is preparing to discuss the Health Insurance Portability and Accountability Act (HIPAA) security rule with a group of new colleagues. What should the nurse explain about this rule and the use of technology?

A) Does not specify the use of particular technology B) Refers to the Joint Commission standards for technology C) Specifies the utilization of HIPAA approved technology D) Provides a monthly web-based list of approved technology Answer: A Explanation: A) HIPAA does not specify the use of particular technologies. It does call for each organization to determine threats and take appropriate protective measures based on their specific needs.

B) HIPAA does not refer to the Joint Commission standards for technology.

C) HIPAA does not specify the use of particular technologies.

D) HIPAA does not provide a monthly web-based list of approved technology.

Page Ref: 239 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Identify how the HIPAA security and privacy rules protect personal-health information (PHI).

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26) The informatics nurse is reviewing the Health Insurance Portability and Accountability Act (HIPAA) security rule. Which personal health information does this act expect to be protected?

Select all that apply.

A) Age B) Name C) Address D) Telephone number E) Social Security number Answer: B, C, D, E Explanation: A) Age is not considered PHI under HIPAA's security rule.

B) HIPAA's security rule is concerned with protecting PHI. For covered entities, the rule defines 18 criteria that define PHI, including name.

C) HIPAA's security rule is concerned with protecting PHI. For covered entities, the rule defines 18 criteria that define PHI, including address.

D) HIPAA's security rule is concerned with protecting PHI. For covered entities, the rule defines 18 criteria that define PHI, including telephone number.

E) HIPAA's security rule is concerned with protecting PHI. For covered entities, the rule defines 18 criteria that define PHI, including Social Security number.

Page Ref: 263 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Identify how the HIPAA security and privacy rules protect personal-health information (PHI).

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27) A healthcare organization is implementing mobile technology for all staff providing direct patient care. Which should be considered when determining the best approach for the devices?

A) Ensure adequate bandwidth for wifi signals.

B) Make sure all devices are secure before assigning a device to a staff member.

C) Replace all lost devices with those configured to the electronic health record.

D) Configure personal smartphones to interface with the hospital's networking system.

Answer: A Explanation: A) Wifi is vulnerable because signals are simultaneously broadcast in all directions.

B) Devices should be secured before being used by healthcare professionals.

C) Lost devices should be locked or turned off. Replacement of the devices should be according to the information system security plan.

D) Personal smartphones can be hacked or lost, increasing the risk for a breach of personal health information.

Page Ref: 262_263 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Examine special considerations related to mobile and wearable technology.

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28) A healthcare organization is awarding Fitbit devices to staff who exceed expectations on annual performance reviews. Which should the organization provide to the staff prior to supplying the devices?

A) Explanation of how the data will be used B) Commitment to adhere to the advice provided once data are analyzed C) Expectation that health insurance premiums may be affected by the data D) Expectation that it is to be worn as a contingency for continued employment Answer: A Explanation: A) Employers using wearable technology to promote employee well-being need transparency about how that data will be used.

B) A commitment to adhere to the advice provided once data from the device are analyzed is a form of coercion.

C) An expectation that health insurance premiums may be affected by the data is a form of coercion.

D) An expectation that the device is to be worn as a contingency for continued employment is a form of coercion.

Page Ref: 263 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Examine special considerations related to mobile and wearable technology.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 14 Information Networks and Information Exchange 1) The informatics nurse is working with the information technology department to decide if patient personal health information can be shared through a patient portal over the Internet. What are these technology professionals determining?

A) Patient data app B) Information network C) Electronic medical record D) Health information system Answer: B Explanation: A) An information network is not a patient data app.

B) Information networks for the healthcare industry are defined as states and entities meeting a set of standards, specifications, and policies that enable the secure exchange of health information over the Internet.

C) An information network supports the data contained within an electronic medical record.

D) An information network would interface with the health information system to share the information over the Internet.

Page Ref: 271 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.2. Identify essential information that must be available in a common database to support patient care | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Define the concept of health information networks.

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2) The Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services (CMS) transmit personal health information over the Internet. What did these organizations do to ensure privacy and security of this patient data?

A) Sign DURSA. B) Install encryption software.

C) Network all of the computers.

D) Implement biometric authentication.

Answer: A Explanation: A) Federal agencies that need to securely exchange electronic health information include the Centers for Disease Control and Prevention (CDC) and Centers for Medicare and Medicaid Services (CMS). These agencies are accountable for the privacy and security of patient data and must sign the Data Use and Reciprocal Support Agreement (DURSA), which outlines the roles and responsibilities among participants to have mechanisms in place to protect data.

B) Encryption software is expected by organizations and agencies that transmit personal health information.

C) Networking of the computers is not identified as necessary to ensure privacy and security of patient data.

D) There are a variety of authentication methods. Biometric authentication is not identified as necessary to ensure the privacy and security of patient data.

Page Ref: 272 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Define the concept of health information networks.

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3) The preparations for a health information exchange (HIE) include organizing a governing body and establishing financial sustainability. Which is considered a conceptual and sustainable public governance model?

A) Public utility HIE with government oversight B) Public utility HIE with no government oversight C) Private sector-led HIE with local collaboration D) Private sector-led HIE with corporation collaboration Answer: A Explanation: A) Public utility HIE with government oversight where a public sector will serve an oversight role and regulates the private-provided services of the HIE is considered a sustainable conceptual model.

B) Government oversight is needed.

C) Government oversight instead of local collaboration is needed.

D) Government oversight instead of corporation collaboration is needed.

Page Ref: 272 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Compare and contrast the different models for their respective advantages and disadvantages.

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4) A state is using an information network, which is led by the private sector with government collaboration. What is an advantage of this type of network?

A) Functions without an organization B) Easy to adapt to changing service needs C) Subject to government administrative rules and processes D) Provides oversight with or without regulatory control over the information network's infrastructure Answer: B Explanation: A) A network in 22 states functions without an organization and may be staffed by volunteers.

B) An information network led by the private sector with government collaboration is nimble and adaptable to changing service needs.

C) A government-led network with a direct government program is subject to government administrative rules and processes.

D) A public-utility information network with government oversight provides oversight with or without regulatory control over the information network's infrastructure.

Page Ref: 273 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Compare and contrast the different models for their respective advantages and disadvantages.

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5) The informatics nurse is seeking information on patient outcomes. Which type of data network should the nurse access for this information?

A) Clinical data network B) Health information network C) Integrated delivery network D) Health system in another state Answer: A Explanation: A) Clinical data networks were developed to support research on patient outcomes rather than the care delivered.

B) Health information networks exchange patient level information.

C) Integrated delivery networks exchange standard content and identifiers adopted across member hospitals, nursing homes, hospice, homecare, and clinics.

D) Health systems within multiple states are organizations that exchange standard content and identifiers adopted across member hospitals, nursing homes, hospice, homecare, and clinics.

Page Ref: 274 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Differentiate between clinical data networks and health information networks.

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6) A large healthcare organization is interested in learning how another major system in another state handles an ongoing resource utilization issue. Which type of data network should the organization access to learn this information?

A) Clinical data network B) Health information network C) Integrated delivery network D) Health system in another state Answer: B Explanation: A) Clinical data networks were developed to support research on patient outcomes rather than the care delivered. These data-research networks involve two or more healthcare systems and include integrated delivery systems, academic medical centers, and safety-net clinics.

B) Health information networks have been vendor, community-wide, regional, statewide, and global enterprises, such as at military operating sites, with a goal to exchange patient-level information.

C) Integrated delivery networks exchange standard content and identifiers adopted across member hospitals, nursing homes, hospice, homecare, and clinics.

D) Health systems within multiple states are organizations that exchange standard content and identifiers adopted across member hospitals, nursing homes, hospice, homecare, and clinics.

Page Ref: 273 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Differentiate between clinical data networks and health information networks.

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7) The informatics nurse is assisting a large physician practice with obtaining health information on patients who reside in different states. Which would enhance the nurse's ability to obtain this information?

A) Encryption B) Sustainability C) Authentication D) Interoperability Answer: D Explanation: A) Encryption is a safety and security measure applied to the data.

B) Sustainability refers to the actual operating system.

C) Authentication refers to user credentials to access information systems.

D) Interoperability is the ability of two or more health information systems to exchange electronic clinical information with, and use electronic clinical information from, other systems.

Page Ref: 274 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Explain the value of interoperability for health information.

8) The administrator of a large, physician practice is planning to assist with accessing data for the current patient population. What should the administrator expect if the interoperability of the network is classified as being a pilot?

A) Has no or low adoption B) Has not been broadly tested C) Some entities are using the network in a testing or production environment D) Requires additional specification by the standards-development community Answer: C Explanation: A) An emerging network has no or low adoption.

B) An emerging network has not been broadly tested.

C) A pilot network is being used by some entities in a testing or production environment.

D) An emerging network requires additional specification by the standards-development community.

Page Ref: 275 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Explain the value of interoperability for health information.

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9) The informatics nurse is examining the relationship between the national health information network (NHIN) and the health information exchanges (HIE). Which explains this relationship in the United States?

A) The success of the NHIN is dependent on the state-wide HIEs. B) The success of the NHIN is not dependent on the state-wide HIEs. C) The success of the state-wide HIEs is dependent on the NHIN. D) The success of the state-wide HIEs is not dependent on the NHIN. Answer: A Explanation: A) The NHIN is a structure that will bring together the state-level HIE and regional HIOs when all stakeholders are using the evolving information exchange standards. The statelevel HIE programs have the responsibility to organize and facilitate the implementation of interoperability standards with stakeholders through state-wide operational planning. The success for the NHIN depends on the state-wide HIEs. B) The NHIN is a structure that will bring together the state-level HIE and regional HIOs when all stakeholders are using the evolving information exchange standards. The success for the NHIN depends on the state-wide HIEs. C) The role of the state-level HIE program can adapt to the state's needs and priorities based on characteristics of providers from evaluation of current HIT use. The success for the NHIN depends on the state-wide HIEs. D) The agencies such as public health and Medicaid services within the state government are stakeholders and will be involved with HIE services. The success for the NHIN depends on the state-wide HIEs. Page Ref: 279 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Evaluation/Communication and Documentation Learning Outcome: Describe the current status of the nationwide health information network in the United States.

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10) The health information exchange (HIE) requires exchange of health-related information according to nationally recognized standards. What will the HIE link into to ensure users share reliable health-related information in a standardized, secure, and confidential way?

A) Office of National Coordinator (ONC) B) Health information network (HIN) C) National health information network (NHIN) D) Health Information Security and Privacy Collaborative (HISPC) Answer: C Explanation: A) The HIE will not link with the ONC. B) The HIE will not link directly into an organization's HIN. C) The HIE requires the exchange of health-related information according to nationally recognized standards to link into the national health information network (NHIN). The NHIN will provide a standardized, secure, and confidential way to link information systems together for authorized users to share reliable health-related information.

D) The HIE will not link with the HISPC. Page Ref: 279 Cognitive Level: Understanding Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Evaluation/Communication and Documentation Learning Outcome: Describe the current status of the nationwide health information network in the United States.

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11) The informatics nurse reads an article about the international standards for health information exchanges. In which way will this standardization enhance patient care?

A) Allows the reuse of information for multiple purposes B) Supports adherence to the diagnostic-related groupings C) Improves job satisfaction for nurses planning patient care D) Reduces the cost associated with duplicating diagnostic tests Answer: A Explanation: A) The harmonization of concepts and data normalization are both necessary to achieve a level of interoperability, allowing reuse of information for multiple purposes. This interoperability requires international standards to share patient health and care information, initially, for healthcare professionals to provide care and, subsequently, for public-health use and for researchers to generate new evidence.

B) International standards are not viewed as support for the diagnostic-related groupings.

C) International standards are not used to improve job satisfaction for nurses planning patient care.

D) International standards are not used to reduce the cost associated with duplicating diagnostic tests.

Page Ref: 278 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss the need for international standards for integration of information.

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12) A conference being held in Europe has the topic of international standards as a lecture session. Which statements explain the importance of further developing these standards?

A) Improves the use of drug databases B) Increases access to medical journals C) Provides a mechanism to link nursing databases D) Supports communicating information worldwide Answer: D Explanation: A) Drug databases may be purchased and linked to the electronic patient-record and pharmacy systems for searching.

B) Medical-knowledge databases and medical journals are frequently linked to electronic patient-record systems to support searching medical conditions.

C) Nursing-knowledge databases and nursing journals for nursing diagnoses, nursing problems, problem risks, and needs for health enhancement and interventions may be linked; however, these sources are not linked as often as medical sources.

D) International standards are necessary to communicate information worldwide and, when linked to appropriate translated knowledge resources, provide meaning for intelligent or learned use of the information and knowledge when making decisions.

Page Ref: 278 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.2. Identify essential information that must be available in a common database to support patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss the need for international standards for integration of information.

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13) The informatics nurse is asked why health information exchanges (HIE) are required since they can be costly to maintain. Which should the nurse explain as an advantage of these exchanges?

A) They are data repositories accessible by patients and healthcare providers.

B) They are tools that provide background information to support healthcare decisions.

C) They are massive databases that store all health-related information for safekeeping.

D) They maintain complete histories of services used to justify changes in cost and reimbursement.

Answer: B Explanation: A) A HIE is more than a data repository. It links the data.

B) HIEs link the electronic health record (EHR) and personal health record (PHR) to provide background information on individual abilities and disabilities to support healthcare decisions.

C) HIEs are not massive databases used to store health-related information for safekeeping.

D) HIEs may be used to analyze cost trends, but they are not used primarily as a source to justify changes in cost and reimbursement.

Page Ref: 280 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.2. Identify essential information that must be available in a common database to support patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Describe the implications of interoperability for healthcare professionals and impact on healthcare delivery.

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14) National standards for interoperability are constantly being developed. Which entity controls the future of health information exchanges (HIEs)?

A) Nationwide health information network (NHIN) B) The Department of Homeland Security C) HIPAA D) HIMMS Answer: A Explanation: A) Although great strides have been made concerning interoperable standards, the capabilities of the systems along with the standards need further investigation through nationwide health information network.

B) The Department of Homeland Security does not control the future of HIEs. C) HIPAA does not control the future of HIEs. D) HIMMS does not control the future of HIEs. Page Ref: 280 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.2. Identify essential information that must be available in a common database to support patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Evaluation/Communication and Documentation Learning Outcome: Describe the implications of interoperability for healthcare professionals and impact on healthcare delivery.

15) A large healthcare organization is a member of a health information exchange (HIE). What should this organization expect as a stakeholder in the exchange?

A) Paying a membership fee B) Reduction in reimbursement from Medicare C) Reduced rates for purchasing bulk medical supplies D) Group rates for nursing continuing education programs Answer: A Explanation: A) The HIE network sustains operations through a membership fee, where stakeholders pay to support shared services for all.

B) Being a member of an HIE will not result in reduced reimbursement from Medicare.

C) Being a member of an HIE will not reduce the rates for medical supplies.

D) Being a member of an HIE will not provide group rates for nursing continuing education programs.

Page Ref: 281 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.2. Identify essential information that must be available in a common database to support patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Describe the process and use cases for health information exchange (HIE).

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16) A health information exchange (HIE) charges physicians in private practice a fee to access the exchange to research medication uses and the latest in diagnostic testing for a specific patient population. In which way could this be viewed as a HIPAA violation?

A) It is not a HIPAA violation.

B) The information is being sold for profit.

C) The physicians may not keep the information confidential.

D) Accessing the system may be done by unapproved personnel.

Answer: B Explanation: A) The data are being sold, which could violate HIPAA. B) The use of data for profit presents ethical concerns that consumers and participating providers can raise as HIPAA violations.

C) There is no evidence that the physicians would violate HIPAA privacy laws.

D) There is no evidence that unapproved personnel will access the system and share personal health information contained with the HIE. Page Ref: 281 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.3. Protect confidentiality of protected health information in electronic health records | AACN Essential Competencies: IV.8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients' right to privacy | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Evaluation/Communication and Documentation Learning Outcome: Describe the process and use cases for health information exchange (HIE).

17) To accomplish exchanges, an HIE infrastructure requires not only technology but an organizing structure for processes. Which does the organizing structure establish?

A) Nontechnical standardization B) Secure application and rules of operation C) Trans-operational exchanges D) Standardized workflow to obtain nonessential information Answer: B Explanation: A) The organizing structure establishes technical standardization.

B) The organizing structure establishes secure application and rules of operation.

C) The organizing structure establishes secure application and rules of operation and technical and content standardization for interoperable exchanges among entities.

D) Nonessential information is not accessed. Information for meaningful use is accessed.

Page Ref: 281 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.2. Identify essential information that must be available in a common database to support patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss key factors in the infrastructure for HIE.

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18) A healthcare organization is reviewing the health information exchange being considered.

Which is a prerequisite for the HIE organizing infrastructure? Select all that apply.

A) Master person index B) Record locator service C) Methods of authentication D) Authorization for users E) Escalating fees for use Answer: A, B, C, D Explanation: A) A master person index (MPI) is a standard person-identifier code that uniquely identifies an individual and permits the correlation process to match the person's data from a variety of different sources of health providers B) A record-locator service used to access and find health information that matches the identified individual.

C) Authentication is necessary to identify who is allowed to access health information through the HIE record-locator services.

D) The authorization process can occur through the healthcare organizations that already manage employment or through professional appointments. These organizations are positioned to facilitate role-based security for a clinician user to gain access to the record-locator service for health information exchange.

E) Fee structure is not part of the organizing infrastructure of an HIE. Page Ref: 281-284 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.2. Identify essential information that must be available in a common database to support patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Discuss key factors in the infrastructure for HIE.

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19) The informatics nurse is meeting with the leadership team of a multiple physician practice who do not want to participate in the health information exchange (HIE). Which should the nurse identify as a barrier to the implementation of the exchange? Select all that apply.

A) Developing a sustainable HIE business model B) Funding C) Location D) Personnel E) Integration into daily workflow Answer: A, B, E Explanation: A) Developing a sustainable HIE business model was the greatest barrier to progressing the efforts of HIE in 2014, as reported by 33% of operational HIEs. B) The lack of funding remains a barrier.

C) The location is not considered a barrier. HIEs have endured a variety of obstacles with policy, organizational structure, financial sustainability, legal procedures, technical designs and equipment, and operational processes.

D) Personnel are not considered a barrier.

E) Another barrier that impacts adoption of technology solutions is the integration of the HIE process into the professionals' daily workflow.

Page Ref: 286 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.2. Identify essential information that must be available in a common database to support patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Describe obstacles to network development and sustaining the operations for information exchange.

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20) Healthcare providers who participate in the health information exchange must adopt the 2016 standards for EHRs to exchange common data. Which additional actions must occur at this time?

Select all that apply.

A) Adopt implementation specifications.

B) Use new workflows.

C) Educate end-users on the clinical terminologies.

D) Consider the cost for using the system.

E) Limit the of type exchange available.

Answer: A, B, C Explanation: A) The process of adopting new standards includes the adoption of implementation specifications.

B) The process of adopting new standards includes the use of new workflows.

C) The process of adopting new standards includes education of end-users on the use of clinical terminologies.

D) The process of adopting new standards does not include the cost for using the system.

E) The process of adopting new standards does not include limits when the exchange can be used.

Page Ref: 286 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.2. Identify essential information that must be available in a common database to support patient care | AACN Essential Competencies: IV.6. Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Describe obstacles to network development and sustaining the operations for information exchange.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 15 The Role of Standardized Terminology and Language in Informatics 1) The informatics nurse is examining structured and controlled languages that have been developed according to terminology development guidelines. What is the nurse studying?

A) Standardized terminologies B) Healthcare standards C) Healthcare terminology D) Health-information standards Answer: A Explanation: A) Standardized terminologies are structured and controlled languages developed according to terminology-development guidelines and approved by an authoritative body.

B) Healthcare standards are not a controlled language.

C) Healthcare-terminology standards are designed to enable and support widespread interoperability among healthcare-software applications for the purpose of sharing information.

D) Health-information standards are not a controlled language.

Page Ref: 294 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Explain standardized healthcare terminology and its importance to nursing.

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2) The division of nursing wants to ensure that all data collected are accurate and valid. Which strategy would ensure that this goal is met?

A) Standardized terminology B) Tablets C) Bar coding D) Handheld devices Answer: A Explanation: A) The use of standardized terminology is a means of ensuring the data collection is accurate and valid. Standardized terminology is essential for successful development and implementation of an electric health record (EHR). Terminology is required to represent, communicate, exchange, manage, and report data, information, and knowledge. It enables safe, patient-centric, high-quality healthcare that optimizes data collection for the measurement of patient outcomes.

B) A tablet is a device used to input data. There is no guarantee that the data are accurate and valid.

C) Bar coding is a method for billing and safety. Data are not collected.

D) Handheld devices are used to input data. There is no guarantee that the data are accurate and valid.

Page Ref: 294 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Explain standardized healthcare terminology and its importance to nursing.

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3) The informatics nurse is explaining the American Nurses Association criteria for recognizing standardized terminologies in that the terminologies must meet established criteria to be approved. Which criterion must be present? Select all that apply.

A) Outcome identification B) Diagnosis C) Problem solving D) Decision making E) Nursing process data elements Answer: A, B, E Explanation: A) Terminologies must be used to support nursing practice that reflects the nursing process, including outcome identification.

B) Terminologies must be used to support nursing practice that reflects the nursing process, including diagnosis.

C) Terminologies must be used to support nursing practice that reflects the nursing process.

Problem solving is not a step in the nursing process.

D) Terminologies must be used to support nursing practice that reflects the nursing process.

Decision making is not a step in the nursing process.

E) Terminologies must be used to support nursing practice that reflects the nursing process. The nursing process data elements include assessment, diagnosis, outcome identification (goal), planning, implementation (interventions), and evaluation.

Page Ref: 299 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Describe the American Nurses Association (ANA) criteria established for recognizing standardized terminologies.

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4) A healthcare organization is implementing an electronic health record that uses SNOMED. Which should the informatics nurse explain about the relationship of this taxonomy with the American Nurses Association (ANA)?

A) Is not recognized by the ANA B) Is currently under review by the ANA C) Contains ANA recognized taxonomies D) Does not contain ANA recognized taxonomies Answer: C Explanation: A) SNOMED is recognized by the ANA. B) The ANA is not currently reviewing SNOMED. C) The ANA-recognized terminologies should be mapped to SNOMED. D) SNOMED contains the ANA recognized taxonomies.

Page Ref: 300 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Describe the American Nurses Association (ANA) criteria established for recognizing standardized terminologies.

5) The informatics nurse is working with a committee on the implementation of a health information system. Which terminology should the nurse mention that has been approved by the American Nurses Association (ANA)? Select all that apply.

A) Nursing Management Minimum Data Set (NMMDS) B) Nursing Minimum Data Set (NMDS) C) Cumulative Index of Nursing and Allied Health Literature (CINAHL) D) Clinical Care Classification (CCC) E) North American Nursing Diagnosis International (NANDA-I) Answer: A, B, D, E Explanation: A) The NMMDS is approved by the ANA. B) The NMDS is approved by the ANA. C) The CINAHL is a nursing research database.

D) The CCC is approved by the ANA. E) NANDA-I is approved by the ANA. Page Ref: 300, 303 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Describe each of the ANA-recognized terminologies and the benefits of use when implemented within an electronic healthcare record system.

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6) The informatics nurse is reviewing the Clinical Care Classification (CCC) System. Which should the nurse emphasize as the usefulness of this system?

A) Facilitates the collection and dissemination of lab values B) Offers improved outcomes C) Facilitates patient care documentation at the bedside D) Discloses standardized nursing terminologies Answer: C Explanation: A) The CCC does not facilitate the collection and dissemination of lab values.

B) The CCC does not offer improved outcomes.

C) The CCC is a nursing classification designed to document the six steps of the nursing process across the care continuum. It facilitates patient care documentation at the point of care.

D) The CCC does not disclose standardized nursing terminologies.

Page Ref: 302 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Describe each of the ANA-recognized terminologies and the benefits of use when implemented within an electronic healthcare record system.

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7) The division of nursing wants a nursing classification system within the healthcareinformation system that documents the six steps of the nursing process across the care continuum. Which system should the informatics nurse recommend?

A) International Classification of Nursing Practice (ICNP) B) NANDA International Nursing Diagnoses C) NANDA-I Taxonomy II D) Clinical Care Classification (CCC) System Answer: D Explanation: A) The ICNP is a unified nursing language system developed by the ICN in Geneva, Switzerland. ICNP is a compositional terminology for nursing practice that facilitates the development of, and the cross-mapping among, local terms and existing terminologies. ICNP contains nursing phenomena (diagnoses), nursing actions, and nursing outcomes. ICNP is represented using a seven-axis model. The ICNP has developed specific guidelines for using the seven-axis model to develop nursing diagnosis, outcome, and intervention statements.

B) The NANDA International Nursing Diagnoses is not identified as a classification system to support the steps of the nursing process.

C) NANDA-I identifies nursing diagnoses across 13 domains.

D) CCC is a nursing classification designed to document the six steps of the nursing process across the care continuum. It facilitates patient care documentation at the point of care.

Page Ref: 300 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss standardized terminologies used for the different parts of the nursing process and their similarities and differences.

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8) The informatics nurse is aware that the ANA has recognized the Omaha System and integrated the terminology into SNOMED CT. Which should be realized as the value of the Omaha System?

A) Is a problem classification scheme B) Offers outcome labels C) Provides nursing diagnoses D) Provides diagnoses and intervention Answer: A Explanation: A) The Omaha System is a problem classification scheme that identifies signs and symptoms, clinical findings, intervention scheme interventions, and procedures.

B) Nursing Outcomes Classification offers outcome labels.

C) NANDA-I provides nursing diagnoses.

D) CCC provides diagnoses and interventions.

Page Ref: 306 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Discuss standardized terminologies used for the different parts of the nursing process and their similarities and differences.

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9) The nurse is entering assessment findings for a patient scheduled for surgery. Which standardized terminology will the nurse most likely use?

A) The Omaha System B) The PeriOperative Nursing Data Set (PNDS) C) North American Nursing Diagnosis International (NANDA-I) D) International Classification of Nursing Practice (ICNP) Answer: B Explanation: A) The Omaha System is a problem classification scheme that identifies signs and symptoms, clinical findings, intervention scheme interventions, and procedures.

B) PNDS developed by the Association of periOperative Registered Nurses (AORN), is a standardized perioperative nursing vocabulary that provides nurses a clear, precise, and universal language for clinical problems and surgical treatments.

C) NANDA-I provides nursing diagnoses.

D) ICNP is a unified nursing language system developed by the ICN in Geneva, Switzerland.

ICNP is a compositional terminology for nursing practice that facilitates the development of, and the cross-mapping among, local terms and existing terminologies.

Page Ref: 306 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss standardized terminologies used for the different parts of the nursing process and their similarities and differences.

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10) The informatics nurse is charged with identifying a terminology system that can be used to document the elements of the nursing process within the care plan. Which system should the nurse recommend?

A) The Omaha System B) The PeriOperative Nursing Data Set (PNDS) C) Personal health record D) NANDA-I Answer: D Explanation: A) The Omaha System is a problem classification scheme that identifies signs and symptoms, clinical findings, intervention scheme interventions, and procedures.

B) PNDS, developed by the Association of periOperative Registered Nurses (AORN), is a standardized perioperative nursing vocabulary that provides nurses a clear, precise, and universal language for clinical problems and surgical treatments.

C) The personal health record is not identified as a system to document the elements of the nursing process within the care plan.

D) NANDA-I is used to document nursing diagnoses within all settings and across the care continuum. The coding system can be used within the electronic health record. NANDA-I has been linked to the NIC interventions and NOC outcomes.

Page Ref: 304 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Define the different types of terminology structures, such as a classification system (e.g., NANDA, NIC, or NOC) versus a reference terminology (ICNP, or SNOMED CT).

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11) The informatics nurse is researching the use of the nursing classifications approved by the ANA. For which reason does the ANA recognize nursing classifications to codify data?

A) Used during the nursing process such as assessments, nurse sensitive problems, interventions, and outcomes B) Used to support input devices C) Align nursing outcomes D) Retrieval of billing invoices Answer: A Explanation: A) The ANA-recognized nursing classifications codify data used during the nursing process, such as assessments, nurse sensitive problems, interventions, and outcomes.

B) The ANA-recognized nursing classifications do not codify data used to support input devices.

C) The ANA-recognized nursing classifications codify data used for more than nursing outcomes.

D) The ANA-recognized nursing classifications do not codify data used for retrieving billing invoices.

Page Ref: 308 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Define the different types of terminology structures, such as a classification system (e.g., NANDA, NIC, or NOC) versus a reference terminology (ICNP, or SNOMED CT).

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12) The informatics nurse prepares an educational program that explains how a classification system is used to categorize the details of the clinical encounter. Which statement should the nurse delete from the content about a classification system?

A) Groups data to determine costs and outcomes of treatment B) Captures the level of detail necessary to document specific items at the point of care C) Provides data to consumers on costs and outcomes of treatment options D) Facilitates the collection and reporting of health statistics Answer: B Explanation: A) A classification system provides data to consumers on costs and outcomes of treatment options.

B) A classification system does not capture the level of detail necessary to document specific items at the point of care.

C) A classification system provides data to consumers on costs and outcomes of treatment options.

D) A classification system is used in the collection and reporting of health statistics.

Page Ref: 295 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Define the different types of terminology structures, such as a classification system (e.g., NANDA, NIC, or NOC) versus a reference terminology (ICNP, or SNOMED CT).

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13) An organization uses SNOMED CT within the electronic health record. Which is a benefit of this system? Select all that apply.

A) Provides interoperable data collection that can be analyzed and used for evidence-based practice models B) Provides interoperable data collection that can be analyzed and used for decision-support rules C) Provides interoperable data collection that can be analyzed and used in reporting quality measures D) Provides interoperable data collection that can be analyzed and used for medication renewals E) Provides interoperable data collection that can be analyzed and used for administrative billing Answer: A, B, C, E Explanation: A) SNOMED CT provides interoperable data collection that can be analyzed and used in the implementation of evidence-based practice.

B) SNOMED CT provides interoperable data collection that can be analyzed and used for decision-support rules, reporting quality measures, and administrative billing.

C) SNOMED CT provides interoperable data collection that can be analyzed and used to report quality measures.

D) SNOMED CT is not used for medication renewals.

E) SNOMED CT provides interoperable data collection that can be analyzed and used for administrative billing.

Page Ref: 300-301 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Define the different types of terminology structures, such as a classification system (e.g., NANDA, NIC, or NOC) versus a reference terminology (ICNP, or SNOMED CT).

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14) The informatics nurse is explaining the use of concepts within clinical terminology. The nurse should explain that these concepts support which facets of healthcare? Select all that apply.

A) Healthcare provider orders B) Assessments C) Billing D) Medication renewal E) Outcomes Answer: A, B, E Explanation: A) Clinical concepts are used to document ideas related to patient care or express orders, assessment, and outcomes within an EHRS. B) Clinical concepts are used to document ideas related to patient care or express orders, assessment, and outcomes within an EHRS. C) Clinical concepts are not used for billing.

D) Clinical concepts are not used for medication renewals.

E) Clinical concepts are used to document ideas related to patient care or express orders, assessment, and outcomes within an EHRS. Page Ref: 294 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Demonstrate how standard terminologies facilitate the use of evidencebased practice and decision-support rules.

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15) A group of information technologists are analyzing how the use of standard terminologies has been scientifically investigated for its effectiveness and impact on patient care. The use of standard terminologies can facilitate which of the following?

A) Multiple support languages B) Consumer informatics C) Computer literacy D) Evidence-based practice and decision-support rules Answer: D Explanation: A) Multiple support languages are not relevant when discussing a standardized language.

B) Consumer informatics is not associated with standardized terminologies.

C) Computer literacy is not associated with standardized terminologies.

D) Standard terminologies can facilitate the collection and analysis of data. As a central repository for data, the investigator can extrapolate and analyze data. From the analysis, linkages can be determined and models that support decisions are developed. As evidence-based practice models are generated, clinical nursing practice and outcomes are improved.

Page Ref: 294 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Demonstrate how standard terminologies facilitate the use of evidencebased practice and decision-support rules.

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16) The informatics nurse reviews how Medicare and Medicaid have begun to offer financial incentives to healthcare providers to promote adoption and meaningful use of interoperable health information systems and a qualified health record. Which statement should be used to describe the goal of meaningful use?

A) Input data in a manner that creates evidence-based practice models.

B) Exchange clinical structured data in a manner that is accurate and complete to improve patient care in a cost-efficient way.

C) Provide a warehouse of data that supports medication renewal and patient teaching plans.

D) Offer the clinician patient-care tools for improved outcomes.

Answer: B Explanation: A) The goal of meaningful use is not to input data that created evidence-based practice models.

B) The goal of meaningful use is to exchange clinical structured data in a manner that it is accurate and complete to improve patient care in a cost-efficient way. One of the primary facets of meaningful use is the use of standardized language.

C) The goal of meaningful use is not to provide a warehouse of data that supports medication renewal and patient teaching plans.

D) The goal of meaningful use is not to offer patient care tools for improved outcomes.

Page Ref: 294 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Illustrate how using standardized healthcare terminologies correlates to the US meaningful use criteria.

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17) The healthcare providers in a group practice are struggling with proving meaningful use with the electronic health record. Which should the informatics nurse recommend to help with this issue?

A) Ensure all data are encrypted.

B) Use standardized terminology.

C) Post the HIPAA privacy and security notices.

D) Encourage all providers to document during patient care.

Answer: B Explanation: A) Encrypted data do not necessarily indicate meaningful use.

B) One of the primary criteria identified for meaningful use is the use of standardized terminologies.

C) Posting HIPAA notices does not indicate meaningful use.

D) Documenting at point of care does not indicate meaningful use.

Page Ref: 294 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Illustrate how using standardized healthcare terminologies correlates to the US meaningful use criteria.

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18) Terminologies can be incorporated within the electronic health record to improve practice.

Which should the informatics nurse explain are uses for this technology in healthcare? Select all that apply.

A) Classification B) Reference C) Point of care D) Coding E) Denial of claims Answer: B, C Explanation: A) Terminologies are not used for classification.

B) Terminologies are used as reference terminology. A reference terminology consists of a set of concepts with definitional relationships.

C) Terminologies are used as a point-of-care terminology. A point-of-care terminology, frequently referred to as an interface terminology, is what the clinicians see on the screen and consists of terms with which clinicians are familiar.

D) Terminologies are not used for coding.

E) Terminologies are not used for denial of claims.

Page Ref: 295 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Identify the benefits of using structured terminologies within electronic healthcare record systems.

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19) A healthcare organization is investing in an upgrade for the EHR that includes pay-forperformance initiatives, care coordination, patient-safety monitoring, and public-health surveillance. Which type of data is being used with this system?

A) Patient B) Coded C) Embedded D) Qualitative Answer: B Explanation: A) Patient data are not being used for all of these upgrades.

B) The use of coded data has expanded to include pay-for-performance initiatives, care coordination, patient-safety monitoring, and public-health surveillance.

C) Embedded data are not being used for all of these upgrades.

D) Qualitative data are not being used for these upgrades.

Page Ref: 314 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Identify the benefits of using structured terminologies within electronic healthcare record systems.

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20) The informatics nurse is challenged with explaining the use of standardized terminology within a healthcare organization's electronic health record system. Which should the nurse emphasize as benefiting from the use of this terminology? Select all that apply.

A) Patients B) Providers C) Healthcare organizations D) Healthcare industry E) Informational technicians Answer: A, B, C, D Explanation: A) Implementing standardized terminology has many benefits to multiple beneficiaries, including the patient.

B) Implementing standardized terminology has many benefits to multiple beneficiaries, including providers.

C) Implementing standardized terminology has many benefits to multiple beneficiaries, including healthcare organizations.

D) Implementing standardized terminology has many benefits to multiple beneficiaries, including the healthcare industry in general.

E) Information technicians are not identified as being a beneficiary of standardized terminology.

Page Ref: 309 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.3. Contrast benefits and limitations of different communication technologies and their impact on safety and quality | AACN Essential Competencies: IV.5. Use standardized terminology in a care environment that reflects nursing's unique contribution to patient outcomes | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Identify the benefits of using structured terminologies within electronic healthcare record systems.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 16 Continuity Planning and Management (Disaster Recovery) 1) The leadership team is analyzing the life cycle of business-continuity planning (BCP). For which reason should this healthcare facility engage in continuity planning?

A) Lost or corrupted data are costly to recreate and threaten the survival of a business or healthcare delivery system in a highly competitive environment.

B) It validates the implementation process.

C) It calculates the cost incurred by vendors.

D) It minimizes the amount of data corrupted after a disaster.

Answer: A Explanation: A) BCP is the process of ensuring the continuation of critical business services regardless of any event that may occur. It includes IT disaster planning. Continuity planning consists of several steps that are best defined as life-cycle stages.

B) BCP is not done to validate the implementation process.

C) BCP does not calculate the cost incurred by vendors.

D) BCP is not done as a way to minimize the amount of data corrupted after a disaster.

Page Ref: 340 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Examine the continuity life cycle.

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2) The informatics nurse is working with the leadership team on business-continuity management (BCM). On what should the team focus when creating this plan?

A) The direction to provide during and immediately after an incident B) The process that ensures the organization is capable of withstanding disruption to normal functioning C) The outcome from assessing the essential functions of systems inside and outside of the organization D) The short periods of operational disruptions with core processes documented during contingency planning Answer: B Explanation: A) Emergency mode or crisis management provides direction during, and immediately after, an incident.

B) BCM is the process that seeks to ensure organizations can withstand any disruption to normal functioning.

C) Risk analysis is the outcome from assessing the essential functions of systems inside and outside the organization.

D) Downtime planning focuses on short periods of operational disruptions, with core processes documented during contingency planning.

Page Ref: 321 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Examine the continuity life cycle.

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3) The leadership team is drafting documents to support the disaster recovery plan. Which event should be eliminated from this plan?

A) A virus infects a walk-in clinic's electronic medical record (EMR) system and randomly deletes data on Friday afternoon. The IT staff is on vacation.

B) The rheumatology department of a multispecialty clinic is without analog telephone access for two hours (computer network connections remain intact).

C) The health department records are severely damaged after a fire.

D) A hospital is without electrical power for 48 hours due to a hurricane and flooding.

Answer: B Explanation: A) Having data randomly deleted by a virus without support for the system would qualify as a disaster.

B) Losing analog telephone service is an inconvenience but not a disaster. Patients can still be cared for, data are not lost, and all mission-critical activities can occur despite a potential delay.

C) Loss of an entire building or office with health records can be considered a disaster.

D) Loss of electrical power in a hospital would qualify as a disaster because patient care will be severely compromised.

Page Ref: 323 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Evaluate the importance of continuity planning.

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4) The leadership team is reviewing the emergency and data backup plans in the event of a disaster. Which should the team keep in mind when analyzing these plans?

A) An emergency plan outlines the availability, integrity, and protection of health data, whereas a data backup plan provides direction during and immediately after an incident.

B) An emergency plan is tested routinely, whereas a data backup plan is only used if the emergency plan fails.

C) Emergency and data backup plans are the same.

D) A data backup plan outlines the availability, integrity, and protection of health data, whereas an emergency plan provides direction during and immediately after an incident.

Answer: D Explanation: A) An emergency plan provides direction during and immediately after an incident.

B) All plans should be routinely tested.

C) An emergency plan and data backup plan are not the same.

D) A data backup plan outlines the availability, integrity, and protection of health data, whereas an emergency plan provides direction during and immediately after an incident.

Page Ref: 323 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Evaluate the importance of continuity planning.

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5) The leadership team is reviewing the business-continuity plan for IT. Which should be included in this plan? Select all that apply.

A) Servers B) Air conditioning C) Networking equipment D) Linen and water pitchers E) Storage devices and media Answer: A, B, C, E Explanation: A) The business-continuity plan for IT needs to include servers.

B) The business-continuity plan for IT needs to include air conditioning.

C) The business-continuity plan for IT needs to include networking equipment.

D) Linen and water pitchers would be required for a plan to support direct patient care.

E) The business-continuity plan for IT needs to include storage devices and media.

Page Ref: 322 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Explain the rationale for developing a business-continuity plan (BCP).

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6) The informatics nurse is assisting the information technology department develop a businesscontinuity plan. Which questions should be asked when developing this plan? Select all that apply.

A) Will the plan scale to fit future requirements?

B) How will the remote data center be managed?

C) How will the members of the department communicate?

D) How can the integrity and privacy of the data be preserved?

E) How will applications perform over a WAN or the Internet?

Answer: A, B, D, E Explanation: A) When developing the business-continuity plan, specific questions should be asked to determine if the plan will scale to fit future requirements.

B) When developing the business-continuity plan, specific questions should be asked regarding management of the remote data center.

C) When developing the business-continuity plan, specific questions should be asked, but staff communication is not one of them.

D) When developing the business-continuity plan, specific questions should be asked about how to protect the integrity and privacy of the data.

E) When developing the business-continuity plan, specific questions should be asked about how the applications will perform over a WAN or the Internet.

Page Ref: 322-323 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Explain the rationale for developing a business-continuity plan (BCP).

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7) The leadership team is examining ways to protect electronic heath information in the event of a disaster. On what should this team focus? Select all that apply.

A) Ensuring that all patient care information is available in hardcopy B) Safeguarding business continuity by protection of healthcare data C) Supporting patient care by providing continual access to patient information D) Recovery and restoration of healthcare data and information E) Stopping all patient care until the disaster is over Answer: A, B, C, D Explanation: A) A mechanism needs to be in place to access patient data. Hardcopy is one potential method to do so.

B) Healthcare data need to be protected from corruption.

C) The patient-care staff need to be able to access patient information when providing and documenting care.

D) In the event that electronic health records are damaged, there needs to be a way to recover the data and restore it to support patient care and organization operations.

E) It is unrealistic to stop all patient care until the disaster ends.

Page Ref: 323 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss the relationship between continuity planning and disaster recovery.

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8) The leadership team is reviewing the disaster recovery plan for a large hospital. Which information should be in this plan? Select all that apply.

A) Training B) Objectives C) Gaps D) Essential functions E) Mock drills Answer: A, C, E Explanation: A) Disaster-recovery planning includes training.

B) Business-continuity plans must identify the plan's objectives.

C) Disaster-recovery planning includes the evaluation of identified gaps.

D) A risk assessment is performed to include essential functions of systems inside and outside the organization's walls.

E) Disaster recovery planning includes testing by holding mock drills.

Page Ref: 323 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Evaluation/Communication and Documentation Learning Outcome: Discuss the relationship between continuity planning and disaster recovery.

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9) The leadership team of a large healthcare organization is engaged in continuity planning.

Which should be identified as a component of the business-impact analysis (BIA)?

A) Securing top management support B) Establishing continuity maintenance policies and procedures C) Assessing the continuity plan for weaknesses D) Determining critical functions of the organization Answer: D Explanation: A) Securing top management support is part of the planning process.

B) Putting policies and procedures into place to maintain business continuity is part of the implementation process.

C) Assessment of the continuity plan for weaknesses is part of the evaluation process.

D) BIA is the process of determining the critical functions of the organization. This includes the information vital to maintaining these operations as well as the applications and databases, hardware, and communication facilities that use, house, or support this information.

Page Ref: 326 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Outline the steps of the continuity-planning process.

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10) The leadership team is developing a preparedness program. Which stages should be included in this program? Select all that apply.

A) Program management B) Planning C) Implementation D) Testing and exercise E) Data retrieval Answer: A, B, C, D Explanation: A) Program management is the first stage of the preparedness program as identify by the US Department of Homeland Security.

B) Planning is the second stage of the preparedness program as identify by the US Department of Homeland Security.

C) Implementation is the third stage of the preparedness program as identify by the US Department of Homeland Security.

D) Testing and exercise is the fourth stage of the preparedness program as identify by the US Department of Homeland Security.

E) Data retrieval is not a stage of the preparedness program as identified by the US Department of Homeland Security.

Page Ref: 326 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Outline the steps of the continuity-planning process.

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11) The informatics nurse is reviewing a continuity plan to anticipate problems and minimize losses incurred by damage. Which should the nurse keep in mind as advantages associated with continuity planning? Select all that apply.

A) Strategies for correction of organization vulnerabilities B) Allowing time for restoration of equipment, facility, and services C) Means to capture information needed for regulatory and accrediting agencies D) Providing continuity of client records and delivery of care E) Complete protection against interruption in services Answer: A, B, C, D Explanation: A) Advantages associated with continuity planning include strategies for correction of organization vulnerabilities.

B) Advantages associated with continuity planning include allowing time for restoration of equipment, facility, and services.

C) Advantages associated with continuity planning include a mechanism to capture information needed for regulatory and accrediting bodies.

D) Advantages associated with continuity planning include ensuring continuity of the client record and delivery of care.

E) Complete protection against interruption in services is not an advantage associated with continuity planning.

Page Ref: 328-329 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Review the advantages associated with continuity planning.

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12) The leadership team is engaged in continuity planning. Which should the team be cautioned against when preparing this plan?

A) A good continuity plan is intentionally ambiguous to prevent hacking.

B) Wait time decreases satisfaction and can diminish quality of care.

C) Healthcare organizations are catching up with other industries in understanding the business case for continuity of operations.

D) Healthcare organizations must be able to effectively deal with crises.

Answer: A Explanation: A) A good continuity plan is clear and concise; one advantage is that it expedites the reporting of diagnostic tests.

B) An effective disaster plan saves patients from unnecessary delays in treatment and avoids redundant procedures.

C) Healthcare organizations are catching up with other industries in understanding the business case for continuity of operations. This is an ongoing process.

D) Healthcare organizations must be able to deal effectively with crises. A good plan can make the difference between an organization's survival and demise.

Page Ref: 329 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Review the advantages associated with continuity planning.

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13) The informatics nurse reviews a disaster plan created for a healthcare organization. Which statement should the nurse eliminate from this plan?

A) Limits the loss of data B) Increases in the budget line to prepare for future disasters C) Limits loss of equipment D) Offers a logical system to employ during an unforeseen disaster Answer: B Explanation: A) An effective disaster plan saves money upfront and over time through limiting loss of data.

B) An effective disaster plan does not include a budget line increase to prepare for future disasters.

C) An effective disaster plan saves money upfront and over time by limiting loss of equipment.

D) An effective disaster plan saves money upfront and over time by limiting loss of services.

Page Ref: 329 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Evaluation/Communication and Documentation Learning Outcome: Review the advantages associated with continuity planning.

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14) The IT department is analyzing a process to ensure that healthcare operations will continue 24-hours-a-day, 7-days-a-week. What should this process identify as the first line of defense in providing the continuous systems availability that is required in a healthcare setting?

A) Adequate firewall protection B) Software redundancy C) Installing antivirus software D) Hardware redundancy Answer: D Explanation: A) Adequate firewall protection is a good practice but is not the first line of defense.

B) Having copies of software is a good practice; however, it is not the first line of defense.

C) Installing antivirus software is a good practice but is not the first line of defense.

D) Hardware redundancy is the first line of defense in providing continuous systems availability.

It allows operations to continue even when individual components fail.

Page Ref: 330 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Identify events that can threaten business operation and information systems (IS).

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15) The informatics nurse and information technology staff members are analyzing approaches for long-term data retention. For which reason should metadata be considered?

A) Data are stored off-site in a cold storage facility.

B) It is a set of data that provides information about how, when, and by whom data are collected, formatted, and stored.

C) It provides a backup copy of all data within an organization.

D) It is a set of data that is transferred electronically over high-speed telephone lines to another site and set to expire at the correct time.

Answer: B Explanation: A) Metadata is essential to the creation and use of data repositories.

B) Metadata is a set of data that provides information about how, when, and by whom data are collected, formatted, and stored.

C) Backup allows restoration of data if, or when, they are lost.

D) Backup allows restoration of data if, or when, they are lost.

Page Ref: 331 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Identify events that can threaten business operation and information systems (IS).

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16) The healthcare agency is incorporating a continuity plan to ensure business continuity and successful recovery after a disaster. Which should be considered as the most effective way to emphasize the importance of disaster preparedness?

A) Conduct staff reviews of continuity and recovery plans.

B) Test the emergency staff notification system.

C) Incorporate mock disaster situations into staff training.

D) Display continuity plans in conspicuous places.

Answer: C Explanation: A) Conducting staff reviews of continuity and recovery plans help to ensure business continuity and successful recovery.

B) Testing the emergency staff notification system helps to ensure business continuity and successful recovery.

C) The healthcare agency emphasizes the importance of disaster preparedness by incorporating mock disaster situations into staff training.

D) Displaying continuity plans in conspicuous places helps to ensure business continuity and successful recovery.

Page Ref: 334 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss how information obtained from a mock or an actual disaster can be used to improve responses and revise continuity plans.

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17) A healthcare organization is reviewing post-disaster feedback to improve the design and implementation of a better continuity plan for use. What is the purpose of this analysis?

A) Feedback collected is used to identify what worked and what did not because plans that looked good before a disaster may not look so good after one.

B) Feedback collected after disasters (or mock disasters) is not useful because the staff had no other options during the disaster.

C) Feedback collected after disasters (or mock disasters) is not necessarily accurate.

D) Feedback collected after disasters (or mock disasters) provides data for change in a limited number of areas.

Answer: A Explanation: A) Feedback collected after disasters (or mock disasters) is key to the design and implementation of a better continuity plan for use in future disasters. The feedback should be used to identify what worked and what did not. Plans that looked good before a disaster may not look so good after one.

B) Feedback collected after disasters (or mock disasters) is useful.

C) Feedback collected after disasters (or mock disasters) should be assessed for accuracy before using.

D) Feedback collected after disasters (or mock disasters) helps the entire organization prepare a better plan.

Page Ref: 338 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Evaluation/Communication and Documentation Learning Outcome: Discuss how information obtained from a mock or an actual disaster can be used to improve responses and revise continuity plans.

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18) The HIPAA security rule requires continuity planning and disaster recovery processes for protected health information. Which activity is required for a healthcare organization to safeguard protected patient information? Select all that apply.

A) Lowering security requirements during a disaster B) Developing disaster recovery processes C) Establishing a continuity plan D) Creating, accessing, storing, and destroying manual records E) Giving access codes and usernames to emergency personnel Answer: B, C, D Explanation: A) Lowering security requirements during a disaster is incorrect because the rule demands safeguards for security in normal operating mode and during disaster mode.

B) The HIPAA security rule requires a disaster recovery processes. All healthcare organizations must have a data backup plan, a recovery plan, an emergency mode of operation plan, and testing and evaluation procedures.

C) The HIPAA security rule requires continuity planning. All healthcare organizations must have a data backup plan, a recovery plan, an emergency mode of operation plan, and testing and evaluation procedures.

D) The HIPAA security rule requires continuity planning and disaster recovery processes. All healthcare organizations must have a data backup plan, a recovery plan, an emergency mode of operation plan, and testing and evaluation procedures.

E) The HIPAA security rule requires continuity planning and disaster recovery processes. This does not include giving access codes and usernames to emergency personnel.

Page Ref: 338 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss legal and accreditation requirements for continuity plans.

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19) A healthcare organization is reviewing the business continuity plan. How many emergency drills should the organization conduct each year to comply with The Joint Commission recommendations?

A) One B) Two C) Three D) Four Answer: B Explanation: A) The Joint Commission suggests that organizations conduct at least two emergency drills per year, with one being community-wide. Accredited organizations must identify their role in community-wide emergencies and demonstrate a command structure, emergency preparedness training for staff, and a mechanism to enact an emergency plan. One drill is insufficient.

B) The Joint Commission suggests that organizations conduct at least two emergency drills per year, with one being community-wide. Accredited organizations must identify their role in community-wide emergencies and demonstrate a command structure, emergency preparedness training for staff, and a mechanism to enact an emergency plan.

C) The Joint Commission suggests that organizations conduct at least two emergency drills per year, with one being community-wide. Accredited organizations must identify their role in community-wide emergencies and demonstrate a command structure, emergency preparedness training for staff, and a mechanism to enact an emergency plan. Three drills are not necessary.

D) The Joint Commission suggests that organizations conduct at least two emergency drills per year, with one being community-wide. Accredited organizations must identify their role in community-wide emergencies and demonstrate a command structure, emergency preparedness training for staff, and a mechanism to enact an emergency plan. Four drills are not necessary.

Page Ref: 339 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss legal and accreditation requirements for continuity plans.

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20) The informatics nurse is reviewing resources for a business-continuity plan. Which legislation authorized the development of a national, near real-time information network to coordinate federal and state response to public-health emergencies?

A) Health Insurance Portability and Accountability Act B) Pandemic and All-Hazards Preparedness Act C) Sarbanes-Oxley Act D) Federal Information Privacy and Security Act Answer: B Explanation: A) The HIPAA security rule requires continuity planning and disaster recovery processes.

B) The Pandemic and All-Hazards Preparedness Act authorized development of a national, near real-time information network. This network coordinates federal and state response to publichealth emergencies.

C) The Sarbanes-Oxley Act legislates corporate responsibility; it impacts the healthcare industry by increasing demands for fiscal responsibility and accurate financial reports and disclosure.

D) The Federal Information Privacy and Security Act established a minimum standard of performance for the protection of information and information systems managed by federal agencies, their contractors, and other agencies acting on their behalf.

Page Ref: 339 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss legal and accreditation requirements for continuity plans.

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21) A healthcare organization is performing a BIA and crisis management analysis, employee training, continuity-plan reviews, planning for information-technology disasters and recovery, and auditing the continuity-plan processes as required by The Joint Commission and HIPAA. Which other body can the organization use to achieve compliance? Select all that apply.

A) National Institute of Standards and Technology (NIST) B) Disaster Recovery Institute International C) Federal Emergency Management Agency (FEMA) D) Food and Drug Administration (FDA) E) National Institutes for Health (NIH) Answer: A, B, C, D Explanation: A) NIST provides voluntary guidelines for better business continuity management that help continuity planners to achieve HIPAA and the Joint Commission compliance.

B) Disaster Recovery Institute International provides voluntary guidelines for better business continuity management that help continuity planners to achieve HIPAA and the Joint Commission compliance.

C) FEMA provides voluntary guidelines for better business continuity management that help continuity planners to achieve HIPAA and the Joint Commission compliance.

D) The FDA provides voluntary guidelines for better business continuity management that help continuity planners to achieve HIPAA and the Joint Commission compliance.

E) The NIH is not identified as providing voluntary guidelines to meet HIPAA and the Joint Commission compliance.

Page Ref: 339 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.A.5. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care | AACN Essential Competencies: IV.3. Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Discuss legal and accreditation requirements for continuity plans.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 17 Using Informatics to Educate 1) The nurse educator is planning a program to be provided through a web-based environment.

Which should the education plan do to maximize student participation?

A) Assign group projects for students to encourage interaction and discussion among students.

B) Use the latest version of software to encourage efficient and timely student responses.

C) Make detailed, lengthy documents for students to download and peruse at their leisure.

D) On the class website, load multimedia presentations that utilize plug-ins to enhance instruction.

Answer: A Explanation: A) Web 2.0 is best defined as the second generation in the development of the World Wide Web that focuses more on user collaboration, or communication, through the sharing of content, along with social networking. Group projects stimulate student interaction; this is important when students do not meet physically.

B) Because student equipment is variable, faculty should provide materials that can be accessed by older software programs without plug-ins.

C) Simple, short materials should be posted.

D) Faculty should provide materials that can be accessed by older software programs without plug-ins.

Page Ref: 346 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: VIII.13. Articulate the value of pursuing practice excellence, lifelong learning and professional engagement to foster professional growth and development | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Identify a variety of appropriate information-technology resources for educators.

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2) A school of nursing uses a learning management system (LMS) to support all classes. Which is an advantage for the instructor in using this learning platform? Select all that apply.

A) Post examinations B) Monitor course materials C) Send announcements via email D) Flexible approach to attending class E) Ability to track and manage students Answer: A, B, C, E Explanation: A) An LMS focuses on partnerships between students and faculty, which includes the core component of posting examination.

B) An LMS focuses on partnerships between students and faculty, which includes the core component of managing course materials.

C) An LMS focuses on partnerships between students and faculty, which includes the core components of announcements and email.

D) Flexibility with attending class is an advantage for the student.

E) An LMS focuses on partnerships between students and faculty, which includes the core component of tracking and managing students.

Page Ref: 347 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: VIII.13. Articulate the value of pursuing practice excellence, lifelong learning and professional engagement to foster professional growth and development | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Assessment/Teaching and Learning Learning Outcome: Identify a variety of appropriate information-technology resources for educators.

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3) The informatics nurse is asked to present information about the importance of researching health information found on the Internet for people interested in this topic across the United States. Why should the massive online open course (MOOC) be used for this program?

A) Costs less to attend B) Uses a traditional learning approach C) Able to reach large groups of people D) Engages the learner with response technology Answer: C Explanation: A) There are no data to support that a MOOC costs less.

B) The learning approach for a MOOC is not identified.

C) MOOC are best defined as online courses intended to accommodate, with open and free access, an unlimited number of participants. It is thought that the role of the MOOC is to support lifelong or networked types of learning and to reach large groups of like-minded individuals.

Having access to the Internet is the only prerequisite for someone to be able to sign-up and participate.

D) Interactive technology is not identified as being a part of a MOOC. Page Ref: 347 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: VIII.13. Articulate the value of pursuing practice excellence, lifelong learning and professional engagement to foster professional growth and development | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Identify a variety of appropriate information-technology resources for educators.

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4) A school of nursing is using a virtual learning environment (VLE) that uses the Internet to assist faculty in developing, managing, and administering educational materials for students.

Which type of nursing education content is least suited for a VLE alone?

A) A program reviewing assessment of heart and lung sounds B) A refresher program on various types of injection administration skills C) A program reviewing drug calculations and dosages for medication administration D) A program reviewing documentation for an electronic medical record Answer: B Explanation: A) Observing how to assess is a valid topic for VLE. B) Clinical simulations in second life are challenging because actual hands-on skills are not possible.

C) Reviewing drug calculations and dosages for medication administration is a valid topic for VLE. D) Reviewing electronic medical records documentation is a valid topic for VLE. Page Ref: 359 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: VIII.13. Articulate the value of pursuing practice excellence, lifelong learning and professional engagement to foster professional growth and development | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Discuss ways that informatics may be used to support and improve nursing education in academic and clinical locations.

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5) Virtual Learning Environments (VLEs) are used more in the classroom as a learning tool for student nurses. Which should the instructor keep in mind when preparing to use the VLE with a new group of students?

A) Allowing learners to practice new skills without fear of harm to themselves or others B) Difficulty navigating in a classroom setting C) Difficulty creating measurable objectives for its use D) Intimidating to contemporary student nurses Answer: A Explanation: A) VLEs provide consistent instruction in a safe environment, thereby allowing learners to practice new skills without fear of harm to themselves or others.

B) VLEs are becoming more user-friendly with the benefits outweighing the time spent learning how to incorporate the simulation in a classroom setting.

C) Faculty can create measurable objectives for any learning activity.

D) Today's student nurses have been working with computers and simulations since preschool.

The students are comfortable with this technology.

Page Ref: 355 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: VIII.13. Articulate the value of pursuing practice excellence, lifelong learning and professional engagement to foster professional growth and development | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Discuss ways that informatics may be used to support and improve nursing education in academic and clinical locations.

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6) The instructor wants to assist the students in studying for the upcoming NCLEX examination.

In which way should the instructor consider using Twitter to support the students' learning?

A) Tweet a countdown of the number of days until the exam.

B) Retweet a comment made by someone who took the exam and failed.

C) Post a meme that shows a student sitting at a computer taking the test.

D) Tweet a question with a hashtag and have the students comment the correct answer.

Answer: D Explanation: A) Counting down the number of days until the exam does not support learning.

This will create stress.

B) Retweeting a comment about someone failing the test is not motivating to the students.

C) Posting a meme does not support student education.

D) Using 280 characters to post a question and have the students comment with the responses encourages participation and learning.

Page Ref: 349 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: VIII.13. Articulate the value of pursuing practice excellence, lifelong learning and professional engagement to foster professional growth and development | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Discuss ways that informatics may be used to support and improve nursing education in academic and clinical locations.

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7) The school of nursing installs an audience response system (ARS) in the major auditoriums used for classroom instruction. Which statement best describes the use of a clicker with this type of system?

A) A clicker is a handheld device that beams responses from a group of students to specific, realtime questions projected overhead to a receiver on the instructor's computer, which transforms the data into a chart detailing the responses.

B) A clicker beams information to the class about a current event.

C) A clicker is not useful in measuring knowledge.

D) A clicker is not a valuable educational tool.

Answer: A Explanation: A) A clicker is a handheld device that beams responses from a group of students to specific, real-time questions projected overhead to a receiver on the instructor's computer, which transforms the data into a chart detailing the responses.

B) A clicker is not used to share information about a current event.

C) A clicker is used to measure knowledge.

D) A clicker is a tool with an ARS, although other approaches such as using laptops and smartphones can produce the same information in real time.

Page Ref: 351 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: VIII.13. Articulate the value of pursuing practice excellence, lifelong learning and professional engagement to foster professional growth and development | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Implementation/Teaching and Learning Learning Outcome: Promote learning through research, innovative strategies, and development, with a focus on student learning, supported by information technology.

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8) A school of nursing learns that an outbreak of influenza has occurred at an organization that will affect the way the students arrive, prepare, and use personal protective equipment during clinical. Which approach should the instructor use to prepare the students for participating in clinical the next day?

A) Email B) Video podcast C) Twitter comment D) Public service announcement Answer: B Explanation: A) An email does not provide the opportunity to demonstrate the use of protective personal equipment.

B) The video podcast is a consideration when an audio file is insufficient for presenting a topic that would be better explained using video in addition to the audio. These files are shared over the Internet in the form of a recorded lecture (with or without video), or an informational discussion, and students are then able to access them using their smartphones, computers, or tablets. Video podcasting is very similar to what is found on YouTube, which includes both audio and video. Podcasts alone are also an excellent way for faculty to notify students of emergency situations and would support the need to review and demonstrate the use of personal protective equipment before the next clinical day.

C) A Tweet has 280 characters, which is not sufficient to communicate the issue with the students.

D) A public service announcement is not a type of technology used for learning.

Page Ref: 352 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: VIII.13. Articulate the value of pursuing practice excellence, lifelong learning and professional engagement to foster professional growth and development | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Promote learning through research, innovative strategies, and development, with a focus on student learning, supported by information technology.

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9) The instructor in a school of nursing needs to adjust the students' activities for the next few days and desires to communicate the changes and provide the students with an opportunity to ask questions and provide feedback. Which platform should the instructor consider using for this issue?

A) Twitter B) Facebook C) Audio podcast D) Video podcast Answer: B Explanation: A) Twitter is limited to 280 characters, which may not be sufficient for the issue.

B) Facebook is ideal for this situation. The instructor can post the changes, and the students can respond through comments. The instructor can provide individualized feedback to the comments.

C) An audio podcast is recorded and does not provide a mechanism for asking questions or providing feedback.

D) A video podcast is recorded and does not provide a mechanism for asking questions or providing feedback.

Page Ref: 349 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: VIII.13. Articulate the value of pursuing practice excellence, lifelong learning and professional engagement to foster professional growth and development | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Implementation/Teaching and Learning Learning Outcome: Promote learning through research, innovative strategies, and development, with a focus on student learning, supported by information technology.

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10) More schools of nursing are using virtual learning environments (VLEs) to teach students.

Which is an advantage to VLEs? Select all that apply.

A) Learners can proceed at a pace conducive to comprehension.

B) Learning is offered at any site that has computer access.

C) Learners can skim through familiar content and focus on weak areas.

D) The risk of harm to the patient is increased.

E) Instruction is consistent and in a safe environment.

Answer: A, B, C, E Explanation: A) VLEs can be self-paced to support learning.

B) VLEs are flexible and can be accessed through computer software.

C) VLEs provide the student with options to support individual learning needs.

D) VLEs provide an avenue for feedback and improve decision making without risking a patient's life or health.

E) VLE instruction is consistent, and the environment is safe.

Page Ref: 355 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: VIII.13. Articulate the value of pursuing practice excellence, lifelong learning and professional engagement to foster professional growth and development | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Implementation/Teaching and Learning Learning Outcome: Promote learning through research, innovative strategies, and development, with a focus on student learning, supported by information technology.

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11) The school of nursing is researching applicable devices to use in classrooms to facilitate learning. Which approach should be considered?

A) Personal digital assistants B) Cell phones C) Audience response systems (ARS) D) Laptop computers Answer: C Explanation: A) Personal digital assistants, or PDAs, are outdated.

B) Smartphone technology has become increasingly more sophisticated; however, instructors are using clickers, or audience response systems, to identify student knowledge base during classroom activities.

C) Audience response systems are increasingly being deployed to facilitate learning through the use of handheld transmitters. This hardware and software makes use of a "clicker" that beams information showing the responses from a group of students to specific, real-time questions projected overhead to a receiver on the instructor's computer, which transforms the data into a chart detailing the responses. Some ARS systems work using other mobile devices, such as student cell phones, tablets, or laptops.

D) Laptops are considered part of the learning process. However, clickers, or audience response systems, are more interactive in a classroom and help the instructor to identify successful learning.

Page Ref: 351 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: VIII.13. Articulate the value of pursuing practice excellence, lifelong learning and professional engagement to foster professional growth and development | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Assessment/Teaching and Learning Learning Outcome: Promote learning through research, innovative strategies, and development, with a focus on student learning, supported by information technology.

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12) The instructor wants to create a learning experience in a 3-D virtual learning environment (VLE) where the students can practice assessing a patient with a mental health disorder. Which learning category should the instructor use for this experience?

A) Building/Creating B) Exploring/Experiencing C) Role Play and Simulation D) Communicating/Collaborating Answer: C Explanation: A) Building/Creating is the area where the students would design plans, posters, or actual structures.

B) Exploring/Experiencing is the area where the students would have an opportunity to "go" somewhere else to learn or observe.

C) Role Play and Simulation is ideal for students to practice interviewing patients in a safe environment.

D) Communicating/Collaborating is the area where the students and instructor discuss activities, clinical plans, and conduct meetings.

Page Ref: 359 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: VIII.13. Articulate the value of pursuing practice excellence, lifelong learning and professional engagement to foster professional growth and development | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Promote learning through research, innovative strategies, and development, with a focus on student learning, supported by information technology.

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13) The instructor plans to evaluate learning outcomes for a group of students who spent the last several weeks using a 3-D virtual learning environment (VLE). Which approach should the instructor use to for this evaluation?

A) Online quiz B) Audience response system (ARS) C) Questions through Survey Monkey D) Course examination and student paper Answer: D Explanation: A) An online quiz might not be sufficient to measure learning outcomes.

B) An ARS tests knowledge during a lecture or presentation.

C) Survey Monkey is limited and may not be appropriate to test learning outcomes.

D) When a 3-D VLE is used within a course, examinations, projects, and student papers can be used to assess whether students meet course or unit objectives and to compare 3-D VLE versus onsite sections of a course.

Page Ref: 360 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: VIII.13. Articulate the value of pursuing practice excellence, lifelong learning and professional engagement to foster professional growth and development | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Implementation/Teaching and Learning Learning Outcome: Evaluate the impact of information technology on student engagement and teaching effectiveness.

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14) A school of nursing uses high-fidelity simulation for clinical experiences and skill learning.

Which approach should the instructors use to evaluate student performance?

A) Pen-and-paper test B) Student return demonstration C) Video capture of the simulation D) Verbal discussion of the activity Answer: C Explanation: A) Pen-and-paper tests are not identified as a method to evaluate student performance after using a high-fidelity simulation.

B) Student return demonstration is not identified as a method to evaluate student performance after using a high-fidelity simulation.

C) Video capture of the simulation lets educators review student performance multiple times and make more accurate assessments, especially during high-stakes scenarios. Students may review their actions on video to promote self-critique.

D) Oral debriefing is one option; however, it is not identified as the preferred method.

Page Ref: 361 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: VIII.13. Articulate the value of pursuing practice excellence, lifelong learning and professional engagement to foster professional growth and development | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Evaluation/Teaching and Learning Learning Outcome: Evaluate the impact of information technology on student engagement and teaching effectiveness.

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15) The school of nursing uses the process of debriefing after simulations as a method of evaluating learning. Which must occur for this method to be valid and effective?

A) Completed by a member of the student's peer group B) Calculated against the student's test scores and papers C) Conducted by a person who was attentive during the simulation D) Correlated with the student's opinion of the virtual learning environment Answer: C Explanation: A) A peer is not the person to conduct an evaluation of performance after a simulation.

B) Debriefing does not use test scores and student papers to evaluate learning.

C) Debriefing must be conducted in a supportive learning environment by a competent person who was attentive during the simulation. The information shared during the debriefing should be based on a theoretical framework and align with the simulation's objectives and outcomes.

D) The student's opinion of the simulation is not a part of debriefing.

Page Ref: 361 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.1. Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills | AACN Essential Competencies: VIII.13. Articulate the value of pursuing practice excellence, lifelong learning and professional engagement to foster professional growth and development | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Evaluation/Teaching and Learning Learning Outcome: Evaluate the impact of information technology on student engagement and teaching effectiveness.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 18 Consumer Health Informatics 1) The informatics nurse is reading an article that focuses on a field within health informatics devoted to the consumer, or patient, view. What is the nurse reading about?

A) Electronic patient portal B) Personal health record C) Patient education system D) Consumer health informatics Answer: D Explanation: A) An electronic patient portal is an application for a patient to review health information. It is not a field within health informatics.

B) A personal health record is a log of all pertinent health information collected by the patient. It is not a field within health informatics.

C) A patient education system is an application where materials to support health information are stored. It is not a field within health informatics.

D) Consumer health informatics (CHI) is a field within health informatics devoted to the consumer, or patient, view. CHI concentrates on the information structures and processes that empower consumers to manage their own health.

Page Ref: 370 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.6. Describe strategies to empower patients or families in all aspects of the health care process | AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Distinguish between consumer health informatics and other subspecialties of healthcare informatics.

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2) A patient asks for help locating information on the Internet about specific medications to treat a health problem. Which individual is best prepared to assist this patient?

A) Data manager B) Informatics nurse C) Systems technician D) Computer programmer Answer: B Explanation: A) The data manager focuses on the information within a clinical information system.

B) The informatics nurse is best prepared to assist the patient in searching for information that is appropriate and valid for a specific health problem.

C) A systems technician ensures that the computer system is functioning at the optimal level.

D) A computer programmer ensures that the software within a computer system is functioning correctly.

Page Ref: 387 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.6. Describe strategies to empower patients or families in all aspects of the health care process | AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Distinguish between consumer health informatics and other subspecialties of healthcare informatics.

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3) The informatics nurse is working with a lobbyist on healthcare reform. Which information should the nurse emphasize as a critical factor to achieve successful healthcare outcomes?

A) Smartphones B) Cost containment C) Patient engagement D) Easy-to-use applications Answer: C Explanation: A) Smartphones are not identified as a critical factor to achieve successful healthcare outcomes.

B) Cost containment is not identified as a critical factor to achieve successful healthcare outcomes.

C) A series of reports from the Institute of Medicine, including Best Care at Lower Cost, called for patient engagement as key to US healthcare system reform. Engaged consumers are a critical factor in achieving successful healthcare outcomes.

D) Easy-to-use applications are not identified as critical factors to achieving successful healthcare outcomes.

Page Ref: 372 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.6. Describe strategies to empower patients or families in all aspects of the health care process | AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Recognize driving factors behind the development of consumer health informatics.

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4) A large healthcare organization is preparing a major marketing initiative to target consumers of health information. Which driving force caused the organization to prepare this marketing plan? Select all that apply.

A) Meaningful use B) eHealth Initiative C) Online health communities D) Reduced cost for computers E) Patient-centered medical homes Answer: A, B, C, E Explanation: A) Federal initiatives within the United States, such as meaningful use, provide incentives for the development of electronic patient portals to improve data sharing and communication with healthcare consumers, with the idea that access will help to educate and empower consumers.

B) The push for healthcare consumer empowerment comes from groups, such as eHealth Initiative, which draw membership from executives across the healthcare-delivery industry committed to reforming the system.

C) The reduced cost for computers is not identified as a driving force for targeting consumers of health information.

D) Online health communities help drive the further development of consumer health information.

E) Federal initiatives within the United States, such as patient-centered medical homes, provide incentives for the development of electronic patient portals to improve data sharing and communication with healthcare consumers, with the idea that access will help to educate and empower consumers.

Page Ref: 372 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.6. Describe strategies to empower patients or families in all aspects of the health care process | AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Recognize driving factors behind the development of consumer health informatics.

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5) With the growth of consumer informatics, concerns have emerged that has alarmed the informatics nurse. Which is one of the issues associated with health-information-related websites?

A) Abundance of websites B) Number of inaccurate websites C) Increase in websites uploaded by nonprofit societies D) Websites related to illness advice Answer: B Explanation: A) There is not any concern about the number of websites.

B) Although it is agreed that the Internet provides easier access to information, clinicians express concern that poor quality information can undermine informed decision making. Mounting concerns about quality, timeliness, and potential misinterpretation of online information have driven the development of a national and international quality standards agenda to help professionals and consumers alike access and evaluate online health information that is accurate, current, valid, appropriate, intelligible, and free of bias.

C) There is not any concern about the number of websites supported by nonprofit societies.

D) There are is not any concern about websites that focus on illness advice.

Page Ref: 374 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.6. Describe strategies to empower patients or families in all aspects of the health care process | AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss issues associated with consumer health informatics that can negatively impact access to care or ability to self-manage care.

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6) Consumers have access to a wide range of resources that have the potential for informing their healthcare decisions. Which is impacted the most because of these resources?

A) Understanding how electronic health records work B) Developing a cryptic password C) Upgrading personal software D) Self-care Answer: D Explanation: A) The use of resources to aid in healthcare decisions does not impact understanding how electronic health records work.

B) The use of resources to aid in healthcare decisions does not impact creating a password.

C) The use of resources to aid in healthcare decisions does not impact the upgrading of personal software.

D) Consumers have access to a wide range of resources that have the potential to inform their healthcare decisions and thus promote a greater responsibility for self-care.

Page Ref: 374 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.6. Describe strategies to empower patients or families in all aspects of the health care process | AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Discuss issues associated with consumer health informatics that can negatively impact access to care or ability to self-manage care.

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7) The informatics nurse is preparing an educational seminar about consumer use of electronic information. Which statement should the nurse include about consumer informatics?

A) About one-half of all American adults use online resources to locate personal health information.

B) The most trusted websites are not associated with the federal government.

C) Knowledge of technology is not essential in finding quality information.

D) Standards are unnecessary and unattainable in consumer informatics.

Answer: A Explanation: A) Results from the 2011 National Health Interview Study reported that approximately one-half of the participants used chat rooms or Internet searches to locate health information online.

B) The most trusted online healthcare resources have been found to be associated medical schools, medical centers, and federal government websites.

C) Evaluating the quality of online health information requires literacy skills that are grounded in knowledge about technology and health.

D) Quality standards need to be in place to prevent the propagation of inaccurate or outdated online health information.

Page Ref: 374 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.6. Describe strategies to empower patients or families in all aspects of the health care process | AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Examine ways that consumer health informatics is changing how health advice and care are sought and delivered.

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8) A healthcare provider is frustrated because so many patients access the Internet for healthrelated information, but changes in health status do not occur. Which should the informatics nurse explain to the provider?

A) The patients are not accessing valid information.

B) The information is not what the patient wants to learn.

C) The patients need motivation and willingness to change their behavior.

D) The patients are spending too much time playing games on their computers.

Answer: C Explanation: A) There is no evidence that the patients are accessing invalid information.

B) There is no evidence that the information is not what the patients want to learn.

C) High levels of health literacy can enable informed decision making, but motivation and willingness to change behavior must also be present.

D) There is no evidence that the patients are distracted with entertainment while on the Internet.

Page Ref: 374 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.6. Describe strategies to empower patients or families in all aspects of the health care process | AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Examine ways that consumer health informatics is changing how health advice and care are sought and delivered.

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9) The informatics nurse is reviewing consumer health informatics applications for a healthcare organization. Which applications should the nurse include as being used by consumers? Select all that apply.

A) Personal health records (PHR) B) Home telehealth monitoring C) System software D) Social media E) mHealth Answer: A, B, D, E Explanation: A) The PHR allows users to electronically collect, track, and share past and current information about their health or that of someone in their care.

B) The concept of home monitoring is part of connected health–the blending of healthcare with technology at the level of the home. The types of home monitoring options are on the rise. In addition to monitoring chronic conditions, such as congestive heart failure, cardiac arrhythmias, high blood pressure, diabetes, and sleep disorders, there is a growing focus upon devices that support aging in place.

C) System software is designed to operate hardware.

D) Social media, or social networking, encompasses a variety of forms from sites such as Facebook, Twitter, YouTube, and blogs, to Internet-based support groups.

E) mHealth is the use of wireless devices and sensor networks to access healthcare information or services from the community, or to transmit healthcare information to healthcare professionals.

Page Ref: 377 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.6. Describe strategies to empower patients or families in all aspects of the health care process | AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Distinguish key features, advantages, and disadvantages of various consumer health informatics applications.

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10) A group of healthcare providers are advocating the use of wearable devices for select patients with chronic illnesses. In which way will the patients' smartphones support these devices? Select all that apply.

A) Action plans B) Web portal access C) Personalize diaries D) Wean off of the devices E) Automated system reminders Answer: A, B, C, E Explanation: A) mHealth technology is ideal for healthcare consumers and professionals who are accustomed to using technology while on the go. It is particularly well-suited for adolescents and teens with chronic illness such as asthma. Smartphone technology can support action plans.

B) mHealth technology is ideal for healthcare consumers and professionals who are accustomed to using technology while on the go. It is particularly well-suited for adolescents and teens with chronic illness such as asthma. Smartphone technology can support web portal access.

C) mHealth technology is ideal for healthcare consumers and professionals who are accustomed to using technology while on the go. It is particularly well-suited for adolescents and teens with chronic illness such as asthma. Smartphone technology can support personalized diaries.

D) The technology is not used to wean the patient off of the device.

E) mHealth technology is ideal for healthcare consumers and professionals who are accustomed to using technology while on the go. It is particularly well-suited for adolescents and teens with chronic illness such as asthma. Smartphone technology can support automated system reminders.

Page Ref: 380 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.6. Describe strategies to empower patients or families in all aspects of the health care process | AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Distinguish key features, advantages, and disadvantages of various consumer health informatics applications.

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11) An increasing amount of healthcare information is on the Internet, ; however, not all the websites are accurate or have updated information. What should the informatics nurse instruct the healthcare consumer to do?

A) Discuss healthcare information found on the Internet with friends and neighbors.

B) Consider anything published online to be accurate.

C) Understand that any website published within the last 5 years is up to date.

D) Evaluate the website's credibility through a careful analysis of the content's accuracy.

Answer: D Explanation: A) Discussing the information with friends and neighbors will not improve the accuracy of the information.

B) Everything published online is not accurate or valid.

C) Information published within 5 years can be outdated, depending upon the health problem or medication.

D) With the proliferation of data on the Internet, especially health related, the consumer must be aware of the legitimacy and accuracy of content. Through a careful analysis of data, an individual can determine whether the content is to be believed and acted upon in terms of healthy lifestyle and treatment decisions.

Page Ref: 371 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.6. Describe strategies to empower patients or families in all aspects of the health care process | AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Implementation/Teaching and Learning Learning Outcome: Provide recommendations for consumer evaluation of online information.

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12) The informatics nurse is preparing an educational program about the digital divide. In which way can healthcare professionals close this divide?

A) Provide online healthcare resources that are equally distributed.

B) Provide the technology needed to access the Internet.

C) Provide additional resources in regions that do not have access to technology.

D) Provide increased access to free healthcare clinics with computer terminals.

Answer: A Explanation: A) Equitably distributed online healthcare resources, skill in using these resources, and a robust telecommunications infrastructure can contribute to the closing of the digital divide.

B) Providing the technology to access the Internet will not bridge the digital divide.

C) Providing resources in regions that do not have access to technology will not necessarily close the digital divide.

D) Providing computer terminals in free healthcare clinics is not identified as an action to close the digital divide.

Page Ref: 375 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.6. Describe strategies to empower patients or families in all aspects of the health care process | AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Implementation/Teaching and Learning Learning Outcome: Provide recommendations for consumer evaluation of online information.

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13) The role of the informatics nurse has broadened over the past several years. Which are specialty roles for this nurse? Select all that apply.

A) Educator B) Advocate C) Researcher D) Designer E) Leader Answer: A, B, C, D Explanation: A) The informaticist can specialize as an educator on the use of consumer informatics in healthcare delivery.

B) The informaticist can specialize as an advocate for the use of consumer informatics in healthcare delivery.

C) The informaticist can specialize as a researcher in the use of consumer informatics in healthcare delivery.

D) The informaticist can specialize as a designer of consumer informatics in healthcare delivery.

E) Leader is not identified as a specialty role for the informatics nurse.

Page Ref: 385 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.6. Describe strategies to empower patients or families in all aspects of the health care process | AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Examine the informaticist role in the design, adoption, and use of consumer health informatics applications.

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14) The informatics nurse is researching consumer health information for a community health fair. Which criteria should the nurse use to assess this information before sharing with the health fair participants? Select all that apply.

A) Cost B) Impact C) Citation D) Readability E) Comprehensibility Answer: B, C, D, E Explanation: A) Consumer health information does not need to be reviewed for cost.

B) One assessment criteria for consumer health information is impact or the scholarly prestige of the journal in which the material is published.

C) One assessment criteria for consumer health information is citation or the cited sources for the material.

D) One assessment criteria for consumer health information is readability or if the terms in the material are written with good definitions that are understandable.

E) One assessment criteria for consumer health information is comprehensibility or the material is understandable by the lay public.

Page Ref: 388 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.6. Describe strategies to empower patients or families in all aspects of the health care process | AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Examine the informaticist role in the design, adoption, and use of consumer health informatics applications.

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15) The informatics nurse is concerned that a population of consumers does not participate in consumer health information (CHI). What needs to be done to improve accessing this information? Select all that apply.

A) Address literacy issues.

B) Access personal health records.

C) Improve generational knowledge.

D) Remove inequities when accessing technology.

E) Encourage participation in virtual communities.

Answer: A, C, D Explanation: A) CHI enables consumers to partner with providers in their care. Even so, more must be done to address literacy issues to enable consumers that who want to be a part of their own healthcare team realize that capability.

B) Accessing personal health records is an advantage of using CHI. C) CHI enables consumers to partner with providers in their care. Even so, more must be done to remove inequities in generational knowledge to enable consumers who want to be a part of their own healthcare team realize that capability.

D) CHI enables consumers to partner with providers in their care. Even so, more must be done to remove inequities in technology access to enable consumers who want to be a part of their own healthcare team realize that capability.

E) Participating in virtual communities is an advantage of using CHI. Page Ref: 389 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.6. Describe strategies to empower patients or families in all aspects of the health care process | AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Explore future directions for consumer health informatics.

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16) The informatics nurse attends a presentation about a smart home. In which way should this type of home support independence for older adults? Select all that apply.

A) Monitor for falls B) Monitor vital signs C) Examine sleep habits D) Monitor for poor eating E) Provide medication reminders Answer: A, C, D Explanation: A) The use of emerging technology in "smart homes, " where unobtrusive sensors can allow monitoring of safety issues, such as falls in the home setting, will afford greater independence for older adults.

B) Wearable devices and home monitoring equipment are used to monitor vital signs.

C) The use of emerging technology in "smart homes, " where unobtrusive sensors can allow monitoring of safety issues, such as changes in sleep habits in the home setting, will afford greater independence for older adults.

D) The use of emerging technology in "smart homes, " where unobtrusive sensors can allow monitoring of safety issues, such as monitoring for poor eating in the home setting, will afford greater independence for older adults.

E) Smartphone applications provide medication reminders.

Page Ref: 389 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.6. Describe strategies to empower patients or families in all aspects of the health care process | AACN Essential Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship Centered Care | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Explore future directions for consumer health informatics.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 19 Connected Healthcare (Telehealth and Technology-Enabled Healthcare) 1) The informatics nurse is preparing a teaching tool about telehealth. What information should be included regarding this type of connected health?

A) Access to care may be delayed until the proper equipment can be delivered to the patient's home.

B) Patients must travel to special on-site locations where equipment and telecommunication devices are available.

C) Nurse practitioner services may be reduced because physicians can assess and treat patients themselves.

D) Patients may stay within their own community to be assessed and treated, lowering potential costs.

Answer: D Explanation: A) Patients may or may not have equipment at home with which they may transmit information, but access to care would not be delayed just because the equipment had not yet been delivered.

B) Telehealth reduces the need for patients to travel to on-site locations.

C) Nurse practitioner services may actually be extended because of physician availability as resources.

D) Tangible benefits of connected health are realized by the creation of revenue streams through expansion of services to reach patients in remote locations or for consultation services.

Page Ref: 402 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.2. Value technologies that support clinical decisionmaking, error prevention, and care coordination | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Define common terminology associated with connected health and the delivery of telehealth.

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2) A healthcare provider is talking with a patient over the computer, observing a skin rash, and reviewing vital signs measured and transmitted. Which type of technology is being used for this patient's care?

A) Blended B) Smart home C) Synchronous D) Asynchronous Answer: C Explanation: A) Blended is not a type of connected technology.

B) Smart homes are dwellings integrated with sensors and actuators intended to monitor the resident and improve their home experience.

C) Synchronous connected health applications facilitate interactive, real-time, video, and voice interaction and bidirectional communication between patients and healthcare providers.

D) Asynchronous monitoring occurs when patient data are collected and specific questions are answered in order to stratify the patient according to risk.

Page Ref: 404 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.2. Value technologies that support clinical decisionmaking, error prevention, and care coordination | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Define common terminology associated with connected health and the delivery of telehealth.

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3) The informatics nurse is reviewing the areas in which connected health is most likely to be used. Which area would have limited connected health opportunities for nurses?

A) A small community hospital in an urban setting in the Northeast B) A battlefield in a third-world country for the treatment of casualties C) A space shuttle voyage during orbit around the earth D) A prison infirmary to care for state inmates Answer: A Explanation: A) Hospitals in urban settings can communication quickly with other healthcare providers and organizations.

B) A battlefield in a third-world country would benefit from connected health because it would be difficult to reach or have acutely injured patients.

C) A space shuttle would use connected health because it would be difficult to reach the astronaut to provide direct care.

D) A prison infirmary would be appropriate for connected health because of the location of the facility and potentially problematic patients.

Page Ref: 404 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.2. Value technologies that support clinical decisionmaking, error prevention, and care coordination | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Identify the historical milestones and driving forces of technology-enabled healthcare.

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4) The informatics nurse is on a committee that is considering connected health as a tool to improve the quality of healthcare and save money. In which way will this care delivery approach save money for a healthcare organization? Select all that apply.

A) Follow-up care is more convenient.

B) Access to care improves.

C) Physician services are provided.

D) Clients may be treated in their own community.

E) Quality of care improves.

Answer: A, B, D, E Explanation: A) Convenient follow-up improves continuity of care.

B) Improved access to care allows patients to be treated earlier when fewer interventions are required.

C) Extending the services of nurse practitioners (and physician assistants) through ready accessibility to physician services saves on costs.

D) Patients may receive treatment in their own community where services cost less.

E) Convenient follow-up improves continuity of care.

Page Ref: 402 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.2. Value technologies that support clinical decisionmaking, error prevention, and care coordination | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Identify the historical milestones and driving forces of technology-enabled healthcare.

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5) The informatics nurse is reviewing asynchronous technology used for connected care. Which type of patient information is least suited for "store-and-forward" technology?

A) A patient's biopsy sample is digitally photographed and transmitted electronically to the pathology lab.

B) A patient with increasing symptoms of heart failure is instructed to come to the clinic for a stat chest x-ray (CXR).

C) A patient's electroencephalogram (EEG) and brain scan are transmitted to the consulting surgeon to follow up a craniotomy 2 months ago.

D) A patient with chronic asthma comes to the clinic for a routine chest x-ray (CXR).

Answer: B Explanation: A) Store-and-forward is used to transfer digital images and data from one location to another and is appropriate for nonemergent situations, such as a biopsy sample.

B) Store-and-forward technology is least suited for emergent, unstable clients, such as a patient with heart failure.

C) Store-and-forward is used to transfer digital images and data from one location to another and is appropriate for nonemergent situations, such as a follow-up EEG. D) Store-and-forward is used to transfer digital images and data from one location to another and is appropriate for nonemergent situations, such as an asthma patient with a routine CXR. Page Ref: 408 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.2. Value technologies that support clinical decisionmaking, error prevention, and care coordination | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Distinguish the delivery modalities and associated technology for telehealth.

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6) The informatics nurse is asked to prepare an educational offering about telenursing. Which should the nurse use as the best definition for this type of connected care?

A) The synthesis of nursing and information systems B) The synthesis of nursing and telecommunications and information technology C) The synthesis of healthcare and telecommunications D) The synthesis of nursing and communication technology Answer: B Explanation: A) Telenursing is the use of telecommunications and information technology for the delivery of nursing care.

B) Nurses engaged in telenursing practice continue to assess, plan, intervene, and evaluate the outcomes of nursing care, but they do so using technologies such as the Internet, computers, telephones, digital assessment tools, and telemonitoring equipment.

C) Telenursing is the use of telecommunications and information technology for the delivery of nursing care.

D) Telenursing is the use of telecommunications and information technology for the delivery of nursing care.

Page Ref: 403 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.2. Value technologies that support clinical decisionmaking, error prevention, and care coordination | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Distinguish the delivery modalities and associated technology for telehealth.

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7) The informatics nurse is on a committee that is designing the patient criteria for connected care. Which should be kept in mind when determining inclusion and exclusion criteria?

A) Almost all patients can be included.

B) Psychiatric patients are to be excluded.

C) Only patients with chronic illnesses should be excluded.

D) All patients should be evaluated on a case-by-case basis.

Answer: D Explanation: A) Each patient should be evaluated for connected care.

B) Stable psychiatric patients can be included.

C) Connected care is ideal for patients with stable chronic health problems.

D) All patients should be evaluated on a case-by-case basis with the knowledge that connected health will not be an appropriate option for all patients.

Page Ref: 409 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.2. Value technologies that support clinical decisionmaking, error prevention, and care coordination | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Determine key safety, legal, and ethical considerations for practitioners engaged in delivery of care via telehealth.

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8) A healthcare organization is planning to implement connected care. Which legal issues need to be addressed before this care delivery approach can be used? Select all that apply.

A) Online prescribing B) Malpractice liability C) Use of computer software D) Credentialing and privileging E) Licensing of healthcare professionals Answer: A, B, D, E Explanation: A) Online prescribing policies vary across the states. Concerns have arisen over the determination of established patient-provider relationships, accuracy of the patient's history given the self-reporting aspect of connected health, and not meeting state medical-board licensing requirements.

B) Questions of medical liability increase amid a lack of information on existing malpractice liability within connected health.

C) The use of computer software is not a legal issue with connected care.

D) Connected-health technologies have created challenges to healthcare organizations that wish to access medical specialties using the platform. Advances have been made through the Centers for Medicare and Medicaid Services (CMS) and the establishment of a new process to credential and privilege providers. Unfortunately, the process conflicts with established policy in many states.

E) Consultations occurring over great distances require consideration of varied policies governing connected health and physician licensure. Cross-border delivery of healthcare is banned entirely in some states.

Page Ref: 411 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: I.A.7. Explore ethical and legal implications of patientcentered care | AACN Essential Competencies: VIII.12. Act to prevent unsafe, illegal or unethical care practices | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Determine key safety, legal, and ethical considerations for practitioners engaged in delivery of care via telehealth.

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9) A healthcare organization is implementing connected care. Which situation best fits the use of this delivery system?

A) Chronic congestive heart failure patients are assessed in rural clinics using telecommunication technology and are given instructions on how to best manage their care.

B) Patients may sign up with a telehealth provider, who provides health promotion information and activities.

C) Continuing education courses for healthcare professionals are provided to the education department of acute-care institutions for continuing education credits.

D) A physician consultant receives an x-ray, CT scan, and EKG via the telecommunication network to manage the care of a client with congestive heart failure and diabetes.

Answer: A Explanation: A) Patients with chronic conditions are best suited for connected care.

B) Telehealth services include health promotion, disease prevention, diagnosis, consultation, education, and therapy.

C) Telehealth services include health promotion, disease prevention, diagnosis, consultation, education, and therapy.

D) Telehealth utilizes telecommunication technologies and computers to exchange healthcare information and to provide services to clients at another location.

Page Ref: 409 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.2. Value technologies that support clinical decisionmaking, error prevention, and care coordination | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Identify critical patient-safety factors and quality indicators for healthcare delivered via telehealth.

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10) The informatics nurse is working with the directory of a home care agency to identify patients appropriate to receive connected care. Which client is least suited for this type of care?

A) A 63-year-old man with a large pressure ulcer who requires daily wound assessments and dressing B) A 54-year-old client with congestive heart failure who is developing new onset chest pain C) A 77-year-old client who requires glucose monitoring and daily foot ulcer assessment D) A 49-year-old woman who is pregnant for the first time and requires fetal heart rate monitoring Answer: B Explanation: A) Stable clients who must be watched closely are potential candidates, such as the patient with a large pressure ulcer.

B) The patient with congestive heart failure and developing chest pain is least suited for connected care. Patients with such emergent problems should not be monitored and treated electronically.

C) Stable patients who must be watched closely are potential candidates, such as the glucose monitoring client.

D) Stable patients who must be watched closely are potential candidates, such as the older woman pregnant for the first time.

Page Ref: 409 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.2. Value technologies that support clinical decisionmaking, error prevention, and care coordination | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Identify critical patient-safety factors and quality indicators for healthcare delivered via telehealth.

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11) Connected care has caused concern about the privacy of information as it crosses state lines.

Which statements can be considered a resolution by healthcare professionals?

A) Experts have called for the discontinuation of telehealth.

B) Experts have called for the creation of standards for ehealth, particularly for security and identity management.

C) Experts have enacted a number of bills stopping the growth of telehealth.

D) Experts have called for a limit in the number of telehealth patient encounters.

Answer: B Explanation: A) Experts have called for the creation of standards health, particularly for security and identity management.

B) Although telehealth should not create any greater concerns or risks to medical record privacy than any other form of consultation, records that cross state lines are subject to HIPAA regulations and state privacy laws. Security and confidentiality of telehealth services are crucial to acceptance by consumers and professionals. For this reason experts have called for the creation of standards for ehealth, particularly for security and identity management C) No bills have been enacted to stop the growth of telehealth.

D) There have been no calls to limit the number of telehealth patient encounters.

Page Ref: 410 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.2. Value technologies that support clinical decisionmaking, error prevention, and care coordination | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Determine standards for privacy and information security in connected health.

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12) Prior to beginning a connected care session, the nurse notes that several people are in the same room with the patient. What should the nurse do?

A) Continue with the session.

B) Ask the patient if it is acceptable for the session to occur.

C) Cancel the session and reschedule when the patient is alone.

D) Ask the patient to have all other people leave the environment.

Answer: B Explanation: A) The patient needs to be asked if the session can occur with others in the vicinity.

B) Prior to the start of the encounter, and after determining that the patient is appropriate for the scheduled service, the patient's environment should be scanned for any potential issues with privacy and confidentiality. The patient should be asked if it acceptable for the session to occur.

Patients should not proceed with a session if they feel privacy will be compromised at their point of care.

C) A session should not be automatically canceled before discussing the potential issue with privacy and confidentiality.

D) The patient may not want the other people to leave the environment. The nurse needs to assess what the patient would like based upon others being present.

Page Ref: 410 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.2. Value technologies that support clinical decisionmaking, error prevention, and care coordination | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Assessment/Communication and Documentation Learning Outcome: Determine standards for privacy and information security in connected health.

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13) The informatics nurse is assisting with the design of a telenursing department. Which should be prepared to ensure that care provided is evidence based?

A) Develop critical pathways.

B) Complete alpha testing on the software.

C) Select appropriate computer peripherals.

D) Hire nurses with advanced nursing degrees.

Answer: A Explanation: A) Clinical pathways are the identification and plotting of healthcare delivery in order to prevent variability that may lead to undesired results. These pathways are the route by which care is delivered in a standardized, consistent, and evidence-based environment. The informatics nurse specialist will help develop clinical pathways that provide for technologyenhanced care.

B) The informatics nurse may or may not participate in alpha testing of the software.

C) The informatics nurse would not be responsible for selecting computer peripherals.

D) The informatics nurse would not be hiring for the positions.

Page Ref: 412-413 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.2. Value technologies that support clinical decisionmaking, error prevention, and care coordination | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Identify the role of the informatics nurse specialist in the evidence-based practice and delivery of technology-enabled healthcare.

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14) The informatics nurse is drafting a proposal to support the implementation of connected health for a large hospital. What should the nurse identify as advantages of this delivery system?

Select all that apply.

A) Reduces readmission rates B) Improves health outcomes C) Provides clinical support D) Overcomes geographical barriers E) Uses various type of information and communication technologies Answer: B, C, D, E Explanation: A) Although a goal of connected care is to improve health outcomes, reducing readmission rates is not specifically identified.

B) A goal of connected health is to improve health outcomes.

C) Connected health provides clinical support to patients in locations that have limited available healthcare resources.

D) Connected health is intended to overcome geographical barriers.

E) Connected health uses various types of information and communication technologies.

Page Ref: 413 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.2. Value technologies that support clinical decisionmaking, error prevention, and care coordination | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Identify the role of the informatics nurse specialist in the evidence-based practice and delivery of technology-enabled healthcare.

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15) The leadership team is reviewing the proposal for equipment to support connected health.

Which should be used a guide when determining technical and infrastructure requirements?

A) Number of staff B) Location of the patients C) Patient population being contacted D) Type of services and equipment to be used Answer: D Explanation: A) The number of staff members is not used to determine the technical and infrastructure requirements for connected health.

B) The location of the patients is not used to determine the technical and infrastructure requirements for connected health.

C) The patient population being contacted is not used to determine the technical and infrastructure requirements for connected health.

D) Technical and infrastructure requirements are determined by the type of services and equipment to be utilized in the delivery of connected health.

Page Ref: 412 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.2. Value technologies that support clinical decisionmaking, error prevention, and care coordination | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Identify elements of the telehealth network infrastructure, technology selection, bandwidth requirements and utilization.

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16) A vendor is scheduled to provide a demonstration on equipment being considered for connected health. Which criteria should be available to support this care delivery approach?

Select all that apply.

A) Data dictionaries B) Technical support C) Access to broadband Internet D) Connect imaging technology E) Bandwidth to transmit health data Answer: B, C, D, E Explanation: A) Data dictionaries are not a part of the basic requirements for infrastructure, network, and equipment to support connected health.

B) Technical support is a basic requirement for infrastructure, network, and equipment to support connected health.

C) Access to broadband Internet is a basic requirement for infrastructure, network, and equipment to support connected health.

D) Ability to connect to imaging technology is a basic requirement for infrastructure, network, and equipment to support connected health.

E) Bandwidth that is sufficient to transmit health data is a basic requirement for infrastructure, network, and equipment to support connected health.

Page Ref: 412 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.2. Value technologies that support clinical decisionmaking, error prevention, and care coordination | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Identify elements of the telehealth network infrastructure, technology selection, bandwidth requirements and utilization.

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17) During a leadership team meeting, one member vetoes the implementation of connected health for the organization. Which response should be provided?

A) "It is a passing fad."

B) "It isn't a cost-effective method to provide care."

C) "The implementation costs outweigh the return on investment."

D) "It is expected to have explosive growth over the next 5 years."

Answer: D Explanation: A) Connected care is not a passing fad.

B) Connected care is a cost-effective method to provide care.

C) The implementation costs do not outweigh the return on investment for connected care.

D) The industry predicts explosive growth of connected-health programs over the next 5 years.

Page Ref: 414 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.2. Value technologies that support clinical decisionmaking, error prevention, and care coordination | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Implementation/Communication and Documentation Learning Outcome: Define key considerations for future applications of connected health.

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18) A healthcare organization has developed a 5-year plan for the implementation of connected care. Which should this plan include that addresses the expected growth in this care delivery approach? Select all that apply.

A) New digital platforms B) Advancement of biosensors C) Restrictions in reimbursement D) Innovation of wearable devices E) Refinement of current technology Answer: A, B, D, E Explanation: A) The industry predicts explosive growth of connected-health programs over the next 5 years. This growth is fueled by new digital platforms.

B) The industry predicts explosive growth of connected-health programs over the next 5 years.

This growth is fueled by advancement of biosensors.

C) The industry predicts explosive growth of connected-health programs over the next 5 years.

This growth is fueled by changes in healthcare legislation and reimbursement.

D) The industry predicts explosive growth of connected-health programs over the next 5 years.

This growth is fueled by innovations such as wearable devices.

E) The industry predicts explosive growth of connected-health programs over the next 5 years.

This growth is fueled by the refinement of current technology.

Page Ref: 414 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.C.2. Value technologies that support clinical decisionmaking, error prevention, and care coordination | AACN Essential Competencies: IV.2. Use telecommunication technologies to assist in effective communication in a variety of healthcare settings | NLN Competencies: Quality and Safety | Nursing/Integrated Concepts: Planning/Communication and Documentation Learning Outcome: Define key considerations for future applications of connected health.

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Handbook of Informatics for Nurses & Health Care Professionals, 6e (Hebda) Chapter 20 Public Health Informatics 1) The informatics nurse is preparing an educational program on the use of informatics to support public health needs. What should the nurse explain as the systematic application of information and computer science and technology to public health practice, research, and learning?

A) Public health nursing B) Public health practice C) Public health informatics D) Public health research Answer: C Explanation: A) Public health nursing is applying the nursing process to care issues that affect the public.

B) Public health practice is using methodologies and evidence to provide care that affects the public.

C) Public health informatics (PHI) is defined in several ways, but one of the most widely accepted definitions of PHI is he systematic application of information and computer science and technology to public health practice, research, and learning.

D) Public health research studies health concerns that affect the public.

Page Ref: 422 Cognitive Level: Applying Client Need & Sub: Health Promotion and Maintenance Standards: QSEN Competencies: VI.B.8. Use high quality electronic sources of healthcare information | AACN Essential Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Teaching and Learning Learning Outcome: Describe the domain and function of public health.

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2) The informatics nurse is discerning the principles applicable to public health informatics from those that support acute care environments. Which principle should the nurse question?

A) Promote the health of populations as opposed to the health of individuals.

B) Prevent disease and injury by altering the conditions or the environment putting populations at risk.

C) Reflect the private sector context in which public health is practiced.

D) Explore the potential for prevention of all vulnerable populations.

Answer: C Explanation: A) The basic mission of public health is to promote the health of populations, not the health of specific individuals.

B) The basic mission of public health is to alter the conditions of the environment that put populations at risk.

C) The basic mission of public health is to reflect the specific government context, not the private sector context, in which public health is practiced.

D) The basic mission of public health is to explore the potential for prevention for all vulnerable populations by exploring the causal chains leading to disease, injury, or disability.

Page Ref: 421 Cognitive Level: Applying Client Need & Sub: Health Promotion and Maintenance Standards: QSEN Competencies: VI.B.8. Use high quality electronic sources of healthcare information | AACN Essential Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Evaluation/Nursing Process Learning Outcome: Describe the domain and function of public health.

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3) The informatics nurse in public health needs the ability to improve health outcomes and make data-driven decisions within a new or existing health information infrastructure. What is needed to accomplish this goal?

A) Reliable databases B) A cogent plan of action C) Systems implementation D) Public health informatics Answer: A Explanation: A) The ability to improve health outcomes and make data-driven decisions within a new or existing health information infrastructure is critical. There is a clear need for valid and reliable databases.

B) The ability to improve health outcomes and make data-driven decisions within a new or existing health information infrastructure is critical. A plan of action is not identified as required.

C) The ability to improve health outcomes and make data-driven decisions within a new or existing health information infrastructure is critical. Systems implementation is not identified as required.

D) The ability to improve health outcomes and make data-driven decisions within a new or existing health information infrastructure is critical. This is the role of public health informatics.

Page Ref: 424 Cognitive Level: Analyzing Client Need & Sub: Health Promotion and Maintenance Standards: QSEN Competencies: VI.B.8. Use high quality electronic sources of healthcare information | AACN Essential Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Nursing Process Learning Outcome: Discuss the data and information flows that are key to supporting public health functions.

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4) The informatics nurse is reviewing the relationship between information technology and the collection and analysis of data as part of the development of evidence-based practice and improved patient outcomes. Which are essential elements that need to be considered to have a comprehensive, robust health information system to promote public health informatics? Select all that apply.

A) Data definitions B) Coding classification systems C) Data transmission capability D) Health information exchange (HIE) E) Data storage Answer: A, B, C, D Explanation: A) An essential element for a health information systems infrastructure includes data definitions.

B) Coding classification systems are essential elements for a health information system infrastructure.

C) Data transmission capability is an essential element for a health information system infrastructure.

D) A HIE is an essential element for a health information system infrastructure.

E) Data storage is not identified as an essential element for a health information system infrastructure.

Page Ref: 424 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Management of Care Standards: QSEN Competencies: VI.B.8. Use high quality electronic sources of healthcare information | AACN Essential Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Planning/Nursing Process Learning Outcome: Discuss the data and information flows that are key to supporting public health functions.

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5) The informatics nurse is reviewing how population-based health data can be used to track disease potential and prevent outbreaks. Which mechanism can be used for this tracking?

A) Chronic disease registries B) Immunization registries C) Cancer registries D) Diabetes registries Answer: B Explanation: A) Chronic disease registries capture case data on conditions, such as cardiovascular disease, tobacco and alcohol use, physical activity, and nutrition. These data are gathered from clinical records and survey activity.

B) Immunization registries, often called immunization information systems (IIS), are the result of a mandated transmission of immunization data from providers to an IIS in a public health agency. IIS assist with the determination of immunization coverage and, if bidirectional data exchange occurs, can reduce duplication of immunization C) Cancer registries capture details for each cancer episode of care in the United States. These registries include data on patient history, diagnosis, treatment, and status. Data are first collected at the local registry level and are then merged to form population-based cancer data. This data are used to calculate incidence, survival rates, efficacy, treatment, and quality of life.

D) Diabetes registries do not exist.

Page Ref: 428 Cognitive Level: Applying Client Need & Sub: Health Promotion and Maintenance Standards: QSEN Competencies: VI.B.8. Use high quality electronic sources of healthcare information | AACN Essential Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Nursing Process Learning Outcome: Identify critical public health applications used to manage chronic and infectious diseases.

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6) The public health informatics nurse is reviewing a report from the electronic lab reporting (ELR) interface that lists the communicable diseases currently being treated. Which additional information does this nurse need before implementing an action to control these diseases? Select all that apply.

A) Disease onset B) Employment status C) Provider information D) Patient demographics E) Medication and treatment history Answer: A, C, D, E Explanation: A) Public health practitioners need to know more than a laboratory result. To fully understand the implications of the result, they need to know disease onset.

B) Employment status does not need to be known to address a communicable disease.

C) Public health practitioners need to know more than a laboratory result. To fully understand the implications of the result, they need to know provider information.

D) Public health practitioners need to know more than a laboratory result. To fully understand the implications of the result, they need to know patient demographics.

E) Public health practitioners need to know more than a laboratory result. To fully understand the implications of the result, they need to know medication and treatment history.

Page Ref: 426 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: VI.B.8. Use high quality electronic sources of healthcare information | AACN Essential Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Nursing Process Learning Outcome: Identify critical public health applications used to manage chronic and infectious diseases.

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7) The public health informatics nurse is reviewing surveillance data. What are the sources of these data? Select all that apply.

A) Syndromes B) Pharmacy data C) Active systems D) Passive systems E) Indicator factors Answer: A, C, D, E Explanation: A) Public health surveillance is the ongoing systematic collection, analysis, and interpretation of data, closely integrated with the timely dissemination of these data to those responsible for preventing and controlling disease and injury. Surveillance can be based on syndromes that rely on both active and passive reporting but are based on clinical features as opposed to actual diagnoses.

B) Public health surveillance is not based upon pharmacy data.

C) Public health surveillance is the ongoing systematic collection, analysis, and interpretation of data, closely integrated with the timely dissemination of these data to those responsible for preventing and controlling disease and injury. Surveillance can be based on active systems, whereby staff go out and seek information.

D) Public health surveillance is the ongoing systematic collection, analysis, and interpretation of data, closely integrated with the timely dissemination of these data to those responsible for preventing and controlling disease and injury. Surveillance can be based on passive systems, which rely on reports submitted to local or state agencies that are mandated based on certain conditions.

E) Public health surveillance is the ongoing systematic collection, analysis, and interpretation of data, closely integrated with the timely dissemination of these data to those responsible for preventing and controlling disease and injury. Surveillance can be based on indicator factors, such as the number of new cases of diarrhea reported to healthcare providers.

Page Ref: 427 Cognitive Level: Analyzing Client Need & Sub: Safe and Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: VI.B.8. Use high quality electronic sources of healthcare information | AACN Essential Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Nursing Process Learning Outcome: Examine efforts to facilitate exchange between clinical and public health information systems.

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8) The public health informatics nurse receives an updated list of standards that address the submission of electronic data to public health agencies. What do these standards address? Select all that apply.

A) Immunizations B) Location of the patients C) Syndromic surveillance D) Antibiotics being prescribed E) Reportable laboratory results Answer: A, C, E Explanation: A) The Stage 1 Meaningful Use criteria, established by the Office of the National Coordinator and the Centers for Medicaid and Medicare Services contain provisions that create standards for the submission of electronic data to public health agencies. These standards specifically include immunizations.

B) These standards do not include the location of the patients.

C) The Stage 1 Meaningful Use criteria, established by the Office of the National Coordinator and the Centers for Medicaid and Medicare Services contain provisions that create standards for the submission of electronic data to public health agencies. These standards specifically include syndromic surveillance consisting of prediagnostic reporting of data that detain and characterize unusual activity for public health field investigation.

D) These standards do not include the antibiotics being prescribed.

E) The Stage 1 Meaningful Use criteria, established by the Office of the National Coordinator and the Centers for Medicaid and Medicare Services contain provisions that create standards for the submission of electronic data to public health agencies. These standards specifically include reportable laboratory results.

Page Ref: 427-428 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: VI.B.8. Use high quality electronic sources of healthcare information | AACN Essential Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Nursing Process Learning Outcome: Examine efforts to facilitate exchange between clinical and public health information systems.

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9) The public health department receives a notice that a geographic information system (GIS) will be interfaced with the current clinical information system within the network. Which is an advantage of this system? Select all that apply.

A) Pinpoints service areas B) Models where people live C) Provides geographic distribution D) Identifies Internet queries about diseases E) Monitors the health status of communities Answer: A, B, C, E Explanation: A) A GIS integrates hardware, software, and data for capturing, managing, analyzing, and displaying all forms of geographically referenced information. A GIS allows public health practitioners to view, understand, question, interpret, and visualize data in many ways that may reveal relationships, patterns, and trends in the form of maps, globes, reports, and charts. A GIS allows one to pinpoint service area needs with more accuracy.

B) A GIS integrates hardware, software, and data for capturing, managing, analyzing, and displaying all forms of geographically referenced information. A GIS allows public health practitioners to view, understand, question, interpret, and visualize data in many ways that may reveal relationships, patterns, and trends in the form of maps, globes, reports, and charts. GISs are being used in public health to model where people live and the environments to which they are exposed throughout their lives.

C) A GIS integrates hardware, software, and data for capturing, managing, analyzing, and displaying all forms of geographically referenced information. A GIS allows public health practitioners to view, understand, question, interpret, and visualize data in many ways that may reveal relationships, patterns, and trends in the form of maps, globes, reports, and charts. A GIS allows a visual representation of geographical distribution, which is one of the most frequently considered factors in public health and epidemiologic research.

D) Infodemiology may be used to analyze Internet queries about a particular disease to identify pending outbreaks.

E) A GIS integrates hardware, software, and data for capturing, managing, analyzing, and displaying all forms of geographically referenced information. A GIS allows public health practitioners to view, understand, question, interpret, and visualize data in many ways that may reveal relationships, patterns, and trends in the form of maps, globes, reports, and charts. A GIS can be used to identify and monitor the health status of communities, target diagnoses and investigations of health problems, inform and educate communities about hazards and health concerns, link resources within communities, and advocate for local policy.

Page Ref: 429-430 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: VI.B.8. Use high quality electronic sources of healthcare information | AACN Essential Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Implementation/Nursing Process Learning Outcome: Describe systems currently in use to manage the public health mandate.

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10) The public health informatics nurse learns of a potential shortage of a type of antibiotic because a large number of prescriptions are being written for a particular illness. In which way should the nurse use infodemiology to learn which disease process is being treated?

A) Follow Twitter feeds to see who is reporting a disease treated by the antibiotic.

B) Search the Internet to learn which disease is most likely treated by the antibiotic.

C) Analyze geographic information to find out where the people with the disease live.

D) Review geographic information to see which providers are prescribing the antibiotic.

Answer: B Explanation: A) Infodemiology can be used to analyze archived Twitter posts, but following Twitter feeds may not provide the required information.

B) Infodemiology may be used to analyze Internet queries about a particular disease to identify pending outbreaks.

C) Geographic information systems are not a part of infodemiology.

D) Geographic information systems are not a part of infodemiology.

Page Ref: 430 Cognitive Level: Applying Client Need & Sub: Safe and Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: VI.B.8. Use high quality electronic sources of healthcare information | AACN Essential Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment | Nursing/Integrated Concepts: Assessment/Nursing Process Learning Outcome: Describe systems currently in use to manage the public health mandate.

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