NUR 3870 NURSING INFORMATICS FINAL EXAM CHAPTERS 1.What is an ELECTRONIC MEDICAL RECORD (EMR). Describe an EMR. 1. A nursing informatics specialist is conducting a presenta tion about the electronic medical record (EMR) to a group of facility staff. Which statement would the nurse specialist most likely include when describing the EMR? A) The EMR is transportable. B) The data in the EMR are owned by the client. C) It describes the care rendered during an agency visit. D) The EMR lacks standardized vocabulary. ∙ 2. Most important benefit of electronic documentation system 2. An electronic documentation system will be implemented in an agency. As part of the process, the staff is receiving education about the system and the overall benefits. Which benefit would be mentioned as the most important? A) Availability of an audit trail for information B) Decreased decentralization of the healthcare delivery system C) Enhanced ability to extract information D) Improvement in client care outcomes 3. A group of nurses are reviewing information related to the Health Information Technology for Economic and Clinical Health (HITECH) Act. The group demonstrates understanding of this act when they identify which examples as core objectives for supporting healthcare during stage 1? Select all that apply. A) Performing medication reconciliation B) Including clinical lab test results in the EHR C) Using computerized provider order entry D) Using a clinical decision support rule E) Sending secure client reminders for follow-up care ∙ 3. Strengths and weaknesses of paper and electronic documentation 4. A nurse is preparing a presentation to a group of staff members comparing paper and electronic documentation. Which weaknesses of paper records would the nurse include? Select all that apply. A) Legibility B) Lack of a backup system C) Difficult to transport D) Slowness in charting E) Easily damaged 5. A nurse is reviewing a client’s electronic health record. Based on the nurse’s understanding of data standards, which would the nurse identify as defining what data are shared? A) Clinical Document Architecture B) Continuity of Care Document C) Health information system D) Electronic medical record 6. A nurse is reading a journal article about electronic health records and how they can fill in the gaps between evidence and practice. Which benefits would the nurse most likely read about? Select all that apply. A) Monitoring quality improvement outcomes B) Encouraging client partnering with the healthcare provider C) Providing information about controlled clinical trials D) Identifying information that can affect clinical outcomes E) Allowing implementation after extensive long-term knowledge discovery 7. A group of nurses are involved in a lively debate about the strengths and weakness of paper documentation. Which statements would the group use to defend the position for using paper documentation? Select all that apply. A) “Paper records are easily transported.” B) “Paper records are much more complete.” C) “Paper records are quick to retrieve.” D) “Paper records are permanent.” E) “Paper records from past stays are easy to obtain.” 8. A nursing informatics specialist has been asked to prepare a presentation for a group of staff nurses about an electronic documentation system that is being implemented in the facility. Which features would the nurse specialist include as promoting continuity of care? Select all that apply. A) Ability to have real-time documentation B) Inclusion of an audit trail about detailed record access C) Use of decision support systems and alerts D) Ability to obtain trends about practice E) Ability for instant communication among providers 9. When describing meaningful use, which statement would be most appropriate to include? A) Use of information from EHRs to improve healthcare delivery B) A way to provide a picture of a client’s health information C) A means for providing a common structure for clinical documents D) Use of an audit trail to identify information about record access 10. Which component is associated with HIPAA law? Select all that apply. A) Outcomes B) Privacy C) Client engagement D) Security E) Care coordination 11. A new graduate nurse is working at a facility that uses electronic documentation. The nurse has questions about the policies and procedures related to data security. The nurse would identify which person as being responsible for the policies and procedures related to data security? A) Nurse manager B) Nursing informatics specialist C) Client’s primary care provider D) HIPAA security officer 12. A nurse is working on a committee that is involved with electronic documentation. The committee is currently working on stage 1. On which action would the committee be focusing? A) Advanced clinical processes B) Data analysis for improved care C) Data capturing and sharing D) Improve outcomes 13. While working as a member of a group tasked with addressing meaningful use with electronic data, the group has met the criteria for stage 1 and is now moving onto stage 2. Which action would now become a focus for the group? A) Recording smoking status for those 13 years of age and older B) Submitting electronic data to immunization registries C) Transmitting prescriptions electronically D) Maintaining an up-to-date diagnosis list 14. As part of the facility orientation, a nursing informatics specialist is describing the different types of client records to a group of newly hired nurses. Which facts would the nurse specialist include when describing electronic medical records (EMRs)? Select all that apply. A) The client owns the data. B) It is an electronic version of the traditional record. C) The EMR is transportable. D) It provides a connection between the EHR and ePHR. E) A client can have many EMRs. 15. After reviewing information about the benefits of electronic health records, a nurse demonstrates understanding of the information by identifying which as one of the most important benefits? A) Continuity of care B) Privacy C) Analyzable information D) Improved quality 16. A nursing informatics specialist is describing meaningful use of electronic health records to a group of newly hired nurses at the facility. Which requirement would the nurse specialist include? A) An interoperable healthcare information system B) Computer literacy C) Incentives to foster adoption D) Public trust about information security 17. A nursing informatics specialist is describing the benefits of electronic records to a group of facility administrators. The nurse specialist would address which aspect as resulting from searchable and analyzable information? A) Creation of knowledge for informed practice B) Immediate communication with other providers C) Improvement in scheduling of diagnostic tests D) Reduction in transcription errors 18. Which statement best reflects the status of the adoption of electronic records in the United States? A) A majority of hospitals have at least a basic EHR system. B) Security for sharing electronic health information is still low. C) Adoption of electronic health records has plateaued over the past 5 years. D) Data standards are the focus of all EHR efforts of interoperability. 19. A nursing informatics specialist is working as part of a group that is tasked with addressing the core objectives for meaningful use. The group is addressing stage 2 objectives. Which objectives would be addressed? Select all that apply. A) Using secure electronic messaging to communicate with clients B) Providing clinical summaries for each office visit C) Protecting electronic health information D) Including clinical lab test results in the EHR E) Performing medication reconciliation 20. A committee is working on stage 1 core objectives for meaningful use. Which would the committee be most likely to address as menu objectives at this stage? Select all that apply. A) Implementing drug formulary checks B) Creating client lists by condition for quality improvement C) Recording client notes electronically D) Reporting cancer cases to public health cancer registry E) Being able to submit electronic syndrome surveillance data 21. A nurse is working on a committee involved in adopting electronic healthcare systems for the agency. Currently, the agency has clinical documentation, a clinical decision support system (CDSS) with error checking, and a picture archive and communication system (PACS) in place. The committee determines that the agency is at which stage of adoption? A) Stage 0 B) Stage 1 C) Stage 2 D) Stage 3 22. When adopting the electronic healthcare record (EHR), which aspect would be considered the ultimate goal? A) Sharing of information B) Client as the most important focus C) Cost-effectiveness D) Improved time management 23. An administrative group at an agency involved in adopting healthcare information technology is developing a strategic plan. Which component would they include? A) Plan that covers 2 to 3 years B) Structured guide that does not change C) Expenditures offset by client outcome benefits D) Demonstration of a slight return on investment 24. A nurse using a clinical information system is required to document the same data in more than one area because the data do not “flow over” to the other areas and the data fields are not universally designed. Which component is lacking? A) Interoperability B) Intangibles C) Return on investment D) Biometrics 25. A nursing informatics specialist is conducting a seminar on the need for uniformity in user design for data entry screens based on the understanding that: A) Most healthcare providers involved in the design process have background knowledge. B) Database design skills are common in those serving on EHR committees. C) Most providers approach user design using a paper chart thinking process. D) Screen design issues are limited, rarely affecting the time for documentation. 26. When developing a plan for workflow redesign and the use of computerized documentation, which item would be the first thing to consider? A) The number of computers needed B) Location of the computers C) Wheeled or bedside type of computer D) Theft prevention 27. A nursing informatics specialist is describing the use of health information technology to meet national safety goals to a group of nurse managers. The nurse specialist determines that the group needs additional teaching based on which statement? A) “Barcodes aid in meeting the required two client identifiers for improved client safety.” B) “Agencies are using barcode identification for one-person identification and blood transfusion.” C) “Clinical decision support systems could alert providers of critical lab values.” D) “Alarms should be used on all devices to ensure prompt response to safety issues.” 28. A nurse is creating a password for use in accessing the healthcare information system in the agency. Which action would be most appropriate for the nurse to do in creating this password? A) Select mostly lowercase letters. B) Select a combination of letters and numbers. C) Use numbers sparingly. D) Use a word familiar to the nurse. 29. When describing the various biometric methods for authentication, which method would the nursing informatics specialist identify as most secure? A) Fingerprint B) Voiceprint C) Retinal scan D) Iris scan 30. A nursing informatics specialist is describing the similarities and differences between the two types of radio frequency identification (RFID) to a group of agency administrators. Which type would a nursing informatics specialist include as being associated with the passive type? A) Increased cost B) Read–write capability C) Readable from a distance of 1 to 10 feet D) Implantable under the skin 31. A nursing informatics specialist is conducting a seminar for agency staff about the benefits of a fully integrated electronic health record. The nurse specialist determines the need for additional teaching when the group identifies which aspect as a benefit to the client? A) Individualized treatment B) Ability to check the record’s accuracy C) Capability of decision support D) Knowledge of persons with access to the data 32. A nursing informatics specialist is working as part of a team developing a strategic plan for the adoption of healthcare information technology at the institution. Which information would the nurse specialist identify as being an important component of this plan? Select all that apply. A) Overall design flexibility B) Short-term time frame focus C) Inclusion of resource acquisition D) Support for the use of information technology E) A brief overview of the agency’s goals 33. A committee is reviewing the strategic plan for the agency’s return on investment. The committee identifies the tangibles for the plan. Which items would the committee be addressing? Select all that apply. A) Improved decision-making B) Decreased lengths of stay C) Reduced charges per admission D) Enhanced user satisfaction E) Improved communication 34 . A nurse is reading a journal article about syndromic surveillance. The nurse would expect the article to provide which description of this concept? A) Meeting the Joint Commission’s client safety goals B) Identifying unintended consequences of healthcare technology C) A way to measure quality of care and client outcomes D) Providing early detection of potential disease 35. A nurse is working as part of a committee involved in creating passwords for the healthcare agency’s network. Which password would be the strongest? A) Nursing B) NuRs1N9gY C) D) GniSrun 36. A nursing informatics specialist is working as part of a group working with an agency transitioning from the paper record to the electronic record. The nurse identifies that the agency is currently at stage 3 of the adoption model based on which information? A) Flow sheets for clinical documentation are in place. B) Closed loop medication administration is integrated. C) Computerized provider order entry is in use. D) Data warehousing is available. 37. The use of which method would be most effective as the first line of defense in providing data protection from entry by outsiders? A) Audit trail B) Firewall C) Spear phishing D) Data backup 38. A nursing informatics specialist is preparing a presentation for the staff about computerized provider order entry. Based on the nurse specialist’s understanding of the unintended consequences of this system, which issue would the nurse specialist include in the presentation? Select all that apply. A) Problematic communication between the nurses and physicians B) Changes in workflow C) Need for more personnel for maintenance D) Possible continuation of unnecessary daily orders E) Improved ease in how to enter orders 39. A nurse is preparing to access a client’s electronic record. The system verifies that the nurse is the person logging into the system and grants access to the information. This process is known as: A) Phishing. B) Biometrics. C) Authentication. D) Voice recognition. 40. A nursing informatics specialist is conducting an in-service presentation for nurses at a local agency about the importance of maintaining confidentiality of electronic health information. The nurse specialist determines that the teaching was successful when the group identifies which method as a way to protect client confidentiality? Select all that apply. A) Passwords B) Single sign-ons C) Voice recognition D) Palm vein technology E) Automatic logout 41. While talking with a client, a nurse determines that the client is participating in real-time telehealth based on the understanding that this involves: A) Stored images sent for interpretation at a later time. B) Asynchronous transmission of clinical data. C) Affordable method for practice in rural communities. D) Same-time interaction of the client and provider via video. 42. A nurse is describing telehomecare to a group of clients, incorporating the knowledge that this method of care is cost-effective because: A) It provides care in the comfort of the client’s home. B) It promotes self-management for clients with chronic illnesses. C) It allows early detection, reducing the need for unnecessary emergency visits. D) It minimizes the time spent with office appointments. 43. In which locations would a nurse expect to find telemental health? Select all that apply. A) Prison facilities B) Rural areas C) Large cities D) War-torn areas E) Acute care facilities 44. A nurse is preparing a presentation about various telehealth practices for a group of nurses in the community. Which description would the nurse include about e-intensive care (e-ICU)? A) They require minimal planning for execution. B) Workflow typically requires redesign. C) Enhanced communication results. D) Involvement of other departments is limited. 45. A nurse is reading a journal article about teletrauma care. Which description would the nurse most likely find? A) Use of trauma care experts for second opinions B) Trauma specialist guiding trauma care via video C) Emergency care provided via robotics D) Education of rural providers by trauma specialists 46. Which information would a nurse use when describing telenursing? Select all that apply. A) Promotes autonomous practice B) Is practiced primarily in rural areas C) Requires certification D) Increases healthcare costs E) Usually involves on-the-job learning F) Is a new specialty 47. A nursing informatics specialist is talking with a group of agency administrators about implementing telehealth services. When discussing the issue of reimbursement for such services, which aspect would be most important for the nurse specialist to include? A) Most telehealth services are paid for by clients as out-of-pocket expenses. B) Reimbursement is fairly consistent across the different insurers. C) Little progress has been made in reimbursement policies. D) Reimbursement is a large barrier to widespread adoption of telehealth. 48. Technical standards for telehealth and telemedicine would include: A) The HIPAA. B) Research protocols. C) Systems for network connectivity. D) Human resource management. 49. A nurse is reading an article about a surgeon who uses a combination of robotics and virtual reality along with special gloves and audio and video technology to perform surgery by manipulating surgical instruments at a remote site. The nurse is reading about: A) Store and Forward (S&F) technology. B) Telepresence. C) Real-time technology. D) Telemedicine. 50. Which statement would best describe the use of portable monitoring devices used in telehealth? A) Most require access to a wireless connection. B) Many devices involve a touch screen for assessment. C) E-mail is used to address client education needs. D) There is a central device located in the client’s home. 51. A nurse is reading an article about the use of robotics and telehealth. Which outcome would the nurse expect research on this technology to reveal? A) Increased response time B) Increased length of stay C) Improved client outcomes D) Increased costs 52. A nursing informatics specialist is conducting a program for agency staff about telehealth. Which aspect would the nurse specialist include as a benefit of this technology? A) Increased travel time B) Increased productivity C) Increased face-to-face in-person client contact D) Increased healthcare costs 53. When reviewing the core standards for telemedicine operations, which example would a nurse identify as a clinical standard? A) Nursing practice standards of care B) Health Insurance Portability and Accountability guidelines C) Network connectivity standards D) Fiscal management guidelines 54. Which device would most likely be used with Store and Forward (S&F) technology? A) Telephone B) Digital camera C) Videoconferencing D) Satellite system 55. A nursing informatics specialist is conducting a presentation on using telehealth to educate clients. Applying best practices, the nurse specialist would include which action? Select all that apply. A) Setting up impromptu meetings for users B) Providing immediate feedback for questions C) Combining face-to-face with other methods of interaction D) Keeping clients’ health information secure E) Limiting client access to specific areas 56. A nurse is reading a journal article about various telemonitoring devices being used by clients with chronic disease. Which outcome would the article most likely reveal? Select all that apply. A) Decreased costs for care over time B) Stabilized hospital readmission rates C) Consistent rates of emergency department visits D) Improved client care E) Improved accessibility to healthcare 57. A nurse is reviewing a meta-analysis by Blinkhorn (2012) on how telehealth improved disease management for chronic kidney disease (CKD). Which classification was identified in the research? Select all that apply. A) Telecoordinating B) Teleconsultation C) Telemanagement D) Telemonitoring E) Teleconferences 58. A client asks the nursing informatics specialist about the various wellness apps that are available. Which response by the nurse specialist would be most appropriate? A) “The apps are usually quite expensive.” B) “Your healthcare provider should prescribe one for you.” C) “Not all the apps have been approved by the FDA.” D) “Most are very reliable but limited in what they do.” 59. A client tells the nurse that he is having problems sleeping and wanted to know if there is a wearable device that he could use that would help him monitor the quality of his sleep. Which response by the nurse would be most appropriate? A) “The AliveCor Kardia Mobile smartphone app will allow you to monitor your heart rate and sleeping pattern?” B) “There is no wearable device that will allow you to monitor sleep quality, you will need a sleep study.” C) “The is the HemMobile Striiv which will allow you to monitor sleep pattern and quality.” D) “A Fitbit will allow you to monitor sleep quality and body activity.” 60. A client is admitted to the facility and needs a mental health evaluation, but there is no physician on duty. Which telehealth service would be most beneficial for the client? A) Telepsychiatry B) Teletrauma C) Telemental D) Tele-intensive care 61. A nursing informatics specialist is part of the committee working to start telehealth practice at a rural clinic. What are the main issues that can affect implementation of telehealth? Select all that apply. A) Reduced travel time B) Technical issues C) Reimbursement D) Educational opportunities E) Medicolegal issues 62. A nursing informatics specialist is involved with a group in setting up telehealth nursing practice in a rural setting. Which area would be important for the group to address to ensure that the practice meets the standards of telehealth nursing practice? Select all that apply. A) Ethical practice B) Client rights C) Competency D) Research protocols E) Fiscal management 63. Which Store and Forward (S&F) technology allows for asynchronous transmission of clinical data? Select all that apply. A) Interactive video B) Magnetic resonance imaging (MRI) C) Blood glucose levels D) Chest x-ray E) Electrocardiogram 64. Which specialty would lend itself well to the Store and Forward (S&F) technology? Select all that apply. A) Dermatology B) Radiology C) Pathology D) Wound care E) Diabetic medicine 65. A nursing informatics specialist is conducting a seminar for agency staff about telehealth. As part of the seminar, the nurse specialist is comparing Store and Forward (S&F) technology with real-time technology. Which statement would the nurse specialist most likely include? Select all that apply. A) Real-time technology requires two-way communication. B) Store and Forward (S&F) technology involves the use of robotics. C) Store and Forward (S&F) technology involves the use of telepresence. D) With Store and Forward (S&F) technology, interpretation occurs when the image is sent. E) Real-time technology includes asynchronous transmission of clinical data. 66. A clinical nurse specialist is developing a teaching plan for new mothers on a maternal– newborn nursing unit. The nurse is incorporating educational software with computerized video clips, slide presentations, illustrations, and quiz questions developed by nurse experts in the field. The information can be changed in many ways to address the clinical nurse specialist’s needs. Which type of instruction is the clinical nurse specialist using? A) Computer-aided instruction B) Computer-based learning C) Learning management system D) Learning content management system 67. A nurse is preparing an in-service program for staff nurses and is designing learning activities for the group. The nurse wants to focus on the highest level of learning. The nurse includes which activity to achieve this goal? A) Tutorials B) Case studies C) Animations D) Flash cards 68. An educational software program has been developed to sharpen the skills of the nursing staff. The program incorporates a set of fill-in-the-blanks and true/false questions. These activities would promote development of: A) Synthesis. B) Application. C) Knowledge. D) Analysis. 69. A nurse who is attending a graduate educational program is referred to a Multimedia Educational Resource for Learning and Online Teaching (MERLOT) site as an excellent source for learning resources. The nurse would expect to find: A) Hundreds of learning activities. B) Access to other digital libraries. C) No membership requirement. D) User fee for activities. 70. A group of nurse managers are discussing the possible use of a virtual reality for the unit staff to promote skill learning and training. The nurse managers would need to address which aspect of this type of learning before implementing the program with the staff? A) Navigating the virtual world B) Creating an avatar C) Developing broad goals D) Accessing the program 71. A group of faculty from a local college of nursing are thinking about implementing an e- learning program involving fundamental skills for their students. A nursing informatics specialist is describing the advantages and disadvantages of e-learning programs to the group. The nurse specialist determines that the faculty members understand the information when they state: A) “The learners will need to sign up for a time to use the program.” B) “The programs are usually free of technological glitches.” C) “The learners can set our own pace for learning with the program.” D) “The programs provide experiences that the learners would normally encounter.” 72. When developing learning outcomes, which action would be best to use to signify the highest level of learning? A) Demonstrate B) List C) Create D) Analyze 73. A nurse is attending a seminar on distance learning. Which use would the nurse expect to hear as the most common for this method? A) Degree programs B) Certification C) Continuing education D) Personal enrichment 74. A nurse is interested in e-learning opportunities and asks the nursing informatics specialist for advice. Which response by the nurse specialist would be most appropriate? A) “Online learning activities are nice, but they are costly.” B) “You need to be motivated and disciplined with this type of learning.” C) “Unless you are really skilled in computer technology, it’s not for you.” D) “You need to be available at the time set by the course.” 75. A group of nurse managers are working to develop an e-learning program for their staff. When developing this program, which principle would the group address? Select all that apply. A) Collaboration between students and faculty B) Opportunities for practice and rapid feedback C) Passive learning techniques D) Limited faculty–student contact E) Focus on one or two learning styles 76. A nurse is considering enrolling in an e-learning continuing education course and is trying to decide whether the course would be appropriate for him or her. The nurse completes a self-evaluation and identifies characteristics that would indicate that the course would be appropriate. Which characteristic has the nurse identified? Select all that apply. A) Self-motivation B) Limited writing abilities C) Dependence on others for learning D) Open to share experiences E) Ability to ask for help 77. A nurse is participating in an e-learning program to achieve certification. Which action would be most important for the nurse to do to achieve success with the program? A) Provide feedback about the electronic instruction. B) Rely firmly on the instructor. C) Keep appropriate records from the course. D) Engage in simulation exercises. 78. A nurse is reading a journal article about the advantages and disadvantages of online learning as part of determining if an online course is right for him or her. When reading the article, which aspect would the nurse identify as a disadvantage? Select all that apply. A) Software needed B) Backup plan for problems C) Missing of a class D) Technology skills E) Self-discipline 79. A nurse is participating in an e-learning course about current care for diabetes. The content is geared to the application level of learning. Which type of activity would the nurse most likely find in the course? Select all that apply. A) Memorization games B) Case studies C) Animations D) Interactive tutorials E) Flash cards 80. A nurse is using online surveys to gather information for a research project about individuals’ emotional responses to the diagnosis of cancer. When using the surveys, the nurse would ensure that the survey has which certification? Select all that apply. A) Health Insurance Portability and Accountability Act (HIPAA) B) National Institutes of Health (NIH) C) Centers for Disease Control and Prevention (CDC) D) American Cancer Society (ACS) E) Family Education and Rights Policy Act (FERPA) 81. A group of nurse managers are working to develop a refresher course for staff nurses in cardiopulmonary resuscitation and want to use a high-fidelity client simulator. The nurse managers decide this is the best method for teaching the staff for which reason? A) Cost of the program is less than that for an online training program. B) Minimal time is needed for instructor training. C) Realistic learning helps to promote performance. D) Manikins for use are widely available. 82. A nurse is participating in an online course and uses the course materials at various times that are convenient for him or her. The nurse is using which type of learning? A) Streaming video B) Asynchronous C) Blended D) Synchronous 83. A nurse is participating in a blended learning course in which the instructor is using the concept of a flipped classroom. Which activity would the nurse expect to occur? Select all that apply. A) Use class time for lecture content B) Complete some activities before class C) Participate in engaged learning activities in class D) Watch videos on a topic before class E) Practice a skill in class 84. A nurse is participating in an online certification course and is preparing to take the exam. According to the program, the exam uses computerized adaptive testing. The nurse understands that this type of exam: A) Primarily focuses on true–false type questions. B) Provides subsequent questions on previous responses. C) Involves hands-on skill testing. D) Uses a wireless device to answer questions. 85. A nurse is reading a journal article about e-learning and possibilities for the future. Which development in technology would the nurse expect to find as impacting the future of teaching and learning? Select all that apply. A) Learning analytics B) Two-dimensional printing C) Computerized adaptive testing D) Virtual assistants E) Gamification 86. When describing the role of the nurse administrator in relation to information management systems, which would be expected as a basic skill? A) Using spreadsheets B) Recording quality improvement data C) Interpreting benchmarking data D) Using agency database systems 87. A nurse administrator is using a spreadsheet for forecasting. Which action would the administrator do first? A) Review the data for observable patterns. B) Identify any data trends that are occurring. C) Obtain data spanning several years. D) Consider outside influences on the data. 88. A nurse administrator is involved in process improvement and uses a chart to examine the relationships among complex processes. The chart resembles a fishbone. The administrator has used which type of chart? A) Cause-and-effect chart B) Flowchart C) Gantt chart D) Pie chart 89. A nurse administrator is evaluating several human resource