ANCC Infomatics Practice Test 1 Flashcards
“Which one of the following is the first phase of the
traditional project life cycle?
a. Development
b. Initiation
c. Implementation
d. Concept
D: Concept
Every project has a life cycle, or a series of phases during which specific types of work are carried out. Although organizations may define their own life cycles, the traditional project life cycle comprises four phases: concept, development, implementation, and closeout. Concept and development represent project feasibility and focus on planning, while the latter two phases, implementation and closeout, represent project acquisition and are when the actual work of the project is carried out. One phase should be completed before moving on to the next phase.”
The teaching model in which learning takes place outside of a formal classroom with materials provided or recommended by the instructor is:
A. Guided focus
B. Independent study
C. Cognitive apprenticeship
D. Cooperative
A. Guided focus
In the guided focus teaching model, learning takes place outside of a formal classroom with materials provided or recommended by the instructor. In an independent study model, the study is geared toward the needs of the individual and can be self-paced. Materials may be web-based or paper-based and may include audio-visual materials. In a cognitive apprenticeship model, instructors model and learners analyze and apply processes. In a cooperative model, small teams work together through a variety of activities to master a subject, with each member responsible for self-learning and the learning of others in the team.
- The first step in strategic planning is usually to:
a. Conduct an environmental assessment.
b. Revise the previous strategic plan.
c. Review and revise the mission and vision statements.
d. Develop a values statement.”
a. Conduct an environmental assessment
A: Strategic planning usually begins by conducting an
environmental assessment. This may include using a strengths, weaknesses, opportunities, threats (SWOT) analysis to assess internal and external factors that may influence outcomes. The assessment reviews changes, both positive and negative, that have occurred, such as a decrease in second-party reimbursement or an increase in patient population. The information gleaned from the environmental
assessment is then used to develop or revise the mission, vision, and values statements.
According to the HL7 group, the three different types
of interoperability are:
a. Functional, ergonomic, and cognitive
b. Technical, semantic, and process/social
c. Technical, interactive, and non-interactive
d. Functional, technical, and ergonomic
B. Technical, semantic, and process/social
According to the HL7 group, the three different types of interoperability are:
Technical: Systems are able to connect with one other and
exchange data without error.
Semantic: Data is shared among the different systems and interpreted
and understood in the exact same manner in each system.
Process/Social: The system is able to integrate into the workflow
and promote the quality of care by providing usability through
carefully-designed interfaces and allowing users to access and input
information efficiently.
- The father of information theory and the digital age is
considered to be:
a. Albert Bandura
b. Alan Turing
c. Claude Shannon
d. Kurt Lewin”
c. Claude Shannon
- C: In 1948, Claude Shannon, a mathematician, wrote a paper that laid out the basis for modern information theory: “A Mathematical Theory of Communication.” Shannon showed how all forms of information (including text, telephone signals, video, audio, and telephone) could be encoded through a binary system of 0s and 1s and transmitted error free; he also showed how the amount of information carried over a system of communication could be calculated mathematically. Shannon demonstrated that switching circuits could be endowed with decision-making ability (applicable to artificial intelligence).
- If the nurse informatics specialist finds that nursing leaders lack essential knowledge about informatics, the first step should be to:
a. Identify informatics education needs of leaders.
b. Develop a mentoring program for leaders.
c. Complain to the board of directors.
d. Request additional training funds.
a. Identify informatics education needs of leaders.
- A: If the nurse informatics specialist finds that nursing leaders lack essential knowledge about informatics, the first step should be to identify informatics education needs of leaders. Because nurse leaders serve a critical role in motivating other staff and acting as role models, the nurse informatics specialist needs a knowledgeable leadership. Assessment may include surveys, questionnaires, and interviews. Assessment must be completed before requesting funds or establishing a mentoring program because needs may vary widely.
- A primary concern related to bring-your-own-device (BYOD) policies is:
a. Device damage
b. Insurance costs
c. Unequal access
d. Proprietary data misuse
d. Proprietary data misuse
D: Bring your own device (BYOD) is increasingly common in healthcare because the smart phone and tablet are ubiquitous and healthcare providers often use these devices to access and share information. When used for work purposes, these devices can expose proprietary data. Organizations need to have a BYOD policy that outlines acceptable use, provides security awareness training, requires device enrollment, and ensures that all stored and transmitted data are encrypted and that access is secure. Additionally, security audits should be done routinely, and the organization should have the ability to remotely wipe devices of sensitive data.
- Considering computer ergonomics, when a person is using the computer, the top of the monitor should be approximately:
a. 4 inches above eye level
b. 4 inches below eye level 8 inches below eye level
c. 8 inches below eye level
d. At eye level
d. At eye level
- D: Considering computer ergonomics, when a person is using the computer, the top of the computer should be approximately at eye level. While there is some variation in height, most differences relate to lengths of the lower extremities rather than the trunk, so desk placement does not usually pose a problem. However, wall-mounted computer screens (such as at point of care) should be adjustable to provide for ease of use and good visualization.
- Which one of the following is protected by copyright?
a. Domain names
b. Systems
c. Ideas
d. Photographs
- D: Intellectual property protection is provided through copyright, which covers the following:
Artistic works: graphic designs, paintings, photographs, sculptures, maps, and posters Literary works: articles, novels, poems, plays, blogs, and some types of software Musical works: compositions and lyrics
Dramatic works: scripts, screenplays, and plays
Audiovisual works: movies, television programs, and online videos
Architectural designs
Sound recordings: music, sounds, and speeches
Choreographic works: dance moves
Copyright does not cover domain names, systems, or ideas (although the wording of ideas may be copyrighted).
- Regression testing is usually done:
A. After decommission of computer equipment
B. Before decommission of computer equipment
C. After introduction of new software or other changes
D. Before introduction of new software or other changes
C. After introduction of new software or other changes
Regression testing is usually done after introduction of new software or other changes to determine if “regressions” or errors occur. Sometimes a change in one aspect of software may have adverse effects on other aspects. Non-regression testing,
- In which area of the hospital is adding auditory display to visual display likely to be most effective?
A. Emergency department
B. ICU
C. Operating rooms
D. Pediatrics
C. Operating rooms
Auditory visual displays, which use sound to indicate changes in conditions, such as increased pulse or decreased blood pressure, can be distracting in areas that already have a fairly high volume of noise and/or alarms associated with displays, so the area of the hospital in which an auditory display is likely to be most effective is operating rooms. Operating rooms are usually reasonably quiet, and the auditory feedback may be especially useful to anesthesiologists.
- When applying the Complex Adaptive Theory to the system design life cycle, the informatics nurse would expect:
A. Reciprocal changes to occur between user and system
B. Users to bring about changes in systems
C. Systems to bring about changes in users
D. Systems to be too complex to effectively change
A. Reciprocal changes to occur between user and system
When applying the Complex Adaptive Theory to the system design life cycle, the informatics nurse would expect reciprocal changes to occur between the user and the system. Thus, the user changes elements of the system depending on the type of use, and the system in turn changes the behavior of the user. Adaptive systems tend to be dynamic rather than static and are able to adjust to changes to avoid chaos. Adaptive systems generally value effectiveness over efficiency.
Which of the following processes is most useful in determining the steps required to move from a current state of performance to a new one, including the need for action and resources.
A. Cost-benefit analysis
B. Gap analysis
C. Outcomes analysis
D. Return on investment (ROI) analysis
B. Gap analysis
Gap analysis is used to determine the steps required to move from a current state of actual performance or situation to a new potential performance or situation, and the “gap” between the two that requires action or resources. Steps to gap analysis include:
Assessing the current situation and listing important factors, such as performance levels, costs, staffing, and satisfac-tion, and all processes
Identifying the current outcomes of processes dentitying the rarget outcomes for projected processe
Outlining the process required to achieve target outcomes
Identifying the gaps that are present
Identifying resources and methods to close the gaps
- Which of the following types of data/information is primarily subjective?
A. Relevant
B. Timely
C. Flexible
D. Verifiable
A. Relevant
Relevant data/information is primarily subjective because the user must judge whether or not the data/information is relevant for the user’s purposes. Objective data/information is factual and unbiased, and therefore can be proven. Flexible data/in-formation can be used by a variety of users for a number of different purposes. Verifiable data/information can be proven through research to be accurate. Timely data/information is available when needed. Complete data/information contains all the information needed. Reliable data/information is clean data from a trusted source, such as a juried journal.
- Which of the following applies to protection of patient data on terminal displays in publicly accessible areas?
A. No information should be displayed
B. Terminals should have privacy filters
C. Terminals should have a manual locking feature
D. All data are de-identified
B. Terminals should have privacy filters
To ensure protection on patient data on terminal displays in publicly accessible areas, the terminals should have privacy filters that limit indirect viewing and should be facing away from the public areas when possible. If patients’ names are displayed on computer terminals in public areas, such as a waiting room, the name must be partially masked (such as using initials only). Terminals should have automatic locking figures so that the terminal shuts down if no activity occurs for a specific period of time, such as 3 minutes.
- When discussing information, utility refers to the:
A. Ability to produce the same information at another time
B. Ability of users to apply intellectual reasoning to reach a goal while the tools that produced the information disappear
C. Level of difficulty in accessing information for a particular purpose
D. Ability to provide the correct information to the correct user at the correct time for the correct purpose
D. Ability to provide the correct information to the correct user at the correct time for the correct purpose
Utility refers to the ability to provide the correct information to the correct user at the correct time for the correct pur-pose. Transparency refers to the ability of users to apply intellectual reasoning to reach a goal while the tools that produced the information disappear. Usability refers to the level of difficulty in accessing information for a particular purpose. Reproducibility refers to the ability to produce the same information at another time.
- The field of science that attempts to create intelligent technologies and then apply these technologies to the field of informatics is:
A. Cognitive science
B. Cognitive informatics
С. Artificial intelligence
D. Information science
С. Artificial intelligence
The field of science that applies intelligent technologies to the field of informatics is artificial intelligence. Researchers in artificial intelligence must engineer general intelligence and reasoning skills into the artificial intelligence programs as well as the ability to develop and learn from experiences and errors and to process natural language. One example of an artificial intelligence program is Siri, which responds to verbal queries and is found on Apple devices, such as the iPhone and iPad.
- Various models are available to guide healthcare organizations in applying evidence-based research to practice. If using the Iowa Model of Evidence-Based Practice to Promote Quality Care (Titler, 2001), the first step is to:
A Identify problem- and knowledge-focused triggers (practice questions).
B. Determine the resources available for instituting evidence-based practice.
C. Develop consensus among key players regarding evidence-based practice.
D. Establish a time frame for research, analysis, and implementation.
A Identify problem- and knowledge-focused triggers (practice questions).
The Iowa Model of Evidence-Based Practice to Promote Quality Care (Titler, 2001) begins with identifying problem- and knowledge-focused triggers (practice questions) and then assessing whether they are priorities. If not, other triggers should be considered. Researchers form a team to assess the research base, assemble research, analyze and synthesize the research, determine the efficacy of change, and pilot a change program with a follow-up evaluation of outcomes to determine whether the change should be adopted.
- When applying Lewin’s theory of change to implementation of an EHR, during the “unfreeze” stage, the informatics nurse should expect to:
A. Deal with resistance and provide reassurance.
B. Answer questions and dispel rumors.
C. Envolve many staff members in the change process.
D. Establish systems for feedback.
A. Deal with resistance and provide reassurance.
When applying Lewin’s theory of change to implementation of an EHR, during the “unfreeze” stage, the informatics nurse should expect to deal with resistance and provide reassurance as well as determine the needs for change, promote the need for change, and ensure managerial support. During the change stage, communicating, answering questions, and dispelling rumors as well as encouraging involvement is important. The refreeze (last) phase requires developing methods to sustain change and provide feedback and adaptation to the changes.
- The focus of the Administrative Simplification Compliance Act (2000) (ASCA) is the:
A. Transition to electronic Medicare claims submissions
B. Elimination of all paper Medicare claims submissions
C. Reduction of costs of Medicare claims submissions
D. Elimination of Medicare under- and overpayments
A. Transition to electronic Medicare claims submissions
The Administrative Simplification Compliance Act (2000) (ASCA) focuses on the transition to electronic Medicare claims submissions. ASCA has established penalties for failure to comply; however, the law allows exceptions for providers with fewer than 25 full-time employees, those with no internet access, and those with less than $5 million in annual income. CMS is responsible for enforcing the provisions of ASCA. Although compliance with ASCA should result in cost savings, this is not the focus.
- In response to a sentinel event, the informatics nurse should advise an initial response that includes completing a:
A. Plan to avoid recurrence
B. List of potential causes
C. Root cause analysis
D. List of staff involved
C. Root cause analysis
In response to a sentinel event, the informatics nurse should advise an initial response that includes completing a root cause analysis. The informatics nurse may assist in obtaining necessary information from the electronic health record as automated searches are often much faster and more efficient than manual searches. Root cause analysis must be reviewed objec-tively, taking into consideration that environmental factors and indirect causes (such as decreased staff) may contribute to the direct cause (staff error) of an event.
- If the informatics nurse has found a new application that may enhance the existing EHR with CPOE CDS system, the first concern before recommending the application is:
A. Cost
B. Compatibility
C. Usability
D. Safety
B. Compatibility
While all of these are important issues, if the informatics nurse has found a new application that may enhance the existing EHR with CPOE CDS system, the first concern before recommending the application is compatibility. If the application will not work within the existing system or it requires extensive workaround, then it is not a good choice. The informatics nurse should consult with the vendor as well as IT personnel and programmers to determine whether there are compatibility issues.
- If using the SMART goal-setting system, the goals must be:
A. Authentic
B. Astute
C. Ambitious
D. Achievable
D. Achievable
The SMART goal-setting system helps the individual develop goals that are structured and can be tracked and measured.
The SMART goal-setting system consists of the following:
- The structure of data supported by a hierarchical database is:
A. Many-to-many
B. One-to-many
C. Many-to-one
D. One-to-many and many-to-one
B. One-to-many
The structure of data supported by a hierarchical database is one-to-many (tree or parent-child) but not many-to-one because data connects only in descending order. Hierarchical databases are used for simple structures, such as telephone number listings, but are not adequate for the current demands of information storage; so, hierarchical databases have generally been replaced with relational databases, which are built on a table structure and allow both one-to-many and many-to-one relationships.
- When notified that a costly upgrade to the EHR is scheduled for implementation within the next few months, the first step should be to:
A. Evaluate the need for the upgrade.
B. Send RFIs to other vendors.
C. Determine how long the current version will be supported.
D. Request details and a demonstration.
D. Request details and a demonstration.
When notified that a costly upgrade to the EHR is scheduled for implementation within the next few months, the first step should be to request details and a demonstration. Most vendors will provide a demo version so that the organization can have a clear idea of the changes. Updates, such as adding new medications to the medication list, are frequent and usually involve no disruption in workflow or utilization of the EHR, but upgrades may be more problematic so they must be thoroughly assessed. Upgrades often improve functioning or respond to changes in regulations or technology.
- When a perpetrator attempts to obtain another person’s personal information (such as user name and password) through email by pretending to be an authorized individual, this is an example of:
A. Phishing
B. Spamming
C. Whaling
D. Clickjacking
A. Phishing
When a perpetrator attempts to obtain another person’s personal information, such as user name and password, through email by pretending to be an authorized individual, this is an example of phishing, which is a social engineering tech-nique. Additionally, phishing emails may contain infected downloads or links to malware. The emails may contain links to fake websites that are replicas of the real websites. In some cases, phishing may involve instant messaging or pop-up windows that ask for verifying data.
- The purpose of a migration plan during decommissioning of the computer information system (CIS) is to ensure:
A. The computer information system is properly deactivated.
B. Necessary legacy data are transmitted to the new system.
C. The hardware storage devices are removed and destroyed.
D. All legacy data are destroyed and irretrievable.
B. Necessary legacy data are transmitted to the new system.
In many cases, when a computer information system (CIS) is decommissioned, legacy data, such as workflows and clinical data, may need to be transferred to the new CIS. In that case, a migration plan should be developed to outline the project, including the legacy system structure and exactly what components will be transferred. Any migration requirements for hardware and software must be included as well as strategies and quality assurances for data migration and a security overview. The migration plan should also include the impact on interfaces, testing plan, and risks.
- In Kurt Lewin’s change theory, the first stage, motivation to change, is also referred to as:
A. Freezing
B. Unfreezing
C. Unfrozen
D. Refreezing
B. Unfreezing
Change theory stages:
1. Motivation to change (unfreezing): Dissatisfaction occurs when goals are not met. Previous beliefs are brought into question and survival anxiety occurs. Sometimes learning anxiety about having to learn different strategies causes resistance that can lead to denial, blaming others, and trying to maneuver or bargain without real change.
- Desire to change (unfrozen): Dissatisfaction is strong enough to override defensive actions and desire to change is strong but these must be coupled with identification of needed changes.
- Development of permanent change (refreezing): New behavior becomes habitual, often requiring a change in perceptions of self and establishment of new relationships.
- Staff members should be advised not to open email attachments unless they:
A. Know the sender and expect the attachment.
B. Run a virus scan program on the email and attachment.
C. Are using a secure network.
D. Ask a supervisor for permission.
A. Know the sender and expect the attachment.
Staff members should be advised not to open an email attachment unless they know the sender and expect the attach-ment. Even running a virus scan program is not sufficient because new viruses may be undetectable. The most common method for uploading malicious coding or viruses to a computer or network is to send them through email as an attachment.
For this reason, some organizations prohibit the use of email or prohibit opening of any attachments.
- For staff education, which of the following is an example of high-fidelity simulation?
A. Staff practice new EHR using real computers and software with test patients
B. Staff learn EHR skills while actually working and inputting data about real patients
C. Staff watch videos that demonstrate the proper use of the EHR
D. Staff use stereoscopic goggles to practice using the EHR in a virtual reality system
A. Staff practice new EHR using real computers and software with test patients
For staff education, an example of high-fidelity simulation is when staff practices a new EHR using real computers and software with test patients. High-fidelity simulations use real or realistic materials and equipment in order to learn new skills.
Low-fidelity simulations, on the other hand, are usually less expensive and utilize verbal, print, audio, or video materials, and may involve discussing processes and case studies rather than actually carrying out processes.
- The agency/organization that develops standards for information systems to support documentation of nursing practice is:
A. ANSI
B. HL7
C. CMS
D. ANA
D. ANA
The agency/organization that develops standards for information systems to support documentation of nursing practice is the ANA (American Nurses Association) through its Nursing Information and Data Set Evaluation Center (NIDSEC). The ANA
also evaluates information systems that are voluntarily submitted to the organization to determine if they meet the standards.
The ANA Committee on Nursing Practice Information Infrastructure (CNPII) reviews and recognizes taxonomies, nomencla-tures, and vocabularies.
- D: The agency/organization that develops standards for information systems to support documentation of nursing practice is the ANA (American Nurses Association) through its Nursing Information and Data Set Evaluation Center (NIDSEC). The ANA
also evaluates information systems that are voluntarily submitted to the organization to determine if they meet the standards.
The ANA Committee on Nursing Practice Information Infrastructure (CNPII) reviews and recognizes taxonomies, nomencla-tures, and vocabularies. - D: The agency/organization that develops standards for information systems to support documentation of nursing practice is the ANA (American Nurses Association) through its Nursing Information and Data Set Evaluation Center (NIDSEC). The ANA
also evaluates information systems that are voluntarily submitted to the organization to determine if they meet the standards.
The ANA Committee on Nursing Practice Information Infrastructure (CNPII) reviews and recognizes taxonomies, nomencla-tures, and vocabularies.
- According to the human-computer interaction (HCI) framework (Staggers), the primary focus of HCI is:
A. Usability
B. Design
C. Efficiency of operations
D. Interoperability
A. Usability
The primary focus of HCI is usability related to human performance during interactions with computers in different con-texts, including concerns regarding overall ease of use, difficulty in learning, efficiency, satisfaction, ability to carry out error-free interactions, and ability of the computer system to match the tasks. Another focus is the mental model of users, the idea that the users have regarding interactions with computers based on knowledge and experience.
- The primary purpose of the Nationwide Health Information Network (NwHIN) is to:
A. Ensure secure internet exchange of information through standards, policies, and services.
B. Provide servers and networks to facilitate secure exchange of information.
C. Provide licensure for healthcare facilities using the network to exchange information.
D. Provide a network for exchange of evidence-based guidelines.
A. Ensure secure internet exchange of information through standards, policies, and services.
The primary purpose of the Nationwide Health Information Network (NwHIN) is to ensure secure internet exchange of information through standards, policies, and services. NwHIN is funded by the Office of the National Coordinator for Health Information Technology (ONC). The primary goal is to assist healthcare providers to move from a system of paper medical records to a secure electronic health record that can be easily accessed by various healthcare providers and utilized to evaluate the quality of care.
- The goal of translational research is to:
A. Decrease variability in nursing practice.
B. Search coded data for patterns.
C. Translate foreign healthcare articles into English.
D. Translate medical/nursing research into interventions.
D. Translate medical/nursing research into interventions.
The goal of translational research is to translate medical/nursing research into interventions so that it is a basis for evi-dence-based practice. An important factor in translational research is that the scientific aspects of the research are understood by the healthcare providers so that they comply with the recommended interventions. One problem associated with translating research into interventions is that research often presents the most positive aspects of change rather than the negative, so problems may arise during application.
- User acceptance testing (UAT) should ideally be completed:
A. Immediately after a new system has gone live
B. Immediately before a new system goes live
C. During alpha or beta testing before implementation
D. During training sessions after a pilot program is completed
C. During alpha or beta testing before implementation
User acceptance testing (UAT) should ideally be completed during alpha testing (by the developer) or beta testing (by end users) before implementation of the system so that problems can be identified and user acceptance evaluated. Some actual end users should be included in testing, although some surrogate users may be included. If user acceptance is low, then the technology may not be used in the way in which it was intended, and this could result in errors.
- When setting training objectives, they should be clearly linked to:
A. Desired learning outcomes
B. Costs of training
C. Individuals’ needs
D. A specified time frame
A.Desired learning outcomes
Training objectives should be clearly linked to the desired learning outcomes so that the training has a defined purpose and outlines the path that participants need to achieve mastery. For example, if a training objective is for participants to be able to properly use medication management software, a desired learning outcome may be a reduction in medication errors. Training objectives should be written with action verbs, consistent with compliance and industry standards, and should meet the specific, measurable, relevant, time-bound (SMART) goal-setting system objectives.
- As part of an analysis of the interaction of people, processes, and technology, the informatics nurse creates a workflow diagram in order to:
A. Capture real-time data regarding tasks
B. Demonstrate how tasks are done and by whom
C. Create a timeline for the completion of tasks
D. Simulate workflow performance
B. Demonstrate how tasks are done and by whom
A workflow diagram is a visual illustration of the steps of a process and the individuals (e.g., nurse, doctor, clerk, information technologist) who carry out the process. Workflow diagrams use standardized shapes and symbols, such as arrows to indicate flow, rectangles for steps, diamonds for decision points, and ovals for beginning and ending points. Connectors (lines) join the different steps, and steps may be labeled with text. Types of workflow diagrams include flowcharts, process flow diagrams, data flow diagrams, and swim lane diagrams.
- Under Meaningful Use regarding EHRs for eligible hospitals and critical access hospitals (CAHs), which of the following is a core objective?
A. Record smoking status for patients 16 years and older
B. Provide patient with paper copies of their health information on request
C. Provide clinical summaries for patients
D. Record and chart changes in height and weight
D. Record and chart changes in height and weight
Under Meaningful Use regarding EHRs for eligible hospitals and critical access hospitals (CAHs), a core objective is to record and chart changes in height and weight. Current core objectives include using CPOE for medication orders; implementing drug/drug and drug/allergy interaction checks; maintaining current problems, medication, and allergy lists; recording demographics; recording and charting changes in height, weight, BMI, and BP, as well as growth charts for children; recording smoking status for patients at least 13 years; implementing one clinical decision support rule of a high priority hospital condi-tion; providing electronic copies of health information and discharge instructions on request; and protecting electronic health information.
- When an institution is transitioning to a CPOE, a primary role of the informatics nurse is that of:
A. System designer
B. Purchasing agent
C. Software modifier
D. Liaison
D. Liaison
When an institution is transitioning to a CPOE, a primary role of the informatics nurse is that of liaison to promote multidisciplinary collaboration and cooperation among the various members of the healthcare team, including nurses, physicians, and IT specialists, to ensure that the end-product has the functionality that is needed for workflow and that it meets the requirements for safety and security. Needs regarding both hardware and software must be clearly communicated to IT personal
- In a computer, which of the following is considered permanent data storage?
A. CPU
B. IDE
C. RAM
D. SSD
D. SSD
In a computer, an SSD (solid-state drive) is a type of permanent data storage. Another type of permanent storage is a hard disk, where the information is encoded into magnetic bits. While data storage is considered permanent, hard disks and SSDs can fail, resulting in loss of data. By the same token, data that have simply been deleted can often be retrieved, posing a security risk for decommissioned equipment. As such, more drastic measures are required to completely destroy information on permanent storage. This can include strong magnets, fire, or crushing force.
- The type of personal health record (PHR) that is standalone and not connected to a particular system or electronic health record EHR) is:
A. Paper/personal files
B. Untethered
C. Tethered
D. Networked
B. Untethered
Untethered PHRs are standalone and not connected to a particular system or EHR. Information may be carried on a smart card, flash card, CD, or DVD. These pose more security risks than tethered PHRs and require more input from the individual to maintain accurate records. In tethered PHRs, data are tied to a particular system and EHR and are often web-based. A secure patient portal is provided so the individual can access all or parts of the records. In networked PHRs, data are derived from multiple sources in a network rather than one system. This allows for more flexibility. In paper/personal files, patient-maintained paper records are contained.
- The HIPAA Security Rule (2003) focuses primarily on the security of:
A. All types of medical records
B. Coding and billing procedures
C. Electronic protected health information
D. Healthcare organizations
C. Electronic protected health information
HIPAA established the Privacy and Security Rules, both of which took effect in 2003:
Privacy Rule: Ensures patients’ rights. Protects any information included in a medical record (paper or electronic) as well as conversations between a doctor and another healthcare provider, billing information, and any other form of heath information
Security Rule: Focuses on electronic protected health information. The rule protects the privacy of individuals but allows the adoption of new technologies, so it allows for flexibility and scaleability
- When completing process mapping for workflow, which of the following is an example of a process at the micro level?
A. Admitting a patient
B. Transferring a patient from one unit to another
C. Completing a blood draw for a lab test
D. Completing wound assessment, irrigation, and dressing change
C. Completing a blood draw for a lab test
Process mapping may be done at three different levels:
Macro level: A general overview of a process with many component parts, such as admission procedures
Mini level: Process steps in a procedure that involves a number of different tasks, such as completing wound assess-ment, irrigation, and dressing change or transferring a patient
Micro level: Process steps in detail that one individual will take to carry out one procedure, such as completing a blood draw
- During the explorative phase of selecting an information system, which of the following assessment methods is most useful in order to observe the practices in an organization and to identify those agents controlling change?
A. Field study
B. Focus group
C. Delphi
D. SWOT analysis
A. Field study
During the explorative phase of selecting an information system, the assessment method that is most useful in order to observe the practices in an organization and to identify those agents controlling change is a field study, which obtains data from the work environment itself. Data may be obtained by direct observation as well as one-on-one interviews, questionnaires, and surveys. Those conducting the field study may do so as a complete observer (not interacting) or as a participant.
- A collection of data about one particular hospital unit to facilitate decision-making by administration is a:
A. Data mart
B. Data warehouse
C. Data file
D. Data mine
A. Data mart
A collection of data about one particular hospital unit or a specific topic to facilitate decision-making by administration is a data mart. This may be as small as one database or may be a compilation of databases, but is generally a subset of a data warehouse (AKA enterprise data warehouse), which is a very large database or storage depository with integrated data. The data warehouse includes all of an organization’s databases. The data warehouse may be utilized for reporting of data as well as data mining for analysis.
- Which governmental agency is responsible for oversight and enforcement of HIPAA’s Privacy Rule?
A. Centers for Disease Control and Prevention (CDC)
B. Federal Communications Commission (FCC)
C. Chairman. Food and Drug Administration (FDA)
D. Office for Civil Rights (OCR)
D. Office for Civil Rights (OCR)
The governmental agency responsible for oversight of HIPAA’s Privacy Rule is the Office for Civil Rights (OCR), which is part of the Department of Health and Human Services (DHHS). An organization must have procedures in place to limit access to PHI and to limit disclosures to only authorized personnel. HIPAA’s Privacy Rule protects data in the EHR as well as personal communications between the patient and healthcare providers. Billing information is also protected.
- When developing teams for quality improvement processes, the informatics nurse should recognize that power issues among the team members often begin with observations of the:
A. Hierarchical staff roles
B. Team leader
C. Other team members
D. Task requirements
B. Team leader
When developing teams for quality improvement processes, the informatics nurse should recognize that power issues among the team members often begin with observations of the team leader. The team members observe the manner in which the leader uses power and controls the meetings, and, based on these observations, usually begin to form alliances and may begin to exercise individual or group control. This often occurs early in the team-building development and can facilitate team work or hinder it.
- If the informatics nurse wants to provide continuing education units for staff training courses, the first step is to:
A. Send course outlines to the state Board of Nursing.
B. Survey staff.
C. Notify the administration.
D. Query the state Board of Nursing.
D. Query the state Board of Nursing.
If the informatics nurse wants to provide continuing education units for staff training courses, the first step is to query the state Board of Nursing to determine rules and regulations about what an approved course must contain and how many contact hours are needed. The Boards of Nursing may vary in requirements for continuing education units and may have different procedures. For example, the state of California approves providers but not individual courses.
- The informatics nurse should be aware that one of the most common problems with EHRs related to safety is:
A. Failing to document patient information
B. Disclosing passwords to unauthorized personnel
C. Displaying inaccurate ID information on screens
D. Documenting patient information on the wrong record
D. Documenting patient information on the wrong record
The informatics nurse should be aware that one of the most common problems with EHRs related to safety is documenting patient information on the wrong record. If undetected, this presents a serious danger to the patient. If detected and cor-rected, this takes time away from patient care. One method of assessing this problem is to review when information on one record has been removed or identified as an error and the same information is immediately applied to another record.
- The purpose of a software version control system is to:
A. Manage code changes and maintain a history of revisions.
B. Ensure that the latest version of software is uploaded.
C. Identify errors in software applications.
D. Provide security features to protect software.
A. Manage code changes and maintain a history of revisions.
Software version control (aka source control) systems help manage code changes and maintain a history of code revi-sions, including who made the changes and when. Version control systems may be centralized (i.e., all code and history being stored in one repository) or distributed (i.e., each developer has a copy of the code and history). Software version controls systems provide backup so that code is not lost and developers can revert back to an earlier code. It can also allow multiple developers to work on the same project.
- The informatics nurse may recommend gap analysis in order to determine the:
A. Cause of decreased efficiency and/or financial instability
B. Resources that resulted in increased performance and efficiency
C. Resources needed to move from the current state to a proposed state
D. Gaps in security in the electronic health system and use of mobile devices
C. Resources needed to move from the current state to a proposed state
The informatics nurse may recommend gap analysis in order to determine the resources (including time) needed to move from the current state to a proposed state. Gap analysis looks at the “gap” between a current state and a desired one. Steps include assessing the current situation, identifying current processes and outcomes, identifying target outcomes, outlining steps needed to achieve target goals, identifying gaps, and identifying resources and measures needed to close the gaps.
- Which of the following is likely most useful for root cause analysis?
A Prioritization matrix
B. Gantt chart
C. Events and causal factors analysis (E&CFA) chart
D. Delphi technique
C. Events and causal factors analysis (E&CFA) chart
An events and causal factors analysis (E&CFA) chart, which is a combination of affinity diagram and flow chart, is likely most useful for root cause analysis. Steps in a sequence leading up to an event (such as a sentinel event) are outlined as in a flow chart with arrows connecting the events that are listed chronologically and then all possible causal factors are identified for each step by asking why as in am infinity diagram.
- If the informatics nurse is to facilitate usability testing of an information system and applications, the informatics nurse should begin by:
A. Creating test scenarios and identifying metrics
B. Recruiting participants from various departments
C. Arranging for observers to assist with the testing
D. Securing a space for usability testing to take place
A. Creating test scenarios and identifying metrics
The informatics nurse should begin planning for usability testing by creating test scenarios, which typically reflect the ways in which participants will need to use the equipment, and identifying usability metrics. Then, the informatics nurse must recruit a representative group of end users to participate in the testing. Participants may be asked to think out loud and talk through the procedure, noting any problems or issues while expert observers take notes of the participants’ interactions. Collected data is then analyzed, and a usability report is completed with recommendations.
- When planning staff training for EHR implementation, the informatics nurse should keep in mind that the best retention is likely to occur if the participants:
A. Read material about EHRs.
B. Listen to a lecture and audiotapes about EHRs.
С. Research and give presentations about EHRs.
D. Practice using the EHR with real equipment.
D. Practice using the EHR with real equipment.
When planning staff training for EHR implementation, the informatics nurse should keep in mind that the best retention is likely to occur if the participants practice using the EHR with real equipment, which includes both speaking (providing feed-back, asking questions) and doing. Retention at 24 hours is about 90% with this method of instruction. The least effective method of retention is reading, which results in only about 10% comprehension, followed by listening (20%), viewing (30%), listening and viewing (50%), and speaking and writing (70%).
- According to von Bertalanffy’s systems theory, the five elements that comprise a system are:
A. Input, throughput, output, evaluation, and feedback
B. Tasks, contexts, parameters, processes, and outcomes
C. Data, resources, processes, feedback, and adaptation
D. Program, project, process, procedure, and product
A. Input, throughput, output, evaluation, and feedback
According to von Bertalanffy’s systems theory, the five elements in a system include:
Input: This is what goes into a system in terms of energy or materials.
Throughput: These are the actions that take place in order to transform input.
Output: This is the result of the interrelationship between input and processes.
Evaluation: This is ongoing monitoring for success or failure.
Feedback: This is information that results from the process and can be used to evaluate the end result.
Systems theory postulates that the entire system must be viewed holistically rather than concentrating on components of the systems because the interrelationships among different elements of the system must be understood.
- If the informatics nurse is concerned that a computer system may not function well during peak times of access, the type of testing needed is:
A. Load/volume testing
B. System integration testing
C. Black box testing
D. Functional testing
A. Load/volume testing
If the informatics nurse is concerned that a computer system may not function well during peak times of access, the type of testing needed is load/volume testing. This is a non-functional testing for reliability that assesses the ability of the system to function under various loads, such as at peak times when multiple users in multiple departments are accessing the system. The purpose of load/volume testing is to determine the maximum load capacity and to identify the load at which problems begin to occur. Testing is done at both the safe working load (SWL) and above the SWL.
- To facilitate the scalar chain principle of management, an organization needs to outline the:
A. Chain of command
B. Placement of resources
C. Focus of direction
D. Organizational rules
A. Chain of command
Fayol (1916) proposed 14 principles of management, which include the principle of the scalar chain. This principle describes the organizational hierarchy, specifically the chain of command that allows communication to flow from lower to higher in the hierarchy to reduce misunderstandings and miscommunication. Every member of an organization should understand to whom the person must report. This principle also allows for a “gangplank” (i.e., horizontal communication between different departments to save time). The next person in the chain of command should be made aware of horizontal communi-cations.
- The process of “thinking aloud” is used for:
A. Post-test assessment
B. Pre-test assessment
C. Performance testing
D. User aptitude testing
C. Performance testing
The process of “thinking aloud” is used for performance testing.
- Before committing to a cloud service provider, the organization should:
A. Sign a Service Level Agreement (SLA) outlining requirements.
B. Request permission from CMS to utilize a cloud service.
C. Advise the service that it must comply with HIPAA regulations.
D. Ensure that the organization will benefit from cost savings.
A. Sign a Service Level Agreement (SLA) outlining requirements.
Before committing to a cloud service provider, the organization should sign a Service Level Agreement (SLA) that outlines requirements, including the need to adhere to HIPAA Security Rules and ensure privacy of PHI, because the ultimate legal responsibility lies with the healthcare organization that owns the data. The SLA should make clear administrative controls and the types of physical and technical security utilized, as well as where data may be stored, as data that are stored overseas are
- According to Benner’s stages of clinical competence, a nurse who has 2-3 years of experience and the ability to master new situations but who needs extra planning time and may lack flexibility is considered to be:
A. An advanced beginner
B. Competent
C. Proficient
D. An expert
B. Competent
According to Benner’s stages of clinical competence, a nurse who has 2-3 years of experience and the ability to master new situations but who needs extra planning time and may lack flexibility is competent. The 5 stages are (1) novice (little experience and rule-governed), (2) advanced beginner (some experience with new situations), (3) competent (see above), (4) proficient (thinks holistically and relies on experience, adaptable), and (5) expert (has a wealth of experience and acts intuitively).
- According to the XY theory of organizational behavior (McGregor 1960), attitudes toward workers are based on:
A. Work output
B. Data
C. Observations
D. Assumptions
D. Assumptions
- D: The XY theory (McGregor, 1960) theorizes that workers are managed according to conflicting assumptions:
X: Workers are unmotivated, resistive to change, unintelligent, and do not care about the organization; furthermore, they dislike work.
Y: Workers are basically creative and can exercise ingenuity
- When utilizing the FOCUS (find, organize, clarify, uncover, start) model of performance improvement, FOCUS is usually combined with:
A. QIP (Quality Improvement Process)
B. PDCA (plan, do, check, act)
C. Six Sigma
D. FADE (focus, analyze, develop, execute)
B. PDCA (plan, do, check, act)
When utilizing the FOCUS (find, organize, clarify, uncover, start) model of performance improvement, FOCUS is usually combined with PDCA (plan, do check, act) to create a 9-step process because FOCUS is not complete by itself. FOCUS is used primarily to identify problems in an organization, organize a response, clarify the solution to the problems, and start the change process. The FOCUS model does not include the steps necessary to find solutions to the problems, so PDCA, a method of continuous quality improvement, helps to solve specific problems.
- Which of the following is the primary reason for conducting end-user testing?
A. To identify user competencies
B. To identify errors
C. To determine volume capability
D. To determine ongoing education needs
B. To identify errors
The primary reason for conducting end-user testing is to identify errors. Testing is carried out by end users to ensure that the computer system functions correctly and meets the organization’s needs. Analysis may include asking end users to carry out specific tests, interviews with users, questionnaires regarding usability, comparative testing with users comparing work on two different systems, direct observation (over-the-shoulder), and indirect observation (audio/video feeds). Computer-generated data may be evaluated for accuracy and errors.
- The Health Information Technology for Economic and Clinical Health (HITECH) Act under the Enforcement Interim Rule provides:
A. Criminal/civil penalties for violations of HIPAA rules
B. Funding for organizations to develop security protocols
C. Guidelines for organizations to develop security protocols
D. Guidelines for application of HIPAA privacy and security rules
A. Criminal/civil penalties for violations of HIPAA rules
The Health Information Technology for Economic and Clinical Health (HITECH) Act under the Enforcement Interim Rule provides criminal/civil penalties for violations of HIPAA rules. HITECH outlines 4 levels of violations and corresponding penalties, which cannot exceed $1.5 million for all violations of the same provision. Lack of awareness of the rules and regulations is not considered a defense or protection from penalties. HITECH establishes the Health IT Policy Committee, which makes recommendations regarding implementation of a national health IT infrastructure.
- If the informatics nurse is utilizing Boolean logic for a query, the three operators are:
A. SELECT, FROM, and TO
B. AND, OR, and NOT
C. AND/OR and BETWEEN
D. Where, and/or, and not
B. AND, OR, and NOT
If the informatics nurse is utilizing Boolean logic for a query, the three operators are AND, OR, and NOT, and they are case sensitive and must be capitalized. Two symbols-quotes (“ “) and parentheses ()—are also used. The operators can narrow results (AND) because sources with only one term are eliminated, expand results (OR) because sources with either term are returned, or exclude results (NOT). The operator NOT must always be preceded by AND (Liver AND cirrhosis AND NOT alcohol
- Artificial intelligence (AI) is currently used in healthcare primarily to:
A. Control robotic surgery autonomously
B. Prescribe treatment
C. Resolve ethical dilemmas
D. Provide clinical decision support
D. Provide clinical decision support
Artificial intelligence (AI), a machine simulation of human intelligence, is increasingly used as part of clinical decision support and to provide imaging analysis but will likely have expanded uses in the near future. Al is not currently used to pre-scribe treatments, only to recommend, and it does not have the ability to resolve ethical issues. Al may be part of a robotic sys-tem, but the surgeon is still in control, so Al does not autonomously carry out surgical procedures.
- Small form factor (SFF) (“footprint”) computers typically:
A. Use less energy than standard computers.
B. Have less volume than standard computers.
C. Use only “green” technology.
D. Are elevated on “legs.”
B. Have less volume than standard computers.
Small form factor (“footprint”) (SFF) computers typically have less volume than standard computers so that they take up less desk space. Because of their smaller size, SFF computers may have fewer expansion slots, but usually the same features are available in this format. The shape of the computer may differ from other computers as well, with some cube-shaped, book-shaped, and box-shaped. Because there is no industry standard for SFF computers, they vary widely according to manufacturer.
- Incentives for “meaningful use” of EHRs are provided by:
A. CMS
B. NIH
C. FDA
D. FCC
A. CMS
Incentives for “meaningful use” of EHRs are provided by CMS. The American Recovery and Reinvestment Act (ARRA) and its Health Information Technology Act (HITECH) provision allocated $19 billion dollars for a 5-year period for incentives for hospitals and ambulatory care centers, beginning in 2011, and authorized the CMS to provide the incentives to hospitals and eligible providers. Five criteria for meaningful use include (1) improve healthcare quality and reduce disparities, (2) engage both patients and families, (3) improve coordination of care, (4) improve population and public health, and (5) ensure PHI is secure and private.
- Which of the following is an example of a low-level error in inputting or outputting data?
A. User executes the wrong sequence of steps in inputting data
B. User inputs data that are incompatible with the computer system
C. User is unable to make a decision about the correct action
D. User is unable to correctly interpret outcomes data
A. User executes the wrong sequence of steps in inputting data
An example of a low-level error in inputting of data is when the user executes the wrong sequence of steps. This type of error usually results in some type of alarm or hard stop of the program until corrected, so the error can usually be corrected fairly easily. A moderate-level error includes inputting data that are incompatible with the computer system. High-level errors include being unable to make a decision about the correct action or being unable to correctly interpret outcomes data.
- When preparing for a vendor analysis, the initial phase is:
A. Define: technical requirements and prospective vendors
B. Identify: review requests for information (RFIs)/requests for proposal (RFPs) and narrow the list
C. Strategize: consider needs and future direction
D. Evaluate: demonstrations, site visits, and due diligence
C. Strategize: consider needs and future direction
Vendor analysis is carried out in a number of phases:
Strategize: Consider organizational needs, the reason for vendor analysis, and future needs. This process must be
done without bias.
• Define: Determine technical requirements, conduct market research, develop a list of vendors, and send requests for information (RFIs) and requests for proposals (RFPs).
Identify: Review the RFIs/RFPs, and narrow the list of vendors.
Evaluate: Focus on the remaining vendors with demonstrations, site visits, reference calls, and due diligence.
Partner: Enter into a contractual agreement with the selected vendors).
- In a hospital that uses a barcode scanning for medications, one nurse has made copies of patients’ wristbands and attached them to the top of the medication cart. This probably represents:
A. Efficiency
B. Data misuse
С. Negligence
D. Work-around
D. Work-around
In a hospital that uses a barcode scanning for medications, one nurse has made copies of patients’ wristbands and stached them h the top of the edicating the This probably represents one around, a ho put to the prover ethods are common with barcode scanning because barcode bracelets may become soiled, may be lost, and may be difficult to read, increasing the amount of time needed to pass medications.
- When utilizing SAS Enterprise guide to query a database, if the derived data are to be saved permanently, the correct format is:
A. Data view
B. Report
C. Data table
D. Data table or data view
C. Data table
When utilizing SAS Enterprise guide to query a database, if the derived data are to be saved permanently, the correct format is the data table format. The data are saved and not updated until a query is rerun to gain additional information. With the data view format, the data are continually updated each time the results are opened and historical data are not saved. The report format is especially formatted so that it can be presented with options including HTML, PDF, text, or RTF but tasks cannot be completed for results in this format.
- Which of the following interface terminologies is used for classification of nursing diagnoses?
A. NIC
B. NANDA-I
C. NOC
D. PNDS
B. NANDA-I
NANDA-I (NANDA International): used for standardized classification of nursing diagnoses according to a multiaxial tax-ontonomy of classes.
- In a relational database, normalization refers to:
A. Grouping discrete parts of data into larger units
B. Allowing transactions to occur
C. Using terminology in common usage
D. Reducing the redundancy of data
D. Reducing the redundancy of data
In a relational database, normalization refers to reducing the redundancy of data so that data are stored in one place and not multiple places within the database and errors in data are removed. Thus, normalization is a method of cleaning and sim-plifying. Three common forms of normalization are (1) first normal form (1NF), (2) second normal form (2NF), and (3) third normal form (3NF). Each form of normalization has more stringent requirements than the previous form.
- In an EHR with CPOE and CDS, allergy alerts should be triggered:
A. On physician request by accessing a link
B. Before orders are written
C. After orders are written
D. In response to contraindicated drug orders
B. Before orders are written
In an EHR with CPOE and CDS, allergy alerts should be triggered before orders are written and they should be automat-ed. Alerts that occur after orders are written are more likely to be ignored or overridden. Additional alerts, including hard stops, should occur if orders for contraindicated drugs or drugs to which the patient is allergic are ordered despite the original alert. The alerts should be carefully evaluated because excessive alerts may result in “alert fatigue” to the point that clinicians begin to ignore them.
- Data are classified as “dirty” when:
A. The database has not been backed up.
B. The database can be accessed by multiple individuals.
C. The database contains errors.
D. The database is outdated.
C. The database contains errors.
Data are classified as “dirty” when the database contains errors that render the data inaccurate. This compromises the data integrity. Dirty data may result from human errors in entering data (such as misspelling a name or incorrectly entering an ID number). Dirty data may also result from viruses, worms, or other bugs installed into a system. Hackers may enter a system and alter or remove data. Hardware and software may fail, corrupting or destroying data.
- CMS provides a standardized structure with suggested clinical data elements. This structure is used to facilitate data collection and document patient procedures and clinical workflows in order to ensure accuracy and reduce risks. It is referred to as a:
A. Template
B. Flowsheet
C. Diagram
D. Scorecard
A. Template
CMS provides templates, standardized structures with suggested clinical data elements, so that organizations can collect data and document patient procedures and clinical workflow more accurately. The use of templates helps to reduce risks. Templates can be integrated into existing EHRs and can be customized as needed because, although they provide a framework or blueprint for services, all sections of a template may not apply to the patient services provided by a healthcare organization.
With Total Quality Management (TQM), the primary focus is on:
A. Providing cost-effective care
B. Satisfying the needs of the customers
C. Ensuring organizational consistency
D. Promoting staff satisfaction
B. Satisfying the needs of the customers
With Total Quality Management (QM), the primary focus is on satisfying the needs of the customers. The organization conducts various assessments (surveys, interviews, focus groups) to determine customer needs and engages the entire organization at all levels in the improvement process with teamwork and participation encouraged. Measurement is central to TQM’s processes, so criteria are identified through brainstorming and other methods, and quality improvement is measured. For TQM to be successful, it must be supported by top management.
- Of the four levels of practicing nurses (beginning, experienced, informatics nurse specialist, and informatics innovator) related to informatics, which of the following characterizes the expectation regarding the skills of a beginning nurse?
A. Determines trends based on data in the computer information system
B. Applies and integrates the core informatics sciences
C. Manages patients using the organization’s computer information system
D. Conducts informatics research and produces informatics theories
C. Manages patients using the organization’s computer information system
Of the four levels of practicing nurses (beginning, experienced, informatics nurse specialist, and informatics innovator) related to informatics, the expectation of a beginning nurse regarding knowledge is the ability to manage patients using the organization’s computer information system. Other expected knowledge includes a basic comprehension about how the computer and internet functions and the understanding of how to use the computer to carry out required tasks, such as sending and receiving emails and doing internet searches for information.
- Which one of the following is a form of nonfunctional testing?
A. Usability
B. Closed box
C. Integration
D. User acceptance
A. Usability
Nonfunctional testing is associated with factors that improve the experience of the user but do not relate to actual func-tionality. Usability testing is one form of nonfunctional testing. Usability testing involves assessing the ease and efficiency of use, tolerance for errors, satisfaction with use, and successful use for the intended task. Usability testing can validate design decisions, indicate problems with use (such as unclear navigation or directions), and help develop user-friendly design deci-sions.
- A patient fails to complete diagnostic tests ordered by a physician; subsequently, the physician fails to follow up with the patient, who experiences a myocardial infarction and claims that the physician was negligent. What type of negligence does this represent?
A. Negligent conduct
B. Gross negligence
C. Contributory negligence
D. Comparative negligence
C. Contributory negligence
Contributory negligence involves the injured party/patient contributing to his or her own harm. Contributory negligence is a consideration in malpractice actions. In this case, the patient did not follow through with diagnostic tests that may have indicated increased risk of a myocardial infarction, so the physician did not have adequate information. Other types of negligence include negligent conduct in which an individual fails to provide reasonable care based on standards and expertise, gross negligence in which an individual willfully provides inadequate or substandard care, and comparative negligence in which the percentage of negligence is attributed to each individual involved.
- The best method to ensure that nurses follow an evidence-based practice is to:
A. Offer group classes.
B. Print flyers.
C. Give one-on-one instruction.
D. Embed it into electronic nursing documentation.
D. Embed it into electronic nursing documentation.
The best method to ensure that nurses follow an evidence-based practice is to embed it into electronic nursing docu-mentation. Embedding may include alerts, pop-up boxes with clinical information, and adding interaction, which increases staff engagement. Any information should include references so that the nurses can do follow-up research. When possible, nurses should be rewarded in some way for participation, such as with continuing education credits, a certificate of comple-tion, or time off.
- The type of data that includes pharmacy transactions, required reports, financial information, and demographic information is:
A. Medical/Clinical
B. Knowledge based
C. Comparison
D. Aggregate
D. Aggregate
Aggregate data includes pharmacy transactions, required reports, demographic information, financial information, hazard and safety practices, and most things not included in the clinical record. Medical/clinical data includes patient-specific information regarding the patient, diagnosis, treatment, laboratory findings, consultations, care plans, physician orders, and information related to informed consent and advance directives. The medical record should include records of all procedures, discharge summary, and emergency care records. Knowledge based data includes methods to ensure that staff is provided training, support, research, library services, or other access to information, and good practice guidelines. Comparison data includes internal comparisons or external comparisons to benchmarks or best-practice guidelines.
- Which of the following governmental agencies has established certification requirements for the exchange of data electronically?
A. FCC
B. ONC
C. NSF
D. NIH
B. ONC
The governmental agency that has established certification requirements for the exchange of data electronically is the
ONC (Office of the National Coordinator for Health Information Technology), which is part of the US Department of Health and Human Services and was mandated by the HITECH Act to coordinate national implementation of health information technology and data exchange. Data interfaces should be HL7 compatible, and data must be sent using secure encryption.
- Detecting anomalies, identifying relationships, classifying, regressing, and summarizing are steps to:
A. Data aggregation
B. Data representation
C. Data fusion
D. Data mining
D. Data mining
Data mining is the analysis (often automatic) of large amounts of data to identify underlying or hidden patterns. The steps to data mining include detecting anomalies, identifying relationships, clustering, classifying, regressing, and summariz-ing. The effectiveness of data mining depends on many factors, such as hardware and software applications. Data mining may identify similar groupings in data, and these groups can then be further analyzed. Data mining may be applied to multiple patients’ electronic health records to generate information about the need for further examination or interventions.
- According to the contingency theory of organizational behavior, leadership should be:
A. Authoritative
B. Decentralized
C. Appropriate for needs
D. Standardized
C. Appropriate for needs
The contingency theory of organizational behavior (Fiedler, Vroom, Yetton) states that there is no one best method of organizing an organization because it is contingent on several factors; therefore, what works in one organization may not work in another. Leadership should be appropriate for the organizational needs, and different organizations require different styles of leadership. Contingency factors can include size, task complexity, environment (i.e., internal, external, market conditions), technology, organizational culture, employee characteristics, hierarchy, and strategies.
- Clinical practice guidelines should be based primarily on:
A Consensus
B. Evidence based research
C. Expert opinion
D. Historical practice
B. Evidence based research
Clinical practice guidelines are recommendations that help healthcare providers make appropriate decisions regarding specific clinical situations. Clinical practice guidelines are based primarily on evidence-based research
- For ease of reading, when highlighting text on the screen, the best method is to:
A. Italicize
B. Bold
C. Underline
D. Place rext on a colored background
C. Underline
When highlighting text, underlining is more evident than italicizing and bolding because screens have different lighting and resolution. Text against a colored background, especially a deep color, is difficult to read. Colored fonts may be used sparingly to highlight different types of information. Using a variety of fonts and multiple sizes on one screen can be very distract-ing. Long paragraphs should be avoided and information broken into small chunks with adequate white space to rest the eyes.
- When considering improvements to workflow processes, the first issue to address is whether steps in a process:
A. Can be combined.
B. Should be increased.
C. Require alternate paths.
D. Can be eliminated.
D. Can be eliminated.
When considering improvements to workflow processes, the first issue to address is whether steps in a process can be eliminated because the goal is to simplify while still maintaining the integrity of the process. Eliminating steps may result from purchasing new equipment, altering product design, or changing the environment (such as carrying out a process at point of care rather than in another area). In some cases, steps may be simplified by combining some steps with others or by changing the order of steps.
- In trending analysis, which of the following indicates a sentinel event?
A. A run
B. A trend
C. An astronomical value
D. A cycle
C. An astronomical value
Rules applied to trending analysis:
Astronomical value: Data point unrelated to other points indicates sentinel event or special cause variation
Run (shift): ≥7 consecutive data points all above or all below the median (run chart) or mean (control chart)
Trend: ≥7 consecutive data points in either ascending or descending order with ≥21 total data points or ≥6 with fewer than 21 total data points
Cycle: Up and down variation forming a sawtooth pattern with 14 successive data points, suggestive of systemic effect on data; if the trend is related to common cause variation, the variation may be demonstrated with 4-11 successive data points
- According to the concept of groupthink in communication, in order to avoid conflict, members of a group may:
A Prolong decision making
B. Make hasty decisions
C. Avoid making decisions
D, Arrive at conflicting decisions
B. Make hasty decisions
Groupthink (Whyte, Janis) theorizes that group members avoid conflict by reaching consensus without analysis, resulting in hasty decisions that may be ill-conceived. Members tend to censor their own ideas and pressure others to conform in order to maintain consensus and may assume that if people remain silent that they agree. Some members may take on the role of
“mind guard” to protect the other members from opinions that do not conform. Members often think they are invincible and morally right, which can result in ethical or moral consequences for their poor decision making.
- Which of the following is a multidisciplinary terminology?
A. NANDA
B. ОМАНА
C. ICNP
D. SNOMED-CT
D. SNOMED-CT
Systematic Nomenclature of Medicine Clinical Terms (SNOMED-CT) is a multidisciplinary terminology that allows terminology from one classification system to be mapped to concepts from another, such as NANDA, NIC, and NOC. SNOMED-CT contains diagnoses, interventions, and outcomes. Other multidisciplinary terminologies are the Alternate Billing Codes (ABC), used for alternative and complementary treatments, and Logical Observations identifiers, Names, and Codes (LOINC), which includes outcomes and assessments and is used for laboratory results.
- A tool for demonstrating the association between data entities and their attributes within a system is the:
A. Entity-relationship diagram
B. Gantt chart
C. Business process model and notation
D. State transition diagram
A. Entity-relationship diagram
An entity-relationship diagram (ERD) is a specific type of flowchart that visually represents the relationship between different entities and their attributes within a system. Entities can include objects (including people) and concepts, while attributes are characteristics of an entity. For example, an entity may be a nurse, and an attribute may be an identification number or name. The ERD demonstrates the type and number of relationships between entities. ERDs are often used during design of a database system.
- The three primary concerns regarding secure network information are (1) confidentiality, (2) availability, and (3):
A. Integrity
B. Communication
C. Failure
D. Determination
A. Integrity
The three primary concerns regarding secure network information are (1) confidentiality, (2) availability, and (3) integrity.
An organization needs a clear confidentiality policy to ensure the privacy of data and to prevent accidental disclosures, such as may occur with badly placed monitors or shoulder surfing. Availability includes having an acceptable use policy and protecting hardware, such as keyboards from spills. Integrity is exemplified by trust that a system can be trusted to provide accurate infor-mation.
- Which of the following segments of the National Drug Code (NDC) format for barcoding medications is assigned by the FDA?
A. Product code
B. Package code
C. Product and package code
D. Labeler code
D. Labeler code
The National Drug Code (NDC) used for barcoding of medications is recommended by the FDA for use on all inpatient medications and vaccines, applied at the unit dose to decrease the risks of medication errors. An NDC is a code of 10 or 11 digits divided into 3 sections:
…
Labeler code (4-5 digits): Assigned by the FDA and represents the manufacturer, re-packager, or distributer Product code (3-4 digits): Assigned by the labeler and describes the medication, strength, and dose
Package code (1-2 digits): Assigned by the labeler and describes the package form and size
- The revenue cycle in healthcare begins with:
A. Budget / Planning
B. Preauthorization/clearance
C. Patient scheduling
D. Patient arrival
C. Patient scheduling
The financial processes that a healthcare organization uses to manage administrative and clinical processes comprises the revenue cycle. The revenue cycle represents a business transaction in healthcare and begins when the patient is scheduled and terminates with receipt of payment and reconciliation of all charges. Managing the revenue cycle requires the collection of appropriate data, verification of eligibility, accurate documentation, appropriate coding, prompt billing, collections procedures, dispute resolution, and payment posting procedures.
- Relevant data refers to data that:
A. Are available when needed.
B. Can be used for various purposes.
C. Derive from clean data.
D. Apply to user’s needs.
D. Apply to user’s needs.
Relevant data refers to data that apply to users’ needs; therefore, the determination as to whether data are relevant is relatively subjective, depending on whether the data meets the specific needs of a user at a specific time. Timely data are available when needed. Flexible data can be used for various purposes; for example, data about supplies may be accessed and utilized by various departments to obtain supplies and by others to determine budgetary or ordering needs. Reliable data provides reliable
- If assisting a team with meta-analysis, the informatics nurse should advise the team to begin with:
A. Interviews with experts
B. A bibliographic database
C. manual library search
D. A list of preferred sources
B. A bibliographic database
If assisting a team with meta-analysis, the informatics nurse should advise the team to begin with a bibliographic data-base, such as MedlinePlus (free access), Cumulative Index to Nursing and Allied Health (CINAHL) (subscription access), or Cochrane Library (subscription access). Meta-analysis applies statistical methods to evaluate the results of multiple studies on a related topic. Once a list of articles is obtained, further sources may be gleaned from the reference list for each article. Addi-tionally, information may be gained from unpublished works, such as conference presentations.
- Which of the following would be the most likely network type used to connect the departments in an organiza-tion?
A. VSN
B. LAN
C. WAN
D. MAN
B. LAN
The network that connects the departments in an organization is likely a LAN (local-area network). Many LANs nowadays are Wi-Fi-based: WLANs (wireless local area networks). Larger networks, such as in a city or an area of a city are MANs (met-ropolitan area networks). A network that encompasses a much larger area, such as a country, is a WAN (wide area network).
- If needing to convey information to 100 members of an organization, which mode of communication is likely the most effective?
A. Face to face
B. Written email
C. Posted notices
D. Telephone
B. Written email
Email is usually the most effective means of communicating with large numbers of individuals because communication can be sent very rapidly and can be secure. Emails can be sent from almost anywhere and are asynchronous, so the sender and receiver do not need to be available at the same time. Additionally, emails have attachment support, so documents, videos, and images can be sent. Emails also provide a record of communication, which may be important for legal or accountability purpos-es.
- New policies are being instituted, based on evidence-based research, but some staff members are vocally resistant to the changes. What is the most appropriate action?
A. Advise staff that complaining is counterproductive.
B. Provide honest information about the reasons for the changes and how the changes will affect staff.
C. Suggest that staff vote on whether to implement the changes.
D. File a report with human resources about those complaining.
B. Provide honest information about the reasons for the changes and how the changes will affect staff.
When instituting changes, the best approach is to provide honest information about the reasons for changes and how staff will be affected. Resistance to change is common for many people, so coordinating collaborative processes requires anticipating resistance and taking steps to achieve cooperation. Resistance often relates to concerns about job loss, increased responsibilities, and general denial or lack of understanding and frustration. The nurse should be empathetic and patient, allowing people to express their opinions and encouraging their participation.
- A method that can be used prior to utilizing a new process in order to identify and correct problems in the process is:
A, Six Sigma
B. Quality Improvement Process (QIP)
C. Focus, Analyze, Develop, Execute (FADE)
D. Failure, Mode, and Effects Analysis (FMEA)
D. Failure, Mode, and Effects Analysis (FMEA)
A method that can be used prior to utilizing a new process in order to identify and correct problems in the process is Failure, Mode, and Effects Analysis (FMEA). FMEA is a 12-step process that begins with describing the process in detail and developing a team that creates a flow chart listing each step in a process. Then, they brainstorm each step to determine potential causes for failure and potential adverse outcomes, which are rated according to severity, occurrence, and detection, and a risk priority number is assigned. The team then brainstorms methods to reduce potential failures and identify performance measures.
- cording to HIPAA regulations, which one of the following may be excluded from the designated record set?
A. Psychotherapy notes
B. Billing records
C. Claims adjudication records
D. Case management records
A. Psychotherapy notes
According to HIPAA regulations, psychotherapy notes that are maintained separately from the medical record may be excluded from the designated record set. Patients or legal representatives have the right to access any elements of the designated record set, regardless of the form (i.e., paper or electronic). There is no legal right to access other records, such as requisitions for laboratory tests, duplicate records held by business associates, education records, audits, telephone messages, appointment logs, surgery logs, and notes that a covered entity records while meeting with an attorney regarding a pending lawsuit.
- Which of the following types of software is responsible for storage management?
A. Operating system
B. Productivity
C. Creativity
D. Communication
A. Operating system
Operating system software is responsible for storage management. Operating software, which loads first when the computer is turned on, is the most critical, handling both hardware and software applications, and is responsible for a number of processes, including management of memory, devices, processors, application interface, and the user interface. Operating systems include Mac OS X, Unix, Linux, and Microsoft Windows. Current operating systems generally support multiple users and they can also multitask so that users can work in more than one application at a time.
- If a hospital is required to participate in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, how often must surveys be carried out?
A. Weekly
B. Monthly
C. Bimonthly
D. Biannually
B. Monthly
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a national standardized survey of patients’ opinions of their hospital care. The survey asks 29 questions about aspects of the patient’s experience of hospitaliza-tion. A random sample of adult patients must be surveyed each month within 48 hours to six weeks after discharge. Hospitals that are subject to the Inpatient Prospective Payment System (IPPS) must collect surveys and submit data in order to receive full reimbursement from CMS. Non-IPPS hospitals may voluntarily participate. Eleven HCAHPS measures are reported on the Hospital Compare website.
- Cognitive informatics focuses on:
A.Understanding how the brain functions in order to develop computer processes
B. Utilizing intellectual reasoning to determine the best sources of information
C. Acknowledging the functions of the human brain in information seeking
D. Understanding how the computer can mimic intellectual reasoning
A.Understanding how the brain functions in order to develop computer processes
Cognitive informatics focuses on understanding how the brain functions in order to develop computer processes. The field of informatics can help develop an understanding of the processes similar to those of the human brain, such as utilization of data and data storage, and the cognitive/neurological sciences can help to develop an understanding of how the computers may better process information. Cognitive informatics, then, applies knowledge gained from studying the human brain to computer applications, focusing on such factors as memory, thinking/reasoning, and learning.
- If the CDS system recommends a therapy that the clinician ignores, the system usually:
A. Sends an alert to administration
B. Locks down until the action is taken
C. Takes no further action
D. Sends repeated alerts about the therapy
C. Takes no further action
If the CDS system recommends a therapy that the clinician ignores, the system generally takes no further action, as the CDS system only makes recommendations based on inputted data, but the clinician makes the final determination as to whether to follow the recommendation or not. CDS systems are composed of a base of knowledge, a program that utilizes this knowledge base in assessing patient-specific information, and a method of communicating the recommendations, such as through alerts.
- In preparation for the workflow redesign required for the implementation of an EHR, the first step should be to:
A. Conduct surveys about workflow.
B. Map the current workflow.
C. Assess the EHR requirements.
D. Assess compatibility with EHR.
B. Map the current workflow.
In preparation for the workflow redesign required for the implementation of an EHR, the first step should be to map the current workflow at the macro, mini, and micro levels, focusing on areas that are likely to be most impacted by the implementa-tion. Examples of affected areas include patient admission and discharge, laboratory and medication orders, scheduling appointments, referrals, and billing for services.
- The Institute for Safe Medication Practices (ISMP) order set guidelines provide guidance for developing order sets for:
A. Medications
B. Physical therapy
C. Surgical care
D. Internet security
A. Medications
The Institute for Safe Medication Practices (ISMP) order set guidelines provide guidance for developing order sets for medications, both for paper-based and electronic order sets. Guidelines include checklists for format (layout, font, prompts, symbols, abbreviations), content (development, medications, exclusions, inclusions), approval and maintenance (criteria for review, changes, verification, and biannual review of listings), and specific criteria (IV/epidurals, electrolytes, compounded medications, chemotherapy, analgesics, pediatric medications, weight-based dosages, and medications for older adults).
- Semantic interoperability is essential to ensure that:
A. Data can be moved from one system to another.
B. The data moved from one system to another system are understood in the same way.
C. Business functions housing one system can work with those housing another system.
D. Data from one system are protected during transfer to another system.
B. The data moved from one system to another system are understood in the same way.
Interoperability is the ability to transfer, share, and utilize information from one system to another. Aspects of interoperability include:
Technical: the ability to move data freely from one system to another.
- The best type of display to use to demonstrate and manage schedules and time estimates needed to complete a number of tasks associated with quality improvement projects is a(n):
A. Gantt chart
B. Flow chart
C. Storyboard
D. Pareto chart
A. Gantt chart
The best type of display to use to demonstrate and manage schedules and time estimates needed to complete a number of tasks associated with quality improvement projects is a Gantt chart, which is created after completion of a timeline. The chart may have the timeline represented in days, weeks, or months, depending on the overall duration of the project, on the horizontal axis across the top. The tasks are listed on the left on the vertical axis. Color-coded horizontal lines or bars are then drawn from the projected beginning date to ending date for each task.
- The Quality and Safety Education for Nurses (QSEN) project’s informatics competency includes the three elements of:
A. Knowledge skills, and attitude.
B. Data, information, and knowledge
C. Data collection, data storage, and data safety
D. Safety, privacy, and utilization
A. Knowledge skills, and attitude.
The Quality and Safety Education for Nurses (QSEN) project’s informatics competency (“Use information and technology to communicate, manage knowledge, mitigate error, and support decision-making”) includes the three elements of KSAs:
• Knowledge: Ability to evaluate benefits and strengths and weaknesses, evaluate communication technologies, determine information essential to a patient care database, and demonstrate understanding of taxonomy and terminology.
Skills: Participation, selection, implementation, promotion, and evaluation.
Attitude: Values information/communication technologies, need for consensus and collaboration, and use of standardized terminologies.
- An example of aggregate data is:
A laboratory report
B.Hospital census data for the state
C. A patient consent form
D. A patient treatment plan
B.Hospital census data for the state
An example of aggregate data is hospital census data for the state. Aggregate data is derived from a compilation of data from different sources, so the data that is presented as a separate entity (census data) is derived from multiple more discrete data items, such as census reports from each hospital, city, and county. Other types of aggregate data include financial reports, demographic information, and summary reports. Aggregate data, by their nature, do not provide detailed information.
- The first step to knowledge discovery in databases (KDD) is:
A. Data mining
B. Data selection
C. Preprocessing data
D. Transforming data
B. Data selection
The first step to knowledge discovery in databases (KDD) is data selection. Other steps include pre-processing (assem-bling target data set and cleaning data of noise), transforming data, data mining, and interpreting results. KDD is a method to identify patterns and relationships in large amounts of data, such as the identification of risk factors or effectiveness of inter-ventions. KDD may utilize data perturbation, the hiding of confidential information (such as name) while maintaining the basic information in the database, and data mining.
- The term telemedicine refers to:
A. Displaying patient data on a computer screen
B. Providing medical care from a distance through multiple technologies
C. Providing medical care over the telephone
D. Using CPOE to order medications
B. Providing medical care from a distance through multiple technologies
Telemedicine refers to provision of medical care from a distance through multiple technologies including, but not limited to, the telephone. Telemedicine may include distant consultations, such as through videoconferencing; remote monitoring, such as utilization of the cardiac monitor for cardiac assessment; sharing of medical information, such as through social media sites and wireless devices; and medical education, such as training or classes for clinical personnel, such as physicians and nurses. Telemedicine may be delivered through networks as well as the internet and
- When leading a team to facilitate change, an informatics nurse who follows the rules of the organization exactly and expects everyone else to do so is an):
A. Consultative leader
B. Participatory leader
C. Autocratic leader
D. Bureaucratic leader
D. Bureaucratic leader
When leading a team to facilitate change, an informatics nurse who follows the rules of the organization exactly and expects everyone else to do so is a bureaucratic leader. While the bureaucratic leader may be that desired by administration and may engender respect if the nurse carries out the leadership role competently, team members may not be motivated to participate or bring about change because they may feel that their input is not valued.
- The three primary stages of data conversion and migrations are (1) planning, (2) performance, and (3) validation.
During the performance stage of data conversion and migration, it is critically important to:
A. Generate a baseline backup of data.
B. Eliminate duplicate data.
C. Determine the most cost-effective methods.
D. Perform mapping.
A. Generate a baseline backup of data.
During the performance stage of data conversion and migration, it is critically important to generate a baseline of backup data. Stages of data conversion and migrations include the following:
Planning: inventorying the system, reviewing the types and amounts of data and the source and destination formats, considering cost-effectiveness, developing a specific plan for conversion, performing mapping, and creating conversion scripts and specification documents
Performance: generating a baseline backup of all data, extracting data, normalizing data, performing trial and test conversions, and completing data migration
Validation: ensuring that data was converted accurately and completely and formatted correctly, eliminating duplicate data, and resolving problems
- When doing system analysis and gathering information, the first tool is often an:
A. RFQ
B. RFP
C. RFI
D. RFT
C. RFI
When doing system analysis and gathering information, the first tool is often an RFI (request for information). RFIs are often sent to a number of vendors, outlining the information needed and providing an overview of the organization’s plans for purchase. The RFI may include an RFP (request for proposal) as well as a an RFQ (request for a quote), although the RFP and RFQ may be sent after the information is received and reviewed as part of the elimination and selection process. The RFT (re-quest for tender) asks for pricing and information when contracting for a specific project.
- A primary security advantage of point-of-care documenting of the EHR as opposed to documenting in a central location (such as the nursing station) is:
A. Never regists to view protected information
B More restricted access
C. Lower need for passwords
D. Less shoulder surfing
D. Less shoulder surfing
A primary security advantage of point-of-care documenting of the EHR as opposed to documenting in a central location (such as the nursing station) is less shoulder surfing is likely to occur. Shoulder surfing (a common cause of confidentiality compromise) occurs when someone watches the computer screen while another person is accessing records. Computer screens should be positioned so that they cannot be viewed by unauthorized personnel, and healthcare providers should always be on the alert when documenting to ensure that no one is watching the screen.
- The nursing educators at a hospital want to set up computer stations for consumer/patient self-assessment and health education and asks the informatics nurse for advice about placement. The best placement in the facility is probably:
A. dedicated room
B. The gift shop
C. The cafeteria
D. Waiting areas
D. Waiting areas
If nursing educators at a hospital want to set up computer stations for consumer/patient self-assessment and health education, the best placement in the facility is probably waiting areas throughout the hospital as this makes them available to the most individuals, and people in waiting areas often wait for prolonged periods and may welcome a distraction. Interactivity is an important element to include in any electronic presentation, and the subject matter should be presented in a simplified format that appeals to those with varying levels of health literacy.
- According to Mehrabian’s communication theory, what percentage of communication is afforded to body lan-guage?
A. 7%
B. 15%
C. 38%
D. 55%
D. 55%
- D: Mehrabian developed the 7-38-55 rule of communication theory:
7%: Meaning is conveyed by the spoken word-what people hear or perceive.
38%: Meaning is conveyed by the speaker’s tone of voice.
55%: Meaning is conveyed by the speaker’s body language.
For example, if a speaker stands while the receiver sits, the speaker is conveying authority. If the speaker’s voice is loud, this can be considered aggressive. Meaning is also conveyed by the receiver’s body language, such as by folding the arms as a protective mechanism when having a negative response.
- Data definitions must be based on a solid understanding of statistical analysis and epidemiological concepts.
Specific issues that must be addressed include sensitivity, which means that data should:
A. Measure the target adequately so that the results have predictive value.
B. Be classified according to subsets, taking variables into consideration.
С.Include only those cases specific to the needs of the measurement and exclude those that may be similar but are a different population, decreasing the number of false positives.
D. Include all positive cases, taking into account variables, decreasing the number of false negatives.
D. Include all positive cases, taking into account variables, decreasing the number of false negatives.
- D: Data should include all positive cases, taking into account variables, decreasing the number of false negatives.
• Specificity: Data should include only those cases specific to the needs of the measurement and exclude those that may be similar but are a different population, decreasing the number of false positives.
Stratification: Data should be classified according to subsets, taking variables into consideration.
Validity: Data should measure the target adequately, so that the results have predictive value.
Recordability: The tool/indicator should collect and measure the necessary data.
Reliability: Results should be reproducible.
Usability: The tool or indicator should be easy to utilize and understand.
- If applying the ETHICAL model to decision making, the first step is to:
A. Estimate possible outcomes.
B. Educate one’s self.
C. Evaluate alternative decisions.
D. Examine the ethical dilemma.
D. Examine the ethical dilemma.
Steps to the ETHICAL model of decision making include the following:
Examine the ethical dilemma: Collect and consider the gathered information.
Thoroughly understand the alternatives: List possible alternatives and their pros and cons.
Hypothesize any ethical arguments: Consider moral principles.
Investigate, compare, and evaluate the alternatives: Review facts and assumptions.
Choose one of the alternatives: Recommend but challenge personal reasoning.
Act: Make a plan to implement the chosen alternative.
• Look and examine: Evaluate and consider the outcomes, and reevaluate as needed.
- The help desk has received numerous complaints about slow database queries. What type of monitoring is most indicated?
A. Resource utilization
B. Scalability assessment
C. Response time analysis
D. Load and stress testing
C. Response time analysis
Response time analysis assesses the time it takes for a system to respond to a request, such as a database query.
Response time analysis includes assessment of service time (i.e., the time needed to process a request), network latency (i.e., the time needed to traverse a network), queuing time (i.e., the wait time), and client-side processing (i.e., the time to receive a response in web-based applications). Response time analysis uses benchmarks for comparison and can help identify bottlenecks in a system.
- When utilizing barcode scanning for bedside medication verification, the nurse administering medications
must:
A. Scan the medication barcode and check the patient’s ID.
B. Check the medication barcode and scan the patient’s ID barcode.
C. Scan both the patient’s ID barcode and the medication barcode.
D. Scan the medication barcode and the EHR barcode.
A. Scan the medication barcode and check the patient’s ID.
Prior to being issued a unique identifier and password to access and enter data into an EHR, the staff member should have been trained and tested in the EHR system. While some self-study may be indicated, staff members should not be expected to learn on the job or teach themselves because EHR systems can be quite complex, and insufficient training increases the risk of errors. Training must be provided promptly for all new hires or staff members who indicate they need training.
- Prior to being issued a unique identifier and password to enter data into an EHR, the staff member should have:
A. Been trained and tested in the EHR system
B. Reviewed the EHR handbook
C. Been assigned a mentor to monitor and assist in using the EHR system
D. Completed a course of self-study for the EHR system
A. Been trained and tested in the EHR system
Prior to being issued a unique identifier and password to access and enter data into an EHR, the staff member should have been trained and tested in the EHR system. While some self-study may be indicated, staff members should not be expected to learn on the job or teach themselves because EHR systems can be quite complex, and insufficient training increases the risk of errors. Training must be provided promptly for all new hires or staff members who indicate they need training.
- When conducting a literature review to obtain an overview of a topic, the best initial source is likely:
A. Peer-reviewed journals
B. Books and book chapters
C. Academic databases
D. A meta-analysis
C. Academic databases
Peer-reviewed journals are typically considered the gold standard for literature research; however, for an initial overview, journal topics may be too narrowly focused, so a better place to begin is an academic database, such as PubMed (health and biomedical sciences) and IEEE Xplore (technical literature). An academic database can link to journal articles and other types of information sources, providing many avenues of interest to follow. This can
- The primary goal of Health Level Seven (HL7) is:
A. Ensuring compliance with internet protocols
B. Providing and sharing standards for exchange of electronic health information
C. Providing guidance to organizations implementing electronic health records
D. Providing grants to organizations implementing electronic health records
B. Providing and sharing standards for exchange of electronic health information
The primary goal of Health Level Seven (HL7) is providing and sharing standards for exchange of electronic health information (interoperability). HL7 is a nonprofit ANSI-accredited organization. Organizations must utilize the same standards if they are to share data, such as when a patient wants to transfer records from one hospital to another. HL7 is critical to the development of electronic health records. HL7 has a number of different trademarks that can be applied for to use with products and services. HL/ provides specifications but does not provide software.
- The Office of the National Coordinator for Health Information Technology provides the SAFER Guides to healthcare organizations to assist them to carry out assessments in order to:
A. Plan for emergency preparedness.
B. Optimize safety and the safe use of EHRs.
C. Determine the need for upgrades to their information systems.
D. Ensure that there is semantic representation.
B. Optimize safety and the safe use of EHRs.
The Office of the National Coordinator for Health Information Technology’s Safety Assurance Factors for EHR
Resilience (SAFER) Guides provide assistance in optimizing safety and the safe use of EHRs. There are nine different guides available in three categories:
Foundational guides: High Priority Practices and Organizational Responsibilities
Infrastructure guides: Contingency Planning, System Configuration, and System Interfaces Clinical process guides: Patient Identification, Computerized Provider Order Entry with Decision Support, Test Results Reporting and Follow-up, and Clinician Communication
- System testing that involves fault injection is done to:
A. Determine how any errors can occur before a system fails.
B. Provide comparison data regarding expected outcomes.
C. Provide data regarding system errors.
D. Determine the system response if a component fails.
D. Determine the system response if a component fails.
System testing that involves fault injection is done to determine the system response if a component fails. Faults are purposely introduced into the system to cause one or more components to fail, and then test cases or a series of actions are
- An essential component of a cognitive walkthrough when assessing usability is:
A. The exit questionnaire
B. The pre-assessment interview
C. Observational note taking
D. The “think aloud” procedure
D. The “think aloud” procedure
Cognitive walkthrough is one method to assess the users’ abilities to understand the model and its purpose, to produce the desired actions, and to determine if users understand which is the right action and whether they understand system feed-back. The “think aloud” procedure is used while participants utilize a product and carry out the steps in a process, noting any usability problems, including the ability to learn the process without formal training. Sessions may be audiotaped or videotaped for later evaluation.
- As part of gathering data and conducting internal and external analysis for short-term strategic planning, the organization may derive insight from:
A. An FMEA
B. A SWOT analysis
C. A root cause analysis
D. A Pugh decision matrix
B. A SWOT analysis
As part of gathering data and conducting internal and external analysis for short-term strategic planning, the organization may derive insight from SWOT analysis:
Strengths, Weaknesses, threats, & opportunities
- The primary disadvantage to an alert that requires manual activation for viewing is that:
A. Activating the alert requires too much time
B. Activating the alert distracts healthcare providers
C. Alerts requiring activation are of little value
D. Healthcare providers may not activate the alert
D. Healthcare providers may not activate the alert
The primary disadvantage to an alert that requires manual activation for viewing is that the healthcare providers may not activate the alert unless failing to do so results in a hard stop. However, if the information is critical or should be read in all circumstances, then the alert should be automated to save the user the extra step of activating the alarm. Alerts should be carefully designed so that they are meaningful because excessive alerts tend to be ignored or overridden.
- Healthcare-associated data, such as hazard and safety practices and pharmacy transactions, are classified as:
A. Primary data
B. Knowledge-based data
C. Comparison data
D. Aggregate data
D. Aggregate data
Types of healthcare-associated data include the following:
• Aggregate: pharmacy transactions, hazard and safety practices, financial information, and most things not included in the clinical record
• Medical/clinical: all patient-specific medical records, including diagnoses, laboratory findings, physician orders, and informed consent
Knowledge-based: training, support, research, library services, good practice guidelines, drug information databases, clinical decision support system, medical literature and journals, disease registries, coding resources, and medical calculators and tools
Comparison: internal or external comparisons to benchmarks or best-practice guidelines
- Which type of system would be most efficient to track the movement of equipment through the hospital?
A. Barcode
B. Closed circuit TV
C. Passive radio frequency identification (pRFI)
D. Active radio frequency identification (aRFI)
D. Active radio frequency identification (aRFI)
The type of system that would be most efficient to track the movement of equipment and supplies through the hospital is active radio frequency identification (aRFI). With RFI, equipment contains embedded digital memory chips with codes unique to the piece of equipment. Sensors then receive signals from the chips. In passive RFI, signals are only transmitted when the chip is in close proximity to the sensor. However, in active RFI, continuous transmission of signals between the chip and the sensor occurs, allowing for more accurate tracking.
- The best way to promote health equity in a community is through:
A. Community engagement
B. Radio announcements
C. Posters and billboards
D. Brochures & Flyers
A. Community engagement
Community engagement is the best method of promoting health equity because it allows the person to interact with key players who are involved in decision making in the community. Community engagement may include attending meetings of the governing body; serving on committees; engaging in volunteer work; hosting community forums; organizing cleanup drives and fundraisers; offering skills and expertise; and collaborating with schools, businesses, and organizations. Additionally, the person may engage in social media and join local groups on Nextdoor and/or Facebook.
- In a database, each field in a table is a(n):
A. Attribute
B. Entity
C. Data file
D. Route
A. Attribute
In a database, each field in a table is an attribute, with fields being columns and records being rows. A data file (collec-tions of different related records) comprises a table, which is also referred to as an entity. In each record, one field is the primary or key field, which contains the unique identifier for that particular record. A database contains one or more entities. The entity relationship diagram (one-to-one, one-to-many, or many-to-many) indicates the relationships that exist among the different entities.
- Which governmental agency is responsible for enforcing the electronic transactions and code sets for the Administrative Simplification provisions of HIPAA?
A. FDA
B. FCC
C. CMS
D. NIH
C. CMS
The governmental agency responsible for enforcing the electronic transactions and code sets for the Administrative Simplification provisions of HIPAA is the Centers for Medicare & Medicaid Services (CMS). CMS is not responsible for enforcing security or privacy regulations, which are enforced by the Office of Civil Rights.
- The informatics nurse is proposing a costly application investment to the board of directors. In preparation, the informatics nurse should especially be prepared to discuss:
A. Break-even analysis
B. Return on investment
C. Total cost of ownership
D. Cost allocation
B. Return on investment
The profit margin in healthcare organizations are other quite narrow
- In addition to name, which of the following is acceptable as a unique identifier?
A. Age
B. Birthdate
C. Gender
D. Hair color
B. Birthdate
- B: In addition to name, birthdate is an acceptable unique identifier. Other unique identifiers include alphanumeric strings (such as those used for ID numbers) and social security numbers. A unique identifier should not be readily changeable (al-though names alone can be changed). Factors such as hair color (which is easily changeable) or age (which changes with time) are not reliable for identification. Additionally, gender is not sufficient as a unique identifier because gender may be fluid in some individuals, may be faked, and may not be obvious.
- During observational testing for the adaptation phase of an information system, the informatics nurse observes users taking notes of data to enter into the system later when they have more time. This suggests a(n):
A. Cognitive problem
B. Compliance problem
C. Training problem
D. Ergonomic problem
D. Ergonomic problem
If during observational testing for the adaptation phase of an information system, the informatics nurse observes users taking notes of data to enter into the system later when they have more time, this suggests an ergonomic problem in dialoging with the system and requires further assessment to determine if the user interface is not adequately intuitive, if too many screen actions (scrolling, clicking) are required, or if the system responds too slowly.
- At what point in implementation of an EHR should a chart migration plan be formulated?
A. Before going live
B. Before purchase of an EHR
C. During the transition to live
D. After going live
A. Before going live
A chart migration plan should be formulated before going live with an EHR to ensure that important patient data are not lost or are unavailable. The migration plan should outline the steps to transferring data from paper charts to the EHR, including the timeframe, who is responsible, and what data are to be transferred. Because of the changing nature of patients’ conditions and census, much data must be transferred in a short period of time and this can pose numerous logistical prob-lems.
- The healthcare organization provides a digital display that shows current status in a number of different but related performance indicators so that staff can assess progress in meeting performance
goals. This type of display is referred to as a(n):
A. Infographic
B. Scorecard
C. Heatmap
D. Dashboard
D. Dashboard
- D: A dashboard is an easy-to-read and understand visual display that includes a number of different performance measures in one display, typically with charts, tables, or graphs, to aid understanding. Dashboards should be updated frequently so that the information is current. Dashboards are easily customizable and help provide broad involvement of all departments.
Negative trends can easily be identified and targeted for improvement. Dashboards can also help with making informed decisions about necessary changes or use of resources.
- When transferring data from one system to another, free text data must be:
A. Truncated
B. Eliminated
C. Transferred only if critical
D. Transferred intact
D. Transferred intact
When transferring data from one system to another free text data as well as coded data must be transferred intact and not truncated.
- If an alert regarding a patient’s laboratory tests is forwarded to a clinician who does not respond during the three-hour window of specified time, the system should be set up to send:
A. Another alert to the clinician
B. An alert to an alternate clinician
C. An alert to administration
D. An alert to the chief medical officer
B. An alert to an alternate clinician
If an alert regarding a patient’s laboratory tests is forwarded to a clinician who does not respond during the three-hour window of specified time, the system should be set up to send an alert to an alternate clinician. The organization should also have a procedure in place for notifying clinicians about critical information that is in addition to the automated alerts generated.
- When interfacing a new cardiac monitoring system with the EHR, critical initial testing includes:
A. System testing
B. Regression testing
C. Visual testing
D. System integration testing
D. System integration testing
When interfacing a new cardiac monitoring system with the EHR, critical initial testing includes system integration testing, which tests whether or not the interface between software programs (such as cardiac monitoring and the EHR)
- The human-technology interface (HTI):
A. Allows user interaction with technology
B. Standardizes applications utilized in all devices
C. Allows access to the technology only to authorized people
D. Connects a user device to the internet
A. Allows user interaction with technology
The human-technology interface (HTI) allows user interaction with technology, so HTI may include touch (as with touch screens), keyboards, light pens, barcodes, ID badges, or voice (for voice-activated devices or applications). HTIs vary widely according to the hardware and software involved and may include various levels of security. In some cases, there is virtually no security because the interaction may be activated by simply turning on a switch. In other cases, the interaction may be predicated on the use of a user name and password or other method of identification.
- Medicare uses place of service (POS) codes to determine:
A.The duration of service
B. Provider qualifications
C. The medical necessity of services
D. Facility/non-facility payment rates
D. Facility/non-facility payment rates
Place of service (POS) codes are used by Medicare to determine facility (F) or non-facility (NF) payment rates. POS codes have two digits and indicate the setting in which a service was provided. POS codes are used to ensure correct reimbursement, facilitate processing of claims, and collect data. POS codes include the following:
- An easy to access and read computer program that integrates a variety of performance measures or key indicators into one display to provide an overview of an organization is referred to as a:
A. Scattergram
B. Dashboard
C. Balanced scorecard
D. Histogram
B. Dashboard
A dashboard (also called a digital dashboard), like the dashboard in a car, is an easy to access and read computer program that integrates a variety of performance measures or key indicators into one display (usually with graphs or charts) to provide an overview of an organization. It might include data regarding patient satisfaction, infection rates, financial status, or any other measurement that is important to assess performance. The dashboard provides a running picture of the status of the department or organization at any point in time, and may be updated as desired, such as daily, weekly, or monthly.
150. A: The timing of health messages is important. People are more likely to respond when a threat is imminent. Therefore,
- If a healthcare organization wants to communicate health information related to the flu vaccine, when is the best time to convey the message?
A. Before and at the beginning of flu season
B. In the middle of flu season
C. Two weeks before flu vaccinations are due for required individuals
D. At any time of the year
A. Before and at the beginning of flu season
The timing of health messages is important. People are more likely to respond when a threat is imminent. Therefore, communicating about the need for the annual flu vaccine is best done immediately before and at the beginning of flu season in order to reduce risk. Messages at other times of the year are often ignored, and new flu vaccines may not be available yet. If the message is given only before flu season, people may not feel that the need is urgent, and if given in the middle of flu season, many people may already have contracted the flu.
