Ch 18-20

The problems of an existing system have been identified, along with possible solutions. What is the next step in the systems analysis stage? A feasibility study Requirements gathering Systems design Systems testing

A feasibility study

16. A nurse working in a hospital setting discovers problems with the delivery of nursing care on the pediatric unit. Which of the following suggestions from the Institute of Medicines Committee on Quality of Health Care in America (Kohn, Corrigan, & Donaldson, 2000) could help redesign and improve care? Select all that apply. A) Base care on continuous healing relationships. B) Customize care based on available resources. C) Keep the nurse as the source of control. D) Share knowledge and allow for free flow of information E) Practice evidence-based decision making F) Emphasize safety as a system property.

A) Base care on continuous healing relationships. D) Share knowledge and allow for free flow of information E) Practice evidence-based decision making F) Emphasize safety as a system property.

15. A nurse is interested in improving patient care on the unit through performance improvement. What is the first step in this process? A) Discover the problem. B) Plan a strategy. C) Implement a change. D) Assess the change.

A) Discover the problem.

18. Why are quality-assurance programs important in nursing? A) They enable nursing to be accountable for the quality of care. B) They facilitate increased enrollment in educational programs. C) They specify how resources are used or not used. D) They allow increased retention of qualified nurses.

A) They enable nursing to be accountable for the quality of care.

12. A nurse in a community health center has been having regular meetings with a woman who wants to stop smoking. Which of the following outcome decision options would the nurse document if the woman has not smoked for 3 months? A) outcome met B) outcome partially met C) outcome not met D) outcome inappropriate

A) outcome met

2. What is the purpose of evaluation in the nursing process? A) to direct future nursing interventions B) to formulate a database of nursing diagnoses C) to complete an initial plan of care D) to transfer medical orders to the plan of care

A) to direct future nursing interventions

12. What is the primary purpose of the patient record? A) communication B) Advocacy C) Research D) Education

ANS: A A) communication

24. A nurse uses informatics to plan nursing care for a patient. Which three terms best describes this science as it is applied to nursing? A) data, information, knowledge B) process, documentation, analysis C) research, controls, variables D) hypothesis, nursing, practice

ANS: A A) data, information, knowledge

22. What is the primary purpose of an incident report? A) means of identifying risks B) basis for staff evaluation C) basis for disciplinary action D) format for audiotaped report

ANS: A A) means of identifying risks

14. Which one of the following methods of documentation is organized around patient diagnoses rather than around patient information? A) problem-oriented medical record (POMR) B) source-oriented record C) PIE charting system D) focus charting

ANS: A A) problem-oriented medical record (POMR)

6. A student has reviewed a patient's chart before beginning assigned care. Which of the following actions violates patient confidentiality? A) writing the patient's name on the student care plan B) providing the instructor with plans for care C) discussing the medications with a unit nurse D) providing information to the physician about laboratory data

ANS: A A) writing the patient's name on the student care plan

7. Which of the following are examples of breaches of patient confidentiality? Select all that apply. A) A nurse discusses a patient with a coworker in the elevator. B) A nurse shares her computer password with a relative of a patient. C) A nurse checks the medical record of a patient to see who should be called in an emergency. D) A nurse updates the employer of a patient regarding the patient's return to work. E) A nurse uses a computer to document a patient's response to pain medication. F) A head nurse accesses the medical records of a nurse on her shift to check her condition.

ANS: A B D F A) A nurse discusses a patient with a coworker in the elevator. B) A nurse shares her computer password with a relative of a patient. D) A nurse updates the employer of a patient regarding the patient's return to work. F) A head nurse accesses the medical records of a nurse on her shift to check her condition.

18. Which of the following information would a nurse include as part of a minimum data set when using electronic medical records? Select all that apply. A) patient sex B) patient admission date C) patient physical assessment D) patient insurance E) patient history F) patient ethnicity

ANS: A B D F A) patient sex B) patient admission date D) patient insurance F) patient ethnicity

8. Which of the following are examples of incidental disclosures of patient health information that are permitted? Select all that apply. A) A nurse working in a physician's office puts out a sign-in sheet for incoming patients. B) Two nurses are overheard talking about a patient through the door of an empty patient room. C) A nurse places a patient chart in a holder on the examining room door with the name facing out. D) A nurse leaves an x-ray on a light board in the hallway that leads to the examining rooms. E) A nurse calls out the name of a patient who is seated in the waiting room. F) A nurse leaves a reminder for an appointment on a patient's answering machine along with the results of lab work.

ANS: A B E A) A nurse working in a physician's office puts out a sign-in sheet for incoming patients. B) Two nurses are overheard talking about a patient through the door of an empty patient room. E) A nurse calls out the name of a patient who is seated in the waiting room.

11. Which of the following abbreviations are on the list of the Joint Commission "do not use" abbreviations? Select all that apply. A) U (unit) B) QD (daily) C) NPO (nothing per os) D) mL (milliliters) E) > (greater than) F) mcg (micrograms)

ANS: A B E A) U (unit) B) QD (daily) E) > (greater than)

4. Alice Jones, a registered nurse, is documenting assessments at the beginning of her shift. How should she sign the entry? A) Alice J, RN B) A. Jones, RN C) Alice Jones D) AJRN

ANS: B B) A. Jones, RN

17. Which of the following methods of documenting patient data is least likely to hold up in court if a case of negligence is brought against a nurse? A) problem-oriented medical record B) charting by exception C) PIE charting system D) focus charting

ANS: B B) charting by exception

10. A physician's order reads "up ad lib." What does this mean in terms of patient activity? A) may walk twice a day B) may be up as desired C) may only go to the bathroom D) must remain on bed rest

ANS: B B) may be up as desired

21. A nurse is documenting information about a patient in a long-term care facility. What is used in a Medicare-certified facility as a comprehensive assessment and as the foundation for the Resident Assessment Instrument (RAI)? A) PIE system B) minimum data set C) OASIS D) charting by exception

ANS: B B) minimum data set

16. A nurse organizes patient data using the SOAP format. Which of the following would be recorded under "S" of this acronym? A) patient complaints of pain B) patient symptoms C) patient's chief complaint D) patient interventions

ANS: B B) patient symptoms

13. In what type of documentation method would a nurse document narrative notes in a nursing section? A) problem-oriented medical record B) source-oriented record C) PIE charting system D) focus charting

ANS: B B) source-oriented record

5. In which of the following cases should a progress note be written? Select all that apply. A) for any nurse-patient interaction B) when admitting a patient C) when receiving a patient postoperatively D) when assisting a patient with ADLs E) when a procedure is performed F) when a patient sends back an untouched dinner tray

ANS: B - C - E B) when admitting a patient C) when receiving a patient postoperatively E) when a procedure is performed

3. Which of the following data entries follows the recommended guidelines for documenting data? A) "Patient is overwhelmed by the diagnosis of pancreatic cancer." B) "Patient kidneys are producing sufficient amount of measured urine." C) "Following oxygen administration, vital signs returned to baseline." D) "Patient complained about the quality of the nursing care provided on previous shift."

ANS: C C) "Following oxygen administration, vital signs returned to baseline."

9. A patient asks to see his medical record (chart). How would the nurse respond? A) "I can't let you do that without a doctor's order." B) "Our hospital policy is that you can't do that." C) "I will get your chart and provide you with privacy to read it." D) "Why would you want to do that? It will only make you worry."

ANS: C C) "I will get your chart and provide you with privacy to read it."

19. A nurse has access to computerized standardized plans of care. After printing one for a patient, what must be done next? A) Date it and put it in the patient's record. B) Sign it and put it in the Kardex. C) Individualize it to the specific patient. D) Use it as printed, based on common needs.

ANS: C C) Individualize it to the specific patient.

15. What is the primary purpose of focus charting? A) nursing diagnoses B) medical problems C) patient concerns D) expected outcomes

ANS: C C) patient concerns

1. What is the nurse's best defense if a patient alleges nursing negligence? A) testimony of other nurses B) testimony of expert witnesses C) patient's record D) patient's family

ANS: C C) patient's record

2. A nurse is documenting the intensity of a patient's pain. What would be the most accurate entry? A) "Patient complaining of severe pain." B) "Patient appears to be in a lot of pain and is crying." C) "Patient states has pain; walking in hall with ease." D) "Patient states pain is a 9 on a scale of 1 to 10."

ANS: D D) "Patient states pain is a 9 on a scale of 1 to 10."

20. What part of the patient's record is commonly used to document specific patient variables, such as vital signs? A) progress notes B) nursing notes C) critical paths D) graphic record

ANS: D D) graphic record

23. A group of nurses visits selected patients individually at the beginning of each shift. What are these procedures called? A) nursing care conferences B) staff visits C) interdisciplinary referrals D) nursing care rounds

ANS: D D) nursing care rounds

What is the most common risk to patient privacy and confidentiality? An organization's employees Inadequate firewall protection Inadequate system design Viruses, worms, and Trojan horses

An organization's employees

14. A nurse has developed a plan of care for the nursing diagnosis Risk for Loneliness for a recently widowed man. When evaluating the plan, the man tells the nurse new information about his active social life. What would the nurse do next? A) Continue with the plan. B) Delete the nursing diagnosis. C) Tell the patient he is lonely. D) Adjust the time criteria.

B) Delete the nursing diagnosis.

10. A nurse is counseling a novice nurse who gives 150% effort at all times and is becoming frustrated with a healthcare system that provides substandard care to patients. Which of the following advice would be appropriate in this situation? Select all that apply. A) Tell the new nurse to help other nurses perform their jobs to ensure quality patient care is being delivered. B) Encourage the new nurse to leave her problems at work behind, instead of rehashing them at home. C) After establishing a reputation for delivering quality nursing care, have her seek creative solutions for nursing problems. D) Tell her to view nursing care concerns as challenges rather than overwhelming obstacles and seek help for solutions. E) State that if resources do not permit quality care, it is not the role of the new nurse to explore change strategies within the institution. F) Tell the nurse that if administration is not supportive, moving to another practice setting might be more appropriate.

B) Encourage the new nurse to leave her problems at work behind, instead of rehashing them at home. C) After establishing a reputation for delivering quality nursing care, have her seek creative solutions for nursing problems. D) Tell her to view nursing care concerns as challenges rather than overwhelming obstacles and seek help for solutions. F) Tell the nurse that if administration is not supportive, moving to another practice setting might be more appropriate.

23. A nurse forgets to raise the railings of the bed of a patient who is confused after taking pain medications. The patient attempts to get out of bed, and suffers a minor fall. The nurse asks a colleague who witnessed the fall not to mention it to anyone because the patient only had minor bruises. What would be the appropriate action of the colleague? A) No other steps need to be taken, since the patient was not seriously injured. B) The colleague should inform the nurse that a full report of the incident needs to be made. C) The colleague should monitor the patient closely for any adverse effects of the fall. D) The colleague should report the incident in a peer review of the nurse.

B) The colleague should inform the nurse that a full report of the incident needs to be made.

22. A nurse evaluates nursing care and outcomes for a current patient by using direct observation of nursing care, patient interviews, and chart review to determine whether the specified evaluative criteria are met. This practice is known as: A) a nursing audit B) a concurrent evaluation C) a retrospective evaluation D) an evaluation of patient satisfaction

B) a concurrent evaluation

9. A nurse is teaching a patient how to administer insulin, with the expected outcome that the patient will be able to self-administer the insulin injection. How would this outcome be evaluated? A) asking the patient to verbally repeat the steps of the injection B) asking the patient to demonstrate self-injection of insulin C) asking family members how much trouble the patient is having with injections D) asking the patient how comfortable he or she is with injections

B) asking the patient to demonstrate self-injection of insulin

5. What cognitive processes must the nurse use to measure patient achievement of outcomes during evaluation? A) intuitive thinking B) critical thinking C) traditional knowing D) rote memory

B) critical thinking

17. The nursing staff on a hospital unit are using peer review to improve professional performance. Who performs the review? A) unit manager B) nurses C) patients D) visitors

B) nurses

4. Nurses evaluate many aspects of the healthcare delivery system. Which of the following is always the primary concern when performing the evaluating step of the nursing process? A) the nurse B) the patient C) the healthcare system D) outcome achievement

B) the patient

6. A nurse is evaluating an established plan of care. After identifying the evaluative criteria and standards (expected patient outcomes), what must the nurse do next? A) Interpret and summarize findings. B) Document his or her judgment. C) Collect data about patient responses. D) Formulate a new plan of care.

C) Collect data about patient responses.

19. Which of the following are major premises of a quality-improvement program? Select all that apply. A) It focuses on organizational structure. B) It is driven by external factors. C) It focuses on processes rather than individuals. D) It has no end points. E) Its outcome is focused on assuring quality. F) It focuses on data and statistical thinking.

C) It focuses on processes rather than individuals. D) It has no end points. F) It focuses on data and statistical thinking.

7. Which of the following is a descriptor that helps to define the term criteria? A) immeasurable qualities B) established by authority C) acceptable level of performance D) evidence-based practice

C) acceptable level of performance

11. A plan of care for a patient with a low potassium level includes providing information about the effect of medications and dietary intake of foods high in potassium. How would a nurse measure achievement of an outcome for this plan? A) physical assessment B) health history C) laboratory data D) patient statements

C) laboratory data

21. What is evaluated when conducting a nursing audit? A) physical environment B) policies and procedures C) patient records D) patient satisfaction

C) patient records

Which document articulates the primary factors that guide professional nursing judgment, regarding confidential patient information? Administrative Simplification Provisions Code of Ethics for Nurses with Interpretive Statements Health Insurance Portability and Accountability Act Nursing Informatics: Scope and Standards of Practice

Code of Ethics for Nurses with Interpretive Statements

1. Which of the following best summarizes the evaluating step of the nursing process? A) The nurse completes a health assessment to establish a database. B) The patient and family have met healthcare goals and no longer need care. C) The nurse and patient identify nursing diagnoses and appropriate interventions. D) The nurse and patient measure achievement of planned outcomes of care.

D) The nurse and patient measure achievement of planned outcomes of care.

13. Patient lost 2 of the 5 pound/month goal. How should the nurse alter the plan of care in response to this new data? A) The nurse should not alter the plan of care. B) The nurse should change the diet. C) The nurse should delete the nursing diagnosis. D) The nurse should modify the time criteria.

D) The nurse should modify the time criteria.

3. Which of the following would not be part of the nurses decision about care after evaluating the patients responses to the plan of care? A) terminate the plan of care B) modify the plan of care C) continue the plan of care D) begin the plan of care

D) begin the plan of care

8. A nurse is evaluating the outcomes of a plan of care to teach an obese patient about the calorie content of foods. What type of outcome is this? A) psychomotor B) affective C) physiologic D) cognitive

D) cognitive

20. A hospital is evaluating its policies and procedures. What type of evaluation is the hospital conducting? A) outcome B) process C) quality D) structure

D) structure

What is the initial layer of protection to prevent unauthorized, external access to a facility's information network? Digital certificates Encryption Firewall Password authentication

Firewall

What type of testing is performed on functionally grouped components to ensure that the subset works with the entire system? Integration System Unit User acceptance

Integration

What process produces a blueprint that details how hardware and software meet the needs of the organization? Benchmarking Feasibility study System analysis System design

System design

Using an office computer system to identify a patient whom the linked hospital information system identifies as having positive cultures for pneumonia, a primary care provider orders the patient's antibiotic. This scenario exemplifies: a health information exchange. a system to update patient records. a violation of privacy regulations. an electronic health record.

a health information exchange.

An online course discussion board is a form of: asynchronous learning. didactic learning. synchronous learning. traditional learning.

asynchronous learning.

Integrating clinical practice guidelines with an electronic health record facilitates quality improvement measurement by: comparing guideline parameters to clinical outcomes. presenting results at the point of treatment decisions. providing reference information to measurement staff. representing patient acuity data.

comparing guideline parameters to clinical outcomes.

Informatics nursing is distinguished from other nursing specialties by its focus on: computerized medical records. data and information content and representation. data coding and the use of abbreviations. training and education.

data and information content and representation..

Adult learners most effectively learn about a new clinical information system when the instructor: assumes that the learner knows nothing about the system. begins the formal training as early as possible in the implementation process. emphasizes the technical specifications of the structure of the system. encourages the learner to use previous experience to interpret new learning.

encourages the learner to use previous experience to interpret new learning.

Adherence to a standardized nursing language will lead to: a barrier in national interoperability. a larger database of interventions. improved evaluation of nursing outcomes. increased nursing competencies.

improved evaluation of nursing outcomes.

In project management, the critical path is best described as a series of activities that: includes the path with the most slack or float. indicates the earliest possible time a project can be completed. is scheduled for the next current phase of the process. shows the shortest path through the network diagram.

indicates the earliest possible time a project can be completed.

Because several disciplines support the foundation of informatics nursing, it is important for the informatics nurse to understand that: informatics nursing differs from other disciplines, as it focuses on supporting the process of obtaining data. informatics nursing uses the concepts, tools, and methods of various disciplines to facilitate nursing process. information technology and nursing technology are synonymous, as they have the same goal. the boundaries between the various disciplines are clearly defined.

informatics nursing uses the concepts, tools, and methods of various disciplines to facilitate nursing process.

Applications that are designed to run on a common platform, operate in a common environment, and communicate through direct data transfer are known as: integrated. interfaced. normalized. optimized.

integrated.

Knowledge that is patterned for use in reasoning is known as: artificial intelligence. knowledge query. knowledge representation. neural computing.

knowledge representation.

The informatics nurse violates a patient's legal right to privacy and confidentiality, by: discussing a patient's diagnosis with an authorized family member. discussing care-related information with the patient's physical therapist. looking up a colleague's diagnosis and laboratory results while he or she is hospitalized. providing a handoff report containing patient information to another department.

looking up a colleague's diagnosis and laboratory results while he or she is hospitalized.

The informatics nurse is collaborating with the pharmacy in installing automated dispensing cabinets on the nursing units. These dispensing cabinets will: establish an accurate record of medications given to patients. make medications immediately available to nurses. notify the nurse when supplies are low. require the nurse to scan a patient's ID before dispensing.

make medications immediately available to nurses.

Although social media sites like Facebook and WebMD may provide healthcare consumers with many benefits, using these sites presents risks to patient privacy and misuse of personal health information, because: information downloaded from social media sites may contain malware and infect a patient's home computer. patients openly share information about their health with friends and family on Facebook. personal health information is shared by the patient and not protected under the Health Insurance Portability and Protection Act. personal information that is shared about gender and religion can lead to cyber bullying and social threats.

personal health information is shared by the patient and not protected under the Health Insurance Portability and Protection Act.

The informatics nurse is working on a chart to demonstrate the increasing incidence of obesity in the patient population at a health clinic. The data will represent patients who are of normal weight, overweight, obese, and morbidly obese, and it will include the percentage of the total population for each group. This type of data is most effectively represented by a: bar chart. column chart. line chart. pie chart.

pie chart.

When writing and reviewing the downtime policy and procedure for the new electronic health record, it is imperative to clearly define for the end-user the: policy for how or when to "back-enter" data. policy for system change control. procedure for recovering data after a downtime. procedure for testing software fixes and upgrades.

policy for how or when to "back-enter" data.

A downtime of the electronic health record (EHR) system is planned for three months from today. The informatics nurse is formulating a communication plan for the clinical staff about the downtime. The nurse plans to: announce the upcoming downtime at system-wide meetings, and at department meetings of specific system hospitals affected by the downtime. bring copies of the communication plan to IT meetings, and discuss it with the IT directors and managers. present the information at the "super user" meetings, department and unit meetings, and at other specialty clinician meetings, in addition to having a message posted on the message-of-the-day screen in the EHR. print fliers with the downtime plan and post them in bathrooms and breakrooms, as well as on bulletin boards in various locations in the hospitals.

present the information at the "super user" meetings, department and unit meetings, and at other specialty clinician meetings, in addition to having a message posted on the message-of-the-day screen in the EHR.

Ease of navigation, appropriate language, efficiency of use, ease of learning, and intuitiveness are all examples of: affective skills. behavioral needs. system usability. user ergonomics.

system usability.