Chapter 15 Nursing Informatics

10. The nurse is providing care to a patient newly diagnosed with multiple sclerosis. The patient expresses the desire to communicate with other people living with the disorder. The nurse appropriately refers the patient to: a. an e-mail list with the patient's contacts. b. a social media blog. c. a listserv concerning multiple sclerosis. d. Facebook, Twitter, and LinkedIn.

ANS: C Listservs can be used in health care to connect groups of patients with common problems or to send updated information to large groups. E-mail has become a common means of communication but would not be focused on the patient's issues. Social media include online technologies such as Facebook, Twitter, and LinkedIn that allow people to communicate easily by the Internet to share information and resources, but they are more general than listservs. These technologies enable a potentially massive community of participants to collaborate, providing a mechanism for tapping into collective power in ways previously unachievable. A blog is a social medium that is usually maintained by an individual and has regular entries of commentary, descriptions of events, or other material such as graphics or videos. Most blogs are interactive, allowing visitors to leave comments and message each other. Many blogs focus on health care issues.

14. The patient asks the nurse about how to evaluate websites and standards used to evaluate Internet health sites. The nurse appropriately refers the patient to: a. World Health Organization. b. the U.S. Food and Drug Administration. c. the Internet Healthcare Coalition. d. the U.S. Federal Trade Commission.

ANS: C The Internet Healthcare Coalition, founded in 1997, was created to promote quality health resources online and to ensure that consumers and professionals are able to find reliable, quality information online. This organization consults with various government agencies, including the World Health Organization, the U.S. Food and Drug Administration, and the U.S. Federal Trade Commission, on efforts to promote credible online health care information and combat online health fraud.

13. Patients frequently seek sources for health information online, and nurses, as advocates, need to be prepared to help patients evaluate online sources. To do this, the nurse asks who sponsors the site, is the author listed, and the author's credentials. The nurse is evaluating what? a. Purpose b. Coverage c. Currency d. Authority

ANS: D Authority involves knowing who the sponsor or publisher is. Is this a personal page? Where does it come from? Is the author or organization listed? What are the author's credentials? Purpose is determining to focus of the site. Does the site inform? Explain? Share? Disclose? Sell? What is the intended audience? Coverage tries to determine if citations are correct. Is there a balance of text and images? Currency refers to when the site was created. How often is it updated?

3. Nurses working surrounded by computers and mobile IT must develop skills in the use of all available technology. At the same time, it is important to recognize that: a. the technology in use today will be the same tomorrow. b. cell phones are not usually allowed in the acute care setting. c. most forms of mobile technology are in violation of HIPAA guidelines. d. the technology supports bedside and remote charting.

ANS: D Nurses working surrounded by computers and mobile IT must develop skills in the use of all available technology. At the same time, it is important to recognize that the rapid advancement of IT means that the technology in use today may be entirely different tomorrow. Some facilities have computer access at every bedside, and others have mobile computers, sometimes called workstations on wheels (WOWs), that can be taken to each bedside. Nurses using technology as part of patient care need to work within facility policy and HIPAA guidelines. The technology supports bedside and remote charting. Nurses may use a portable device such as a smartphone or tablet computer to access reference materials, including medical information and vast amounts of drug information. Some facilities issue these devices to staff.

7. The nurse is assigned to administer medications to a patient on a unit that has just implemented bar code medication administration (BCMA). Which step is proper for the nurse to follow? a. Open the medication packages at the nurses' station. b. Ask the patient to verify his or her address. c. Scan the nurse's ID, the patient's ID, and the code on the medication package. d. Ask the patient to name two patient identifiers.

Answer: c The BCMA system scans the nurse's ID, the patient's ID, and the medication package to ensure that the proper drug is given to the correct patient. Asking the patient's address or two random identifiers that the patient may not be aware of would be inappropriate. Proper protocol for administration is to open the medication packages at the bedside. Use of a scanning device requires the medication to still be in the package while scanning to ensure that it is the proper medication.

1. Which descriptions are advantages of health care information technology (IT)? (Select all that apply.) a. Increases health care delivery costs b. Improves communication among providers c. Improves administration functions d. Increases time necessary to document care e. Decreases the safety of providing care

Answers: b, c Health care IT improves communication among providers by providing immediate access that is legible and standardized to patient data by all providers. IT improves administrative functions by addressing the issues of quality, cost-effectiveness, and outcomes of care. Although there are initial costs to purchase hardware and software, these systems are cost-effective in the long run. Systems that support data collection at the point of care can directly enhance patient care by decreasing the time spent on documentation, reducing the potential for errors, and supporting improved assessment and data communication

13. Which nursing action demonstrates the category of utility in the informatics competency classification system? a. computer and software use b. maintenance of privacy c. critical thinking and evidence-based practice d. application of accountability and quality assurance

c. critical thinking and evidence based practice

7. Computerized provider order entry (CPOE) allows orders to be directly communicated to the appropriate department. Other advantages of CPOE include: a. decrease in number of transcribing errors. b. enhanced provider acceptance because of new technology. c. decreased work flow issues in general. d. less dependence on technology and computers.

ANS: A Computerized provider order entry (CPOE) allows orders to be directly communicated to the appropriate department. CPOE systems ensure legible orders and have the potential to reduce ordering and transcribing errors. Disadvantages of CPOE include workflow issues, provider resistance to new technology, and overdependence on technology (AHRQ, 2012).

9. Computerized provider order entry (CPOE): a. allows orders to be communicated to the appropriate department. b. creates an intermediary for order transcription. c. slows documentation and provider communication. d. may lead to increased ordering and transcription errors.

ANS: A Computerized provider order entry (CPOE) allows orders to be directly communicated to the appropriate department—diet orders to dietary, medication orders to the pharmacy, laboratory orders to the laboratory. Elimination of an intermediary for order transcription decreases the potential for errors related to the ambiguity of handwritten orders and allows quicker responses by appropriate departments. Legibility and availability of computerized documentation improve provider communication. The Agency for Healthcare Research and Quality (AHRQ) recommends CPOE as one of the safe practices for better health care. CPOE systems ensure legible orders and have the potential to reduce ordering and transcribing errors. Disadvantages of CPOE include workflow issues, provider resistance to new technology, and overdependence on technology (AHRQ, 2012).

1. The integration of nursing, computers, and information science for the management and communication of data, information, knowledge, and wisdom is: a. nursing informatics. b. computer science. c. medical informatics. d. informatics.

ANS: A Informatics is a broad academic field encompassing artificial intelligence, cognitive science, computer science, information science, and social science. Medical informatics refers to informatics related to health care and describes a distinct specialty in the discipline of medicine. Nursing informatics is a specialty area of informatics that addresses the use of health information systems to support nursing practice. The American Nurses Association (ANA, 2008) states that the specialty of nursing informatics integrates nursing computer and information science for the management and communication of data, information, knowledge, and wisdom.

15. One classification system for nursing informatics competencies uses technical, utility, and leadership categories. Leadership competencies involve: a. maintaining privacy and confidentiality. b. using computers and other technological equipment. c. using a variety of software programs. d. addressing critical thinking applications.

ANS: A One classification system for nursing informatics competencies uses technical, utility, and leadership categories. Leadership competencies address the ethical and management issues related to using IT in nursing practice, education, research, and administration. Specific leadership competencies include the application of accountability, maintenance of privacy and confidentiality, and quality assurance. Technical competencies pertain to the use of computers and other technological equipment and the use of a variety of software programs for word processing, spreadsheet and database development, presentation, referencing, and e-mail. Utility competencies address critical thinking and evidence-based practice applications. Nurses who have a utility competency recognize the relevance of nursing data for improving practice and can access multiple information sources for gathering evidence for clinical decision making.

4. The home health nurse provides care for a patient with congestive heart failure. Daily the patient weighs himself and takes his own temperature, pulse, respirations and blood pressure. That information is sent as electronic data to the patient's physician and nurse daily to make adjustments to the plan of care as indicated. This is an example of: a. telehealth nursing. b. computerized decision support system (DSS). c. computerized provider order entry (CPOE). d. point of care technology.

ANS: A Telehealth nursing is the transmission by a nurse of electronic data, images, or audio from a patient's bedside or home to other health providers for the purpose of providing care and improving outcomes. Patients may have telehealth hardware in their homes to provide in-home monitoring and direct reporting to their health care providers. Computerized decision support systems (DSSs) include safe practice alerts and reminders that improve the quality of care. Some DSSs assist in determining a correct diagnosis and choosing an appropriate medication. Computerized provider order entry (CPOE) allows orders to be directly communicated to the appropriate department—diet orders to dietary, medication orders to the pharmacy, laboratory orders to the laboratory. Computers, tablets, or pocket devices used at the bedside for documentation are examples of point-of-care technology. Patient data collected by a nurse and recorded electronically are immediately available to all members of the health care team.

16. The Computer Ethics Institute has developed guidelines for ethics in the development and use of computer technologies. These guidelines are called: a. the Ten Commandments of Computer Ethics. b. the eHealth Code of Ethics. c. HIPAA guidelines. d. the Internet Healthcare Coalition.

ANS: A The Computer Ethics Institute (CEI) was founded in 1985 to serve as a forum and resource for identifying, assessing, and responding to ethical issues associated with the advancement of information technologies and to facilitate the recognition of ethics in the development and use of computer technologies. CEI developed the Ten Commandments of Computer Ethics. The eHealth Code of Ethics, developed by Health Informatics Europe (2005), is "to ensure that people worldwide can confidently and with full understanding of known risks realize the potential of the Internet in managing their own health and the health of those in their care." The Health Insurance Portability and Accountability Act (HIPAA) of 1996 sets the standards on how security and confidentiality of health care information must be maintained. The act also sets the penalties for any breach in security of health care data. The Internet Healthcare Coalition, founded in 1997, was created to promote quality health resources online and to ensure that consumers and professionals are able to find reliable, quality information online.

8. When using electronic medical records (EMR), the nurse knows that the EMR: a. holds the documentation of a single episode of care. b. is a longitudinal record of care for each patient. c. is widely used for individual health care encounters. d. includes progress notes for all disciplines.

ANS: A The electronic medical record (EMR), which is the documentation of a single episode of care (i.e., outpatient visit or inpatient stay), becomes a part of the electronic health record (EHR), which is a longitudinal record of care. EHRs are becoming widely used for individual health care encounters and for maintaining patients' health records over long periods. As EHRs become fully implemented, they include provider order entries, progress notes for all disciplines, computerized medication profiles, access to diagnostic test results on a timely basis, decision support systems, and online clinical reminders and alerts.

18. While adopting new technology to enhance patient care and safety, nurses can continue to provide: a. compassionate care. b. consumer empowerment. c. self-management of wellness. d. education about health care.

ANS: A While adopting new technology that enhances patient care and safety, it is the nurse's responsibility to continue to provide compassionate care. The spread of IT supports consumer empowerment and self-management of wellness and disease. Consumers can electronically access their own health information, communicate with their health care providers, and seek needed education about health care.

1. Nurses at the beginner level of informatics competencies stress the need to (Select all that apply.) a. be computer literate. b. be Internet literate. c. become a software developer. d. be able to suggest areas for IT system improvement.

ANS: A, B Beginner skills include computer, information, and web literacy; fundamental skills in information management and computer technology; and the ability to identify and collect relevant data. The nurse at the beginning level may have keyboarding skills, can document in the EHR, and can look up medications and other health information on reputable Internet reference sites. Developing new software to enhance nursing care is at the specialist level of competency. Being able to suggest areas for IT system improvement is at the experienced level of competency.

3. It is unethical to (Select all that apply.) a. use proprietary software for which you have not paid. b. assume a false identity. c. access your own patient's records. d. take another person's intellectual output and claim it as your own.

ANS: A, B, D It is not ethical to use proprietary software for which you have not paid. It is not ethical to assume a false identity. It is not ethical to take another person's intellectual output and claim it as your own. It is ethical to access your own patient's files for legitimate work purposes.

2. Which are major areas to be addressed when evaluating a website? (Select all that apply.) a. Authority b. Purpose c. Popularity d. Verification

ANS: A, B, D Website evaluation criteria include authority, purpose, coverage, currency, objectivity, accuracy, and verification. Popularity is not one of the criteria to use when evaluating a website.

1. The use of telemonitoring offers the opportunity to: (Select all that apply.) a. reduce cost of health care. b. improve patient satisfaction. c. increase duplicate orders. d. improve patient outcomes. e. improve organization.

ANS: A, B, D, E The use of telemonitoring offers the opportunity to reduce the cost of health care while improving outcomes and patient satisfaction. Use of health care IT has improved organization, communication, and decision making; reduced duplicate orders, charting time, and paperwork; made medication administration safer; and enhanced information access and administrative functions.

3. In reviewing a patient's written chart, the nurse notes the use of the terms "bed sore," "decubitus ulcer." And "pressure ulcer." The nurse knows in order to reach maximum potential in computerized charting and data analysis that a standardized nursing terminology must be utilized. In an attempt to standardize nursing terminology: (Select all that apply.) a. The Nursing Minimum Data Set (NMDS) was the first attempt to do so b. The focus was to provide a shared understanding of patient problem labels. c. The NMDS data was completed and is the definitive source of patient labels. d. The ICNP was developed to provide a standard for international nurses. e. Standardized terminology can lead to better utilization of resources.

ANS: A, B, E A standardized nursing terminology is a structured vocabulary that provides a common means of communication among nurses. A standardized language ensures that when a nurse talks about a specific patient problem, another nurse fully understands the problem. An example is the choice between pressure ulcer, decubitus ulcer, and bedsore. Do all nurses in all settings have a shared understanding of these labels for a patient problem? The Nursing Minimum Data Set (NMDS) represents the first attempt to standardize the collection of essential nursing data. These core data, used on a regular basis by most nurses in the delivery of care across settings, provide accurate descriptions of the nursing diagnoses, nursing care, outcomes of care, and nursing resources used. Collected on an ongoing basis, the NMDS enables nurses to compare data across populations, settings, geographic areas, and time. The International Classification for Nursing Practice (ICNP), developed under the auspices of the International Council of Nurses (ICN), provides a standard that facilitates the description and comparison of nursing practice locally, regionally, nationally, and internationally.

4. The Health Insurance Portability and Accountability Act (HIPAA) of 1996: (Select all that apply.) a. requires the user to have verification codes. b. ensures access to information without fear of audits. c. sets the standards on how information is maintained. d. sets the penalties for any breach in security of health data. e. has no legal authority relative to security issues.

ANS: A, C, D Access to electronic records requires a user to have system access and verification codes as a measure of security and protection of the patient's privacy. The codes leave an electronic trail of authorized users that can be audited. HIPAA sets the standards on how security and confidentiality of health care information must be maintained. The act also sets the penalties for any breach in security of health care data.

2. The Technology Informatics Guiding Education Reform (TIGER) initiative identified a set of skills needed by all nurses practicing in the 21st century. The TIGER Vision Pillars include: (Select all that apply.) a. management and leadership. b. certification by HIMSS. c. communication and Collaboration. d. informatics design. e. IT policy and culture.

ANS: A, C, D, E The Technology Informatics Guiding Education Reform (TIGER) initiative (2012) identified a set of skills needed by all nurses practicing in the 21st century. The TIGER Vision Pillars include management and leadership, education, communication and collaboration, informatics design, and IT policy and culture. This skill set includes informatics competencies that range from basic computer skills to advanced-level IT and literacy competencies and expertise. TIGER's vision for the future of nursing addresses informatics and emerging technologies to provide safer, patient-centered care by using evidence and technology in practice, education, and research. After meeting the educational and experience requirements, the nurse can receive certification in nursing informatics from the Health Care Information and Management Systems Society (HIMSS) and through the American Nurses Credentialing Center (ANCC). However, certification is not one of TIGER's Vision Pillars.

3. Standardized nursing terminologies include a. the ABC coding system. b. NANDA, NIC, and NOC. c. SNOMED-CT. d. ICD9 codes.

ANS: B A standardized nursing terminology is a structured vocabulary that provides a common means of communication among nurses. A standardized language ensures that when a nurse talks about a specific patient problem, another nurse fully understands the problem. Standardized nursing terminologies recognized by the American Nurses Association include NMDS (nursing minimum data set), NMMDS (nursing minimum data set), CCC (clinical care classification), ICNP (international classification of nursing practice), NANDA-I (NANDA International), NIC (nursing interventions classification), NOC (nursing outcomes classification), Omaha System, and PNDS (perioperative nursing data set). ABC and SNOMED CT are examples of multidisciplinary terminologies. ICD-9 details terminology for billing and coding, not nursing.

1. Data are best described as a. organized information. b. facts, observations, and measurements. c. knowledge used to make decisions. d. the appropriate application of knowledge.

ANS: B Data are facts, observations, and measurements that can be used as a basis for reasoning, discussion, or calculation.

5. Information can be best defined as a. organized and processed information that can be applied to problem solving and decision making. b. organized and processed data that can be communicated and are meaningful and useful to the recipient. c. the transformation of patient data to clinical information. d. the appropriate application of knowledge.

ANS: B Information is organized and processed data that can be communicated and are meaningful and useful to the recipient. Knowledge is organized and processed information that can be applied to problem solving and decision making. The transformation of patient data to clinical information becomes nursing knowledge. Wisdom addresses the use of knowledge and experience to manage and solve problems. Wisdom is the appropriate application of knowledge.

8. The standard of how security and confidentiality of health care information must be maintained is determined by a. NANDA-I. b. HIPAA. c. each health care facility. d. the Computer Ethics Institute.

ANS: B The Health Insurance Portability and Accountability Act (HIPAA) of 1996 sets the standards on how security and confidentiality of health care information must be maintained. Health care facilities may have additional guidelines to follow, but they do not set the standard. NANDA International has developed nursing terminology related to nursing diagnoses. The Computer Ethics Institute has developed its own Ten Commandments of Computer Ethics, but they do not set the standard.

11. The nurse can see data relationships, can make judgments based on trends and patterns in the data, is skilled in information management and the use of computer technology, and is able to suggest areas for IT system improvement. The nurse's level of informatics competency can be described as: a. beginner. b. experienced. c. specialist. d. innovator.

ANS: B Descriptions of nursing informatics competencies often focus on levels that include beginner, experienced, specialist, and innovator. Beginner skills include computer, information, and web literacy; fundamental skills in information management and computer technology; and the ability to identify and collect relevant data. The nurse at the beginning level may have keyboarding skills, can document in the EHR, and look up medications and other health information on reputable Internet reference sites. The nurse at the experienced level of informatics competencies is able to see data relationships and make judgments based on trends and patterns in data, is skilled in information management and the use of computer technology, and is able to suggest areas for IT system improvement. The nurse at the specialist level of competency focuses on information needs for the practice of nursing; integrates and applies information science, computer science, and nursing science; and applies skills in critical thinking, data management, processing, and system development. At the specialist level of competency, the nurse may conduct research based on information trends or patient data, devise applications for computer technology in nursing, or develop new software to enhance nursing care. Nursing informatics innovators conduct research and generate theory. They develop solutions and understand the interdependence of systems, disciplines, and outcomes.

2. The hospital has recently implemented computer charting. The computerization of nursing practice: a. enhances and increases the time spent on documentation. b. makes patient data immediately available to the health care team. c. makes retrieval of data more difficult but safer. d. is enhanced by limiting the use of point-of-care technology.

ANS: B Patient data collected by a nurse and recorded electronically are immediately available to all members of the health care team. The computerization of nursing practice data enables capture, storage, retrieval, organization, processing, and analysis of information. The information can be used to make a diagnosis, plan for care, provide nursing decision support, enhance documentation, and identify nursing care trends and costs. Systems that support data collection at the point of care can directly enhance patient care by decreasing the time spent on documentation, reducing the potential for errors, and supporting improved assessment and data communication. Computers, tablets, or pocket devices used at the bedside for documentation are examples of point-of-care technology.

4. Social media includes such sites as (Select all that apply.) a. HIPAA. b. Twitter. c. Facebook. d. LinkedIn.

ANS: B, C, D Social media includes online technologies such as Facebook, Twitter, and LinkedIn, which allow people to communicate easily via the Internet to share information and resources. HIPAA stands for the Health Insurance Portability and Accountability Act, and is not an example of social media.

4. Information Literacy is best defined as a. knowing how to access an electronic library. b. understanding data processing. c. knowing how to recognize when information is needed and to locate, evaluate, and effectively use the needed information. d. knowledge of computers and the ability to use them efficiently.

ANS: C Information literacy is the ability to recognize when information is needed and to locate, evaluate, and effectively use the needed information. Computer literacy is knowledge of computers and the ability to use them efficiently. Understanding data processing and knowing how to access an electronic library are not the best definitions of information literacy.

12. The director of nursing on a medical-surgical floor has met education and experience requirements in nursing informatics. The nurse might expect administration to request that he/she pursue: a. technical competencies. b. utility competencies. c. certification from ANCC. d. leadership competencies.

ANS: C After meeting the educational and experience requirements, the nurse can receive certification in nursing informatics from the Health Care Information and Management Systems Society (HIMSS) and through the American Nurses Credentialing Center (ANCC). Technical competencies pertain to the use of computers and other technological equipment and the use of a variety of software programs for word processing, spreadsheet and database development, presentation, referencing, and e-mail. Utility competencies address critical thinking and evidence-based practice applications. Nurses who have a utility competency recognize the relevance of nursing data for improving practice and can access multiple information sources for gathering evidence for clinical decision making. Leadership competencies address the ethical and management issues related to using IT in nursing practice, education, research, and administration. Specific leadership competencies include the application of accountability, maintenance of privacy and confidentiality, and quality assurance. Technical, utility, and leadership competencies can be achieved without certification.

5. Information technology (IT) can be used to increase patient safety. The nurse uses IT in this way by: a. creating redundancy in orders making them safer. b. removing the need for verification by the nurse. c. analyzing errors to develop prevention strategies. d. eliminating the need for bar codes in medication administration.

ANS: C IT can be used to increase patient safety. Errors are analyzed to develop strategies for prevention. Diagnostic test results are available faster to support treatment decisions and avoid redundancy in orders. When technology such as a bar-code medication administration (BCMA) system is used as part of the process of medication administration, fewer errors are made. After signing into the system or scanning his/her identification (ID) badge, the nurse electronically scans the bar codes of the patient ID, the medication administration record (MAR), and the drug to determine that the right patient is getting the right drug and dose at the right time. An alert signals a potential error, and it is the nurse's responsibility to verify all information before administration

6. When technology such as a bar-code medication administration (BCMA) system is used as part of the process of medication administration, fewer errors are made. The proper procedure when using the BCMA includes: a. signing into the system using the patient's ID number. b. typing in the patient's name and room number. c. scanning the patient's ID, MAR, and medication. d. discontinuing the medication if the system signals an error.

ANS: C When technology such as a BCMA system is used as part of the process of medication administration, fewer errors are made. After signing into the system or scanning his/her ID badge, the nurse electronically scans the bar codes of the patient ID, the MAR, and the drug to determine that the right patient is getting the right drug and dose at the right time. An alert signals a potential error, and it is the nurse's responsibility to verify all information before administration.

2. A listserv is best described as a. a website. b. an online library source. c. a blog. d. a program that sends messages to multiple e-mail addresses.

ANS: D A listserv is a computer program that automatically sends messages to multiple e-mail addresses on a mailing list. Listservs can be used in health care to connect groups of patients with common problems or to send updated information to large groups.

6. Computer Literacy is best defined as a. knowing how to access an electronic library. b. understanding data processing. c. knowing how to recognize when information is needed and to locate, evaluate, and effectively use the needed information. d. knowledge of computers and the ability to use them efficiently.

ANS: D Computer literacy is knowledge of computers and the ability to use them efficiently. Information literacy is the ability to recognize when information is needed and to locate, evaluate, and effectively use the needed information. Understanding data processing and knowing how to access an electronic library are not the best definitions of computer literacy.

7. A global perspective on nursing practice might best be obtained from a. NANDA, NIC, and NOC. b. ICD9 Codes. c. SNOMED-CT. d. ICNP.

ANS: D The International Classification for Nursing Practice (ICNP), developed under the auspices of the International Council of Nurses (ICN), provides a standard that facilitates the description and comparison of nursing practice locally, regionally, nationally, and internationally. NANDA, NIC, and NOC are examples of standardized nursing terminologies. SNOMED CT is an example of multidisciplinary terminology. ICD9 is used for billing purposes.

17. The focus of nursing informatics is: a. direct patient care. b. increasing documentation time. c. the introduction of different EHRs. d. how patient care can be improved.

ANS: D The focus of nursing informatics is not on direct patient care but on how the process of patient care can be improved and patient safety ensured. There are challenges to advancements in IT, such as increased amount of time spent documenting, cost of equipment, protection of patient privacy, use of different EHRs in different facilities, and resistance by health care providers to new technology.

5. A famous rock star has just been admitted to Unit 12A after an automobile accident. A nurse on Unit 12B who is a fan of the musician uses the electronic health record (EHR) to find out how the patient is doing. Which is true regarding the use of a patient's EHR? a. Only staff caring for the patient should access this record. b. Permission from a supervisor is needed to read this record. c. The patient's record can be discussed with the nurse's co-worker. d. The nurse can call a friend who works at the local newspaper.

Answer: a Patient information should be accessed only by staff caring for that patient. Security codes are required for EHR access, and access of records can be monitored. Professional ethics should dictate the nurse's behavior, and only the records of patients being cared for should be accessed. A patient's record can be discussed only with those who are caring for the patient, and, because the nurse is not on the same unit, the records should not be accessed or discussed by that nurse. Health Insurance Portability and Accountability Act (HIPAA) laws prevent the discussion of private patient information with anyone outside of the team providing care.

6. Which activity by a unit nurse demonstrates information literacy? a. Researching a patient's diagnosis online b. Entering patient data into the electronic health record (EHR) c. Organizing patient data to study trends d. Learning a new electronic health record system

Answer: a The nurse is demonstrating information literacy (the ability to recognize when information is needed and to locate and use that information) when researching a patient's diagnosis online. Entering patient data into the EHR or learning a new EHR system demonstrates beginner nursing informatics competency. Organizing patient data to study trends demonstrates an experienced level of nursing informatics competency.

2. Which description is an example of data? a. A print-out of a patient's history and physical examination b. A patient's blood pressure and pulse rate c. The nurse's knowledge of a disease d. A nurse's interpretation of a change in the patient's condition

Answer: b Data are facts, observations, and measurements such as blood pressure and pulse rate. A printout of the patient's history and physical is organized information that is meaningful. Knowledge is organized and processed information such as a nurse's knowledge of a disease. When nurses interpret a change in the patient's condition, they are using wisdom or the use of knowledge and experience to manage and solve problems.

4. The hospital has implemented a new electronic medication administration record (MAR). What is true about the use of this new tool? a. Verifies medication dosages b. Reduces medication administration errors c. Eliminates the need to count narcotics d. Requires a hard copy of the MAR to be printed

Answer: b The electronic MAR reduces medication errors by requiring the nurse to scan the patient's identification band and the medication. Although the electronic MAR alerts the nurse to potential errors such as the wrong dose, it is the nurse's responsibility to verify all information before administration of a medication. Narcotic counts are still kept in the electronic system. A hard copy of the MAR is not necessary.

10. Which description is true about the Nursing Minimum Data Set (NMDS)? a. An admission assessment tool b. A discharge summary c. The core nursing data for collection across all sites d. An organization of nursing diagnoses

Answer: c The NMDS is a standardized collection of essential nursing data used by nurses to promote consistent, understandable documentation. Although standard terminology may be used during admission, and discharge, these tools are not a description of NMDS. Nursing diagnoses are organized using NANDA-I.

8. Which statement is correct concerning the implementation of computerized provider order entry (CPOE)? a. The unit secretary transcribes the physician's orders into the computer. b. The nurse must ensure that orders go to the appropriate departments. c. Physician orders go directly to the appropriate department. d. Handwriting legibility is a major problem.

Answer: c Use of CPOE enables orders to go directly to the appropriate department decreasing the potential for errors. There is no transcription of orders and no need for someone to transcribe the orders. Because the orders are typed into the computer, handwriting legibility is not an issue.

3. Which items are supported by point-of-care use of information technology? (Select all that apply.) a. More accurate documentation b. Direct access to diagnostic results c. Confidentiality d. Direct access to records by patients e. Access to medication profiles

Answers: a, b, c, e Point-of-care use of information technology provides more accurate documentation because the nurse documents patient information in real time. Diagnostic results are immediately available to the nurse. Confidentiality is protected when the nurse documents at the bedside using a secure log-in and password. Medication profiles are available to the nurse at bedside. Patients do not have direct access to their medical records because these records are secured by log-ins and passwords accessible to only health care providers caring for each patient.

9. Which behaviors are expected of the nurse at the experienced informatics competency level? (Select all that apply.) a. Collect accurate assessment data. b. Conduct informatics research. c. Group assessment data. d. Document data appropriately on the electronic health record (EHR). e. Integrate information science, computer science, and nursing science.

Answers: a, c, d The nurse at the intermediate level of informatics competency can see data relationships and is able to collect and group data. The nurse is skilled in the use of computer technology and can document in the EHR. Conducting informatics research and integration of the sciences is the advanced level of informatics competency.

14. Which of the following is the biggest advantage of mobile technology in the health care setting? a. improvement in research awareness b. advancement of computer skills c. increased job satisfaction d. prevention of medication errors

d. prevention of medication errors

4. What is telehealth nursing?

transmission by a nurse of electronic data, images, or audio from a patient's bedside or home to other health providers for the purpose of providing care and improving outcomes.