Nrsg Info Test 2

" "In the event of a disaster that results in power failure, the generator should be able to provide power onsite for at least: A. 12 hours. B. 24 hours. C. 48 hours. D. 72 hours.

" "C. 48 hours. So that stored fuel supply must be adequate. Additionally, an uninterruptible power supply (UPS) (such as a battery system) should be available for 10 miutes in order to provide time to switch to the generator. Both the generator and UPS should be tested every 30 days and should be maintained in secure areas that are protected from flooding.

" "According to government standards, when setting up computer access for EHRs, the maximal distance that a healthcare provder should have to walk to access the system is: A. 10 feet B. 20 feet C. 50 feet D. 75 feet

" "C. 50 feet The terminals should be mapped to nearby printers. All acute care nursing units should have access to at leasst one printer. The number of terminals should be adequate enough that wait times to use the terminal are minimal, based on workflow assessments.

" "Which of the following is contained in the CPU of a computer? A. BIOS B. ROM C. Arithmetic-logic unit D. Major chip set

" "C. Arithmetic-logic unit CPU (""brains"") of a computer contains the arithmetic-logic unit, which is necessary to carry out operations related to both arithmetic and logic. The CPU also contains cache memory, a fast memory that holds data and memory that is being used, and the control unit, which controls operations of all other parts of the computer and allows other computer components to respond to instructions. The CPU is located on the computer's motherboard.

"The type of data that include hazard and safety practices is classified as what? A. Aggregate B. Medical/clinical C. Knowledge-based D. Comparison

" "A. Aggregate Also includes financial records, pharmacy transactions, demographic information, and required reports. Medical/ clinical data includes diagnosis, treatment, laboratory reports, care plans, physician orders, and consents. Knowledge-based data are those used for training and research. Comparison data compares data, such as for benchmarking.

" "Which of the following is one of the four main categories of the OMAHA system's Intervention Scheme? A. Case management B. Communication C. Education D. Nursing care.

" "A. Case management The 3 components of the OMAHA system are the problem classification scheme, and problem rating scale for outcomes. The intervention scheme has 4 main categories (1) teaching, guidance and counseling (2) treatments and procedures (3) case management and (4) surveillance. Each component also contains numerous targets that support the categories. For example, the targets of the intervention scheme include behavior modificaiton, continuity of care, cardiac care, family planning care, communication, education and nursing care.

" "Which organizational theory states that management approaches should vary according to needs and environment? A. Contingency theory B. Participative decision making C. Theory of organization D. Bureaucracy.

" "A. Contingency theory This theory postulates that no single method of organizing and managing a company or organization is better than any other but is contingent on a number of different factors, such as the size of the organization, the education of the workforce, technology and resources. The leadership sytle utilized should reflect needs rather than ideology.

" "According to the Quality and Safety Education for Nurses (QSEN) initiative, future nurses require which of the following competencies in order to continuously improve both the quality and safety of the work environment? A. Knowledge, skills and attitudes B. Knowledge, behavior and compassion C. Determination, knowledge and integrity D. Motivation, knowledge and power

" "A. Knowledge, skills and attitudes QSEN began in 2005 and had gove through 4 phases by 2015. Six compentencies were outlied in Phase I and subsequent phases involve setting up pilot programs to integrate the compentencies into nursing education and developing further workshops, conferences and faculty development projects across the United States.

" "A digital dashboard typically displays predominantly what types of data? A. Performance B. Financial C. Staffing D. Knowledge-based

" "A. Performance Usually utilizes various diagrams and charts and is typically used to provide staff members information about performance data, such as patient satisfaction, census and surgical site infection rates. The data may be unit or department-specific or may reflect the entire organization. Data should be updated on a regular basis, such as weekly or monthly so that staff members remain interested and engaged, especially if provided as part of a quality improvement process.

" "Which of the following represents Von Neumann's Model of Computer Architecture? A. Processor, memory, input-output B. CPU, mmonitor, keyboard, peripherals C. Data memory, progrm memory, CPU D. Program memory, data memory, CPU, intake-output

" "A. Processor, memory, input-output This is a 3-component model with program and data memory combined. The processor contains the control unit and the arithmetic/logic unit. The memory in this model contains storage for both data and operating instructions. This model is less complex than the later Harvard model of computer architecture, which is a 4 component model with program memory and data memory as separate units, CPU and input-output.

" "Which of the following types of data/information is primarily subjective? A. Relevant B. Timely C. Flexible D. Verifiable

" "A. Relevant Relevant: primarily subjective because the user must judge whether or not the data/information is relevant for the user's purposes. Objective data/information: Factual and unbiased, can be proven. Flexible data/infomraiton : 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: available when needed. Complete data/information: contains all the information needed. Reliable data/information: clean data from a trusted source, such as juried journal.

" "When designing a user interface or webpage, which of the following is a good font to use? A. Verdana B. Times New Roman C. American typewriter D. Bradley hand

" "A. Verdana A good font to use is Verdana or Arial, both commonly used because they are san serif, making them easier to read on the computer screen than serif fonts, such as Times New Roman. Fonts that mimic typewriter text are also often harder to read on the screen, and fonts that mimic handwriting should be avoided, as they are also harder to read and appear less professional.

" "The orderable items listed in the CPOE should include: A. all formulary and acceptable non-formulary medications B. all formulary medications only C. physician's preferences D. the most-commonly used formulary medications.

" "A. all formulary and acceptable non-formulary medications All non-formulary medications should be clearly labeled as such. Personalized order sets should be avoided, but standarized evidence-based order sets, such as for treatment of chest pain, should be used. Dosing guidelines, such as for insulin, should be available for complex dosing. Recommendations for pediatric dosing should be age and weight-based.

" "The purpose of a virtual private network (VPN) for mobile devices is to ensure that: A. all transmitted data are encrypted. B. data can be acccessed rapidly. C. data are restricted to select individuals. D. transmission is not interruped during access.

" "A. all transmitted data are encrypted. A VPN is a secure network of computers or a network of different networks that are linked together so that they can share data among the different networks that are linked together so that they can share data among the computers and networks as well as to mobile devices over the Internet. Most VPNs are encrypeted so that data is secure although there are different levels of security with Point-to-Point Tunneling Protocol (PPTP) the least secure and Secure Sockets Layer (SSL) the most.

" "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. involve many staff memers in the change process. D. establish systems for feedback.

" "A. deal with resistance and provide reassurance. As well as determining the needs for change, promoting the need for change, and ensuring managerial support. During the change stage, communicating answering question and dispelling rumors as well as encouraging involvement is important. The refreeze (last) phase requires developing methods to sustain change and provide feedback and adaption to the changes.

" "Knowledge discovery and data mining (KDDM) is utilized to: A. discover patterns in healthcare-associated data and make predictions. B. evaluate the effectiveness of different medical interventions. C. provide a prospective evaluation of data. D. evaluate an organizations utiliization of computerized record keeping.

" "A. discover patterns in healthcare-associated data and make predictions. KDDM mines large datasets (often from multiple databases) and applies automated statistical/computational tools to the data. KDDM is a retrospectitve study that typically includes sample sizes that range from 1000 to a million or more. KDDM is especially of value with the conversion of paper documentation to EHRs, which contain a wealth of information.

" "HIPAA and the HITECH Act require that clinical data that is to be transmitted over the Internet must first be: A. encrypted. B. compressed. C. cleaned. D. de-identified.

" "A. encrypted. In order to protect confidentiality and protected health information (PHI). Because patient health records often contain not only health information but also other identifying information, such as address, telephone number, birthdate, social security number and sometimes even credit card numbers, patients may be very vulnerable if data are obtained and misused.

" "If the Joint Commission establishes new core measures, the primary role fo the informatics nurse should be to: A. ensure they are incorporated into the EHR, CPOE, and CDS system. B. educate the staff about the new core measures. C. request additional funds to modify the computer information system. D. post the new core measures at each nursing station.

" "A. ensure they are incorporated into the EHR, CPOE, and CDS system. The EHR, CPOE and CDS systems may need almost continual updating because of new regulations and requirements and new information. If updating is not done promptly, the system can rapidly become outdated and may increase risks to patients because of inadequate information.

" "The best way for a project manager to promote accountability for teams is to: A. establish a reporting mechanism and timeline B. encourage autonomy and decentralized decision-making C. meet daily with all team leaders to assess progress D. establish disciplinary actions for non-accountability

" "A. establish a reporting mechanism and timeline So that team leaders undertand exactly what needs to be done by specific dates and what type of reporting is required, such as a verbal or written report. While some degree of autonomy is good, the overall plan outlined by the project manager must be central so that the teams stay focused on the end goal.

" "If a root cause analysis shows that one staff member failed to note a pop-up allergy alert in the EHR, resulting in a severe anaphylactic reaction in a patient, the response should be to: A. evaluate the alert system. B. discipline the nurse. C. provide additional training to all staff. D. provide additional training to all nurses.

" "A. evaluate the alert system. Pop-up windows, especially if they are frequent, may be ignored or easily overlooked because of ""alert fatigue"". A hard stop may be preferable to a pop-up alert for serious issues, such as allergies.

" "The read range of a standard (non-Bluetooth, non-laser) hand-held barcode scanner is ususally: A. few inches to a few feet. B. up to 10 feet. C. 20 t0 40 feet. D. hundreds of feet.

" "A. few inches to a few feet. So this type of scanner has a very limited range, especially if the scanner is tethered to the computer by a cord. Some of the more expensive cordless scanners have somewhat better range. The quality of scanners may vary widely with some able to read barcodes at an angle or when the numbers are distored but others not. Long-range blue-tooth handheld scanners may have a range up to 45 feet.

" "Before conducting a clinical information system (CIS) needs assessment, the informatics nurse should complete a(n): A. financial status review. B. end-user survey. C. project plan. D. planning budget.

" "A. financial status review. Including current information system budget and analysis of cash flow to determine if the orgnization has the financial means to obtain a clinical information system. Policies, controls and infrastructure needs should be considered as well. An assessment of computer literacy and needs for training may also be done as part of preliminary planning.

" "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. Because nurse leaders serve a critical role in motivating other staff and acting as role models, the nurse informatics specialists 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.

" "The purpose of an ""acceptable use"" policy is to: A. inform staff what computer use is permitted. B. prevent damage to hardware. C. outline the life expectancy and depreciation of equipment. D. explain the steps needed to retrieve information from an EHR.

" "A. inform staff what computer use is permitted. The acceptable use policy should outline use related to accessing the Internet and emails. Internet accesss may be prohibitted because of security concerns, and email access should always be limited to work-related communciations. Staff should have guidelines about appropriate work-related email communications as the emails are the property of the organization and do not include a presumption of privacy.

" "The three primary concerns regarding secure network information are (1) confidentiality, (2) availability and (3): A. integrity. B. communication C. failure D. determinination

" "A. 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 information.

" """Role-based access"" refers to: A. limits on abilities to access or input data B. the categories of staff who can access the EHR C. types of equipment that can be installed as components D. hardware versus software applications

" "A. limits on abilities to access or input data For example, a physician should be able to access and input data more extensively than unlicensed assistive personnel, who may only be able to access the plan of care to document vital signs and personal care provided. Each person with access to the EHR or any part of the computer information system should be assigned role-based access in order to protect patient data, and these roles should be reassessed at least annually.

" "If data stored in one provider's cloud service must be moved back to the organiztion's site and unmodified before the data can be transmitted to another cloud service, this is an example of data: A. lock-in B. corruption C. de-identification D. retrieval

" "A. lock-in (AKA vendor lock-in). This lack of interoperability, which prevents easy transfer of information from one vendor to another, is a problem not only with cloud servies but also with many EHRs. Data lock-in may occur because of the use of proprietary technology, inadequate contractual agreements, or inadquate processes.

" "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 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.

" "For quality improvement projects, a Gantt chart is most valuable for: A. managing time schedule and estimating times required to complete tasks. B. providing a visual representation of the actions of a team. C. listing the steps in a process and conditions affecting those steps. D. brainstorming and generating lists of ideas.

" "A. managing time schedule and estimating times required to complete tasks. The Gantt chart is a type of bar chart with horizontal bars (often color-coded for easy identification of different tasks) indicating projected beginning and ending times for tasks listed on the vertical axis. Gantt charts are often included in project management software and are a valuable planning tool because timelines can be quickly and easily identified.

" "According to the ANA, the core sciences of nursing informatics are: A. nursing, information and computer sciences. B. nurisng, communication and computer sciences. C. nursing, social and computer sciences. D. nursing, cognitive and computer sciences.

" "A. nursing, information and computer sciences. According to the ANA, the core sciences of nursing informatics are: Nursing science: the study of nursing and how it relates to human health, including applicatioin of nursing models and theories Information science: the study of the application and usage of information and knowledge and the interactions between information and users and organizations Computer science: the study of theories and methods related to the use and design of the computer and software to process information.

" "The database management system (DBMS) best suited to handle a variety of data types, which include graphics, audio and video files, is: A. object-oriented DBMS B. network DBMS C. relational DBMS D. heirarchical DBMS

" "A. object-oriented DBMS DBMS (software utilized to manage databases) best suited to handle a variety of data types, which include graphics, audio and video files, is object-oriented DBMS. While expensive, object-oreinted DBMSs have superior multi-media functionality. The choice of DBMS depends on the type of database. The heirarchical database organizes data in ""parent-child"" (tree-like) relationships. Relational databases organize data into tables (entities) with fields and attributes. Network databases organize data acccording to many-to-many relationships.

" "An example of two-factor authentication utilized for access to a system is: A. password and security token B. user name and password C. ID badge and security token D. thumbprint and retina scan

" "A. password and security token Two-factor authentication requires use of two indentifiers of different types. The three types include something that the person accessing knows, such as a user name or password; something the person has or carries, such as a security token or ID badge; and something intrinsic to the person, such as a thumbprint or a retina scan.

" "The four domains of nursing data needs are: A. patient, healthcare provider, administrative and research. B. patient, nurse, physician and organization. C. administration, healthcare providers, regulatory and research. D. medical, business, research and technical.

" "A. patient, healthcare provider, administrative and research. Patient: obtained from patient health record, includes clinical data, care, outcomes Healthcare provider: obtained from data banks, patient health care records and personnel records, includes decision-making and provision of care Administrative: obtained from administrative, financial and regulatory data, includes administrative data, system outcomes, and management procedures Research: obtained from clinical records and relational databases, includes best practices, knowledge base.

" "When a perpetrator attempts to obtain another person's personal information (such as user name and password) through e-mail by pretending to be an authorized individual, this is an example of: A. phishing. B. spamming. C. whaling D. clickjacking.

" "A. phishing. Phishing is a social engineer technique. Additionally, phishing e-mails may contain infected downloads or links to malware. The e-mails 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.

" "Case management information systems focus on providing: A. preventive care. B. access to patient data. C. management of healthcare. D. direct patient care.

" "A. preventive care. Case management systems look at both current and historical case files and search for trends to which preventive measures can be applied. For example, if a patient has had repeated rehospitalizaiton for nonadherence, the preventive plans may focus on educating the patient, providing home health supervision, or simplifying medication regimens. Case management information systems generally utilize standarized plans of care and are especially helpful in managing care of high-risk patients with complex conditions.

" "According to the International Medical Informatics (IMIA) Code of Ethics for Health Information Professionals, the principle of ""legitimate infringement"" refers to: A. right to privacy limited by consideration of greater good B. right to privacy ensured under all circumstances C. withholding of information from patients to prevent distress D. sharing of patient information among patients' clinicians

" "A. right to privacy limited by consideration of greater good Thus, the right to privacy is not absolute from an ethical standpoint. However, any infringement must be the minimum necessary (""least intrusive"") and must not be for efficiency or convenience. Legitimate infringement may occur if withholding or providing private infomation may put another party or parties at risk.

" "The majority of adult learning is: A. self-directed. B. experiential. C. teacher-directed. D. transformative.

" "A. self-directed. According to research, the majority (70%) of adult learning is self-directed learning with 9 out of 10 adults engaged in some self-directed learning every year. Adults are motivated to learn because of interests or needs, which may be personal, work related or family related, and choose the materials and methods independenlty. Adults with low levels of literacy are less likely to engage in self-directed learning than others. When planning education, the informatics nurse should consider helping learners assess their need for information and should provide materials for self-directed learning.

" "When utilizing outcomes data for process improvement, the primary problem is that outcomes data: A. show results but not reasons. B. may be misrepresented. C. are difficult to obtain. D. are costly.

" "A. show results but not reasons. For example, if one hospital unit switched to silver-coated urinary catheters and saw a decrease in urinary tract infections, it's possible that the outcomes resulted from the change in catheters, but it's also possilbe that other factors, such as better adherence to aseptic technique, younger patients or increased use of anitbiotics may have contributed, so outcomes data must be carefully reviewed and analyzed.

" "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 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 not HIPAA-compliant.

" "If the informatics nurse has provided training in use of the new EHR but one staff member has repeatedly failed to become certified in use of the software application equipment, the person/entity that is ultimately responsible is the : A. staff member. B. informatics nuse. C. orgnaization. D. administration.

" "A. staff member. Because each person is responsible for his or her own learning. However, the informatics nurs should assess the person's learning style preferences and try to find ways to help the person learn and/or motivate the person to learn.

" "An important difference between an operational database and a data warehouse is that the data warehouse: A. supports analysis of data B. is usually limited to one application C. is used for EHRs D. allows transactions.

" "A. supports analysis of data The data warehouse may draw data from a number of different applications, systems, and /or databases and usually exist as a separate layer from operational databases, such as the operational database that is used to run an EHR. While operational databaes allow transactions and interactions, data warehouses collect data, which can be mined.

" "Word sense disambiguation refers to determining or identifying: A. the correct meaning or sense of a a word. B. different words that have the same meaning. C. the meaning of abbreviations. D. the syntactical use of words.

" "A. the correct meaning or sense of a a word. A problem that must be automated in electronic health records (HER) with clinical decision support (CDS). For example, hospital discharge and nasa discharge both include the word discharge but the meaning is very different. In this case, each phrase is preceded by a descriptive adjective (hospital and nasal), so this structure (adjective-noun) alone is insufficient to determine the meaning of discharge. Abbreviations are particularly difficult because one abbreviation may have multiple meanings (ambiguity) that cannot always be determined by syntax.

" "The Common Meaningful Use Data Set is intended to facilitate transmission of summary data during: A. transitions of care, such as discharge B. inpatient treatment C. outpatient treatment D. periods when the EHR is on downtime.

" "A. transitions of care, such as discharge Intended to facilitate transmission of summary data during transitions of care, such as discharge and referrals, by requiring interoperability. Data include patient name and demographics, vital signs, diagnosis, procedures, medications, allergies, test results, immunizations, functional status, care plan, care team and reason for referral of discharge instructions. Terminology used may include ISO 6392-a-3, SNOMED CT, LOINC and CVX. The summary of care must be sent in a timely manner.

" "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. 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 applicaitons, focusing on such factors as memory, thinking/reasoning, and learning.

" "Ensuring that a user interface has optimal usability requires: A. user ability to reconfigure some aspects. B. user consensus about configuration. C. ability to annually update configuration. D. use of standardized configuration.

" "A. user ability to reconfigure some aspects. For example, the user should be able to zoom in or out to make text larger or smaller. The brightness of the screen should be adjustable so that the brightness may be decreased during nighttime, and the color scheme should have some options to accommodate those with different types of color blindness (such as red/green blindness).

" "Long-term strategic planning should look at the needs of the organization for: A. 2 to 5 years B. 10 to 15 years C. 15 to 25 years D. 25 to 50 years

" "B. 10 to 15 years But should also include short-term strategic planning for the next 2 to 5 years. Planning for longer periods of time is difficult because too many changes (social, technical, enviornmental, medical) may occur to make planning realistic. Strategic planning should include both internal and external assessments, attempting to identify key issues, such as the strengths and weaknesses of the organization.

" "According to the HIPAA privacy rules, protected health information (PHI) may be legally disclosed to law enforcement officials under which of the following circumstances? A. An officer provides first aid to a person injured in a fall. B. A patient who came to the emergency department with a gunshot wound dies. C. A police officer observes a patient who reminds the officer of a fugivive. D. A police officer requests information about a friend who had a heart attack.

" "B. A patient who came to the emergency department with a gunshot wound dies. A patient comes to the ED with a gunshot wound and dies. Information may be disclosed in this case because it may involve criminal activity that resulted in death. Because a fall is likely not a criminal activity, the patient's information is protected. PHI may be disclosed to help identify a suspect or fugitive, but simply reminding an officer or a fugitive is not adequate cause.

" "The purpose of assistive technology compatibility testing of software and hardware is to ensure compliance with: A. EDA regulations B. ADA regulations. C. ACA regulations. D. CMS regulations.

" "B. ADA regulations. Americans with Disabilities Act (ADA) regulations that require that people with disabilities be able to access and utilize hardware and software. Testing should include the use of screen readers (such as Jaws), screen magnifiers (such as Mac Screen Magnification), speech input devices/programs (such as Siri) as well as input devices (such as on-hand keyboards and keyboard control pedals), and text-to-speech tools (such as Natural Reader).

" "According to Carper's patterns of knowing, which pattern represents access to multicultural practices and beliefs? A. Empirics B. Aesthetics C. Personal D. Ethics/Moral knowledge

" "B. Aesthetics Empirics: focuses on empirical knowledge (facts, theories, laws) and the science of nursing Aesthetics: focuses on access to mulitcultural practices and beliefs and knowledge gained through subjective means Personal: focuses on clinical experience and reactions and the interactions occurring between patient and nurse Ethics/Moral knowledge: focuses on access to ethical standards and experts as well as application of ethical codes of real situations

" "In addition to name, which of the following is acceptable as a unique identifier? A. Age B. Birthdate C. Hair color D. Gender

" "B. Birthdate Other unique identifiers include alphanumeric strings (such as used for ID numbers) and social security numbers. A unique identifier should not be readily changeable (although 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.

" "Which of the following has been the primary factor in the assimilation of computers into clinical practice? A. Increased user familiarity with computers B. Improved hardware and software options C. Increased demands of managed care D. Increased costs of providing care

" "B. Improved hardware and software options Increased the usability of computer systems and electronic health records. Increased familiarity with computers may, in fact, make the users more demanding in terms of usability and less tolerant of inefficient systems. The increased demands of managed care and the need to meet regulatory and accrediting requirements have also been factors. At present, transitioning to computerized systems is not necessarily cost saving because of the costs as well as maintenance costs.

" "What is the primary advantage of adding Six Sigma to an existing Total Quality Management (TQM) program? A. Decreased overall cost of implementation B. Increased emphasis on measurements C. Decreased emphasis on personal responsibility D. Increased emphasis on personal responsibility

" "B. Increased emphasis on measurements TQM focuses on meeting customer needs and continuous improvement with involvement of staff at all levels. Six Sigma is a very data-driven performance model that aims to eliminate problems (""defects"") in processes. Both DMAIC and DMADV improvement projects begin with defining costs and benefits that will derive from changes and measuring (collecting baseline input and output data to establish costs and perform analysis).

" "Which of the following is an indirect cost associated with workplace conflict? A. Litigation costs B. Low morale C. Diability claims D. Turnover costs

" "B. Low morale Workplace conflict can result in both direct and indirect costs: Direct Costs: litigation costs, disability claims, turnover costs, decreased productivity, regulatory fines for failure to comply, increased costs resulting from patient care errors Indirect Costs: low morale, impaired organizational reputation, and increased disruptive staff behavior Because of the rapid changes that take place in healthcare, conflict is almost ineveitable, so managing conflict an anticipating conflict are both critical managerial challenges.

" "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 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.

" "When utilizing the FOCUS (find, organize, clarify, uncover, start) model of performance improvement, FOCUS is usually combine 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) FOCUS is usually combined with PDCA to create 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.

" "According to the Institute of Medicine's STEEP principles for redesigning healthcare, key factors include Safe, Timely, Effective, Efficient, Equitable and: A. Paper-free B. Patient-centered C. Participatory D. Predictable

" "B. Patient-centered These recommendations were proposed in Crossing the Quality Chasm, the second IOM report which outlined deficiencies in medical care in the Untied States. Crossing the Quality Chasm followed publication of the first report To Err is Human, which focused on the high numbers of Americans that die each year because of medical errors.

" "As part of gathering data and conducting internal and external analysis for short-term strategic planning, the organization may derive insight from: A. FMEA B. SWOT analysis C. root cause analysis. D. Pugh decision matrix.

" "B. SWOT analysis

" "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 Limits direct 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 features so that the terminal shuts down if no activity occurs for a specific period of time, such as 3 mintues.

" "How many hosting sites are required for data and operating systems for a healthcare organization, such as an acute care hospital? A. One B. Two C. Three D. Four

" "B. Two These hosting sites must be in geographically distinct (50 miles or more separating them) areas so that data are not lost in the event of a disaster. Mirroring should occur in real-time. If a hosting facility maintains data from various healthcare organizations, each organization's data must be maintained on separate servers.

" "Which of the following is a reason for the increasing trend of utilizing telehealth technologies? A. patient preferences B. aging populations C. increasing acute illnesses D. uneducated populace

" "B. aging populations As a preventive measure (monitoring patient's conditions) and to reduce the need for hospitalization. Other reasons include the increasing cost of healthcare and hospitalization, a more educated populace that wants to be involved in its own healthcare, the shortage of nursing and other healthcare personnel, and the increase (tied to the aging population) of chronic illnesses.

" "If an alert regarding a patient's laboratory test 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. alert to an alternate clinician. C. an alert to adminstration. D. an alert to the chief medical officer.

" "B. 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 by the EHR, such as by direct telephone contact.

" "If assisting a team with meta-analysis, the informatics nurse should advise the team to begin with: A. interviews with experts. B. bibliographic database C. manual library search D. list of preferred sources.

" "B. bibliographic database Such as Medline Plus (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 multipe studies on a related topic. Once a list of articles is obtained,further sources may be gleaned from the reference list for each article. Additionally, information may be gained from unpublished works, such as conference presentations.

" "With the System Improvement Process (SIP), once a problem is identified, the sub-problem that must be dealt with are: A.analysis, solution convergence and implementaion. B. change resistance, proper coupling and model drift. C. problem identification, root cause analysis and feedback. D. personal, organizational and social.

" "B. change resistance, proper coupling and model drift. Change resistance: many people actively resist any change and view changes as threatening Proper Coupling: the staff is coupled with the organization, but the coupling may not have adequate feedback or support to sustain itself Model drift: the organizational management may not be able to keep up with needs to the point that it has ""drifted"" so much it no longer functions well

" "When developing an interactive website for a healthcare organization and including links to other sources of information, the most important consideration is: A. ensuring links are active. B. ensuring the links are to valid sources. C. determining if the source material is easily understandable. D. asking permission to link to another organization's home page.

" "B. ensuring the links are to valid sources. Such as government sites or healthcare organization sites. Fair use allows linking to another organization's home page without permission, but if deep linking (linking to content beyond the home page) or framing (importing information from another website into one's own), then the person linking or framing should ask permission because copyright laws are less clear about this type of linkage.

" "An entity relationship diagram is used to show the relationship of: A. networks in an organization. B. entities in a database. C. patient care providers. D. components of a virtual private network.

" "B. entities in a database. An entity is a table and the fields within the table are the attributes of that specific entity. A database is a collection of one or more related entities. Realtionships demonstrated in an entity realtionship diagram may be one-to-one (one entity is used by another), one-to-many (an entity is used frequently by other entities), or many-to-many (all entities are frequently used by other entities).

" "To assess usability, a heuristic evaluation is carried out by: A. IT personnel. B. experts. C. end-users. D. informatics nurse specialist.

" "B. experts. A heuristic evaluation is carried out by experts with knowledge of standards and principles of usability (heuristics) in order to determine if the computer interface meets criteria for usability. Heuristic evaluations are usually conducted early in the process of design so that problems can be identified and corrected. Usually fewer than 10 experts are utilized from associated fields, such as information science, human computer technology and cognitive engineering. This method of usability testing is relatively inexpensive.

" "The nursing staff has proposed use of a newly developed point-of-care electronic device. The best technique for assessing the value of the device is: A. literature review. B. field study. C. staff surveys. D. vendor information.

" "B. field study. Field study in which the staff use the device in a limited manner, such as on one unit, to evaluate its effectiveness in terms of function and usability and to assess the value in terms of improved patieint care and patient outcomes. In some cases, vendors may provide devices free of charge for field studies so that the organization can determine whether the device is appropriate without undue investment.

" "The primary characteristic of a Web 2.0 site is: A. static web pages. B. interactivity. C. mailto forms D. frames and tables.

" "B. interactivity. Instead of the application being on the individual's computer, it is based on the Internet. Typical Web 2.0 sites include social media (such as Facebook) that allow users to manipulate data and comment as well as YouTube, which allows users to watch videos and upload videos. Web 2.0 has made collaboration over the Internet much easier. Users can generate and edit websites using any browser, such as Firefox or Safari.

" "According to the Foundation of Knowledge Model (Mastrian), the four components that serve as the basis of nursing knowledge are: A. right knowledge, timely knowledge, reproducible knowledge and usable knowledge. B. knowledge acquistion, knowledge processing, knowledge dissemination and knowledge generation. C. objective knowledge, subjective knowledge, relevant knowledge, and flexible knowledge. D. knowledge acquisition, knowledge evolution, knowledge dissemination, knowledge expansion.

" "B. knowledge acquistion, knowledge processing, knowledge dissemination and knowledge generation. Knowledge acquisition: derived from observation and experience Knowledge processing: using and saving Knowledge dissemination: sharing information with others Knowledge generation:creating new models At the base are data (bits, bytes) and information from which the components arise. Circling these components is constant feedback, which is necessary for all processes related to knowledge.

" "When designing a user interface, the informatics nurse should: A. use bright colors for the background and text. B. limit fonts and font sizes to two or three only. C. use attention-getting devices, such as flashing text. D. use a wide variety of different fonts and font sizes.

" "B. limit fonts and font sizes to two or three only. So that the interface does not appear too ""noisy"" or crowded and should be consistent in use; for example, a large font size should only be used for headings. Bright colors (such as orange and red) can be distracting and should be avoided in favor of softer colors (such as blue). Flashing texts or flying windows and popups are very distracting to the user.

" "The purpose of a migration plan during decommissioning of the computer information system (CIA) 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. 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.

" "If the fetal heart monitoring (FHM) system does not interface with the EHR, then: A. nurses only document on one system B. nurses often double document C. archiving of FHM tracings is not possible D. provision of care in inadequate

" "B. nurses often double document Because they commonly make notations on the tracings, but these notations must then be entered into the EHR or critical informaiton may not be documented. The paper must be stored and archived, but because this is separate from the digital data in the EHR, it is more difficult to access and may be overlooked.

" "When it relates to collection of patient data, ""transparency"" refers to: A. patient consent to the collection of personal data. B. patient informed about all aspects of data collection. C. patient access to EHRs and other data. D. patient control over access of others to data.

" "B. patient informed about all aspects of data collection. The patient should have a clear understanding of what data can be collected and the purpose of the data collection. The patient should also understand who has access to the data (insurance companies, employers, clinicians) as well as how the patient can access that data. The patient should be advised about the purpose of data collection at the time the data are obtained.

" "According to the ANA, Informatics Nurse Specialist Standards of Professional Performance include: A. identify alternatives. B. performance appraisal. C. implement solutions. D. identify issues.

" "B. performance appraisal. In 2008, the ANA revised The Scope and Standards of Nursing Informatics Practice, which includes standards of performance and standards of practice. Informatic Nurse Specialist Standards of Professional Performance includes the Standards of Professional Performance include (1) quality of practice, (2) performance appraisal, (3) education, (4) collegiality, (5) ethics, (6) collaboration, (7) research, (8) resource utilization and (9) communication. Informatics Nurse Specialist Standards of Practice include (1) identify the issue or problem, (2) identify alternatiave solutions, (3) choose and develop a solution, (4) implement solutions, and (5) evaluate and adjust solution.

" "Use of free text for documentation on the EHR can: A. improve documentation. B. provide inadequate documentation. C. increase speed of documentation. D. improve retrieval of outcomes data.

" "B. provide inadequate documentation. Use of free text (narrative form) for documentation on the EHR can provide inadequate documentation because the user may avoid making coded entries (which would require double documentation), but the EHR and CDS system are set up in such a way that the system responds to the coded entries, so it may be difficult to analyze the patient care. Additionally, since coded entries are retrieved when accessing information for outcomes assessment, excessive use of free text may alter end results.

" "Telemedicine refers to: A. displaying patient data on a computer screen. B. providing medical care from a distance. C. transmitting patient data from one network to another. D. using CPOE to order medications.

" "B. providing medical care from a distance. 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 telephone.

" "In the role as project manager, the informatics nurse recognizes that one team leader has misrepresented his technical skills, resulting in many mistakes and delays. The best solution is to: A. educate the team leader. B. replace the team leader. C. give the team's assignments to another team. D. report the team leader to administration.

" "B. replace the team leader. Replace with someone more knowledgeable. If one team in a project falls behind, this can affect the entire timeline, as one part of a project often must be completed before another can begin.

" "OSHA's ergonomics requirement for a user sitting at a computer to input or retrieve data includes that the: A. user's trunk must be perpendicular or leaning forward slightly. B. seating must be cushioned with rounded front. C. wrist must be flexed no more than 20%. D. front of the foot must touch the floor.

" "B. seating must be cushioned with rounded front. Rather than a sharp line to prevent pressure on the back of the legs. The user's trunk must be perpendicular or slightly leaning backward into the back support but should not be leaning forward as this may cause back strain. The forearms, wrists and hands should be in a straight line, parallel to the keyboard, and the feet must be flat of the floor.

" "The purpose of end user acceptance testing (UAT) is to assess users': A. computer skills. B. willingness and ability to utilize harware/software as intended. C. understanding of all aspects of the software D. learning curves in mastering the use of the software

" "B. willingness and ability to utilize harware/software as intended. This is a form of ""real world"" testing in which the test subjects (ideally end users although some surrogate users may be included) carry out all the various funcitons of the hardware and software to determine if there are errors or problems that interfere with use. UAT is usually done as a final step prior to an system's going live or, if completed by manufacturer, the final step before delivery of the product.

" "Which of the following is the best method to ensure legal protection against charges of negligence or malpractice? A. Informed patients B. Active risk management C. Complete and accurate documentation D. Continuous supervision

" "C. Complete and accurate documentation From a legal standpoint, an action has not been carried out and an observation has not been made if they are not documented. For this reason, prompt documentation, such as immediately at the point of care, is essential because delays in documentation may lead to questions about memory retrieval. When an adverse incident occurs, an incident report must be completed accourding to established protocols.

" "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 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 repeatedly ""why?"" as in an affinity diagram.

" "When utilizing FMEA (failure modes and effect analysis) to determine how a CPOE may fail, the interdisciplinary team should include at least personnel from: A. informatics, IT and nursing staff from each unit. B. IT and informatics. C. IT, informatics, nursing, pharmacy, administration and medical staff. D. IT, administration, informatics and nursing, and experts in the field of computer information systems.

" "C. IT, informatics, nursing, pharmacy, administration and medical staff. Because all these departments have a role in ensuring the orders are correctly entered and carried out. The process to be examined should be narrowed as much as possible because interdepartmental processes that involve many departments and personnel may be difficult to adequately assess.

" "A nurse feels a patient needs more education but the nurse's caseload doesn't allow time, causing the nurse to feel upset. What type of conflict is this? A. Intragroup B. Intergroup C. Intrapersonal D. Interpersonal

" "C. Intrapersonal Which refers to inner conflict resulting from unmet needs (in this case, time). Interpersonal conflict involves two or more individuals, such as a disagreement between two nurses. Intragroup conflict refers to conflict among members of a group, such as a committee. Intergroup conflict refers to conflicts between members of different groups, such as the nursing staff and the administration.

" "Of the 4 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. 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 e-mails and doing Internet searches for information.

" "The interface terminology used for interventions only is: A. CCC. B. NANDA. C. NIC. D. NOC.

" "C. NIC. NIC (Nursing Interventions Classification) includes independent and collaboratibve interventions. Each nursing intervention includes both a definition explaining an overview of the intervention and then a list of discrete nursing activities that may contribute to completing the intervention. Standardized interventions, such as those of the NIC, are often used in development of the plan of care but should always be individualized.

" "Which of the following is a multidisciplinary terminology? A. NANDA B. OMAHA C. SNOMED CT D. ICNP

" "C. 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 alternatives and complementary treatements, and Logical Observations Identifiers, Names and Codes (LOINC), which includes outcomes and assessments and is used for laboratory results.

" "In a data dictionary, which of the following elements should be included for each data element? A. Size, type and metadata B. Entity and associated fields C. Type, defintion, metadata D. Size, definition and fields

" "C. Type, defintion, metadata Should be included for each data element. Metadata is data that provides information (such as data of creation and author/developer). For example, a webpage may contain metadata in the form of keywords that indicate what the content deals with. Different types of metadata include structural, technical, process, guide, administrative, rights management, and preservation. Metadata with high granularity provides more information that metadata with low granularity.

" "When conducting a user modeling study, which of the following would be classified as a high-level error? A. User makes error in executing steps B. Output is misinterpreted C. User cannot make a decision regarding correct action D. Input is incompatible with computer system

" "C. User cannot make a decision regarding correct action User modeling study (which determines the number and types of errors occurring in human computer interaction) a high level error would be if a user cannot make a decision regarding correct action or is unable to interpret outcomes. Low-level errors include errors in executing steps or misunderstanding of outcome affecting perceptions. Moderate level errors include input that is incompatible with computer system.

" "When setting up test enviornments with de-identified test patients, an apporpirate name for a test patient or test physician is: A. Dr. Who B. Yoda C. XXXSmith D. Donald Duck

" "C. XXXSmith Because this clearly indicates a false name. Clever or humorous names, such as Dr Who, Yoda and Donald Duck, should always be avoided. Naming should clearly indicate a test environment is in use. The test environment should also look distinctly different from the live version, with different background colors and different fonts, to avoid any confusion.

" "Regression testing is usually done: A. after decommision 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 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, on the other hand, tests to determine whether the introduction of new software has the effect intended. Non-regression testing is often done when a new version of software is issued.

" "Downtime drills should be carried out at the organization at least: A. monthly B. biannually C. annually D. biennially.

" "C. annually So that the staff members know how to manage patient documentation, orders, admission and discharges if the system is down. The drills should be scheduled and announced ahead of time. Staff training should include use of the read-only backup EHR as well as use of the paper-based orders and documentation so that the information can be easily entered into the system when the system is back up and running.

" "According to the ANA, the steps to the nursing process include: A. assessment, planning, implementation and evaluation B. assessment, planning, acting, evaluating, modifying plan, reevaluating. C. assessment, diagnosis, outcomes/planning, implementation and evauation. D. assessment, diagnosis, planning, acting, evaluating.

" "C. assessment, diagnosis, outcomes/planning, implementation and evauation. Assessment: collecting and analyzing patient data, including physical as well as psychosocial and economic data Diagnosis: nursing diagnosis based on the clinical judgment of the nurse Outcomes/Planning: identifying expected outcomes and developing the plan of care Evaluation: determining the patient's status and effectiveness of the plan of care

" "Designing a computer interface for ""situational awareness"" helps clinicians to: A. utilize the interface. B. document accurately. C. detect problems. D. interact with others.

" "C. detect problems. For example, the use of icons may , in some cases, present a visual representation that is more readily recognized than text. The layout of the items on the interface may also affect situational awareness. A system of alerts may be utilized to increase situational awareness of potential problems.

" "Substantive rules for guiding ethical behavior include: A. establishing procedures to be followed. B. determining who should or should not carry out actions. C. determining how healthcare should be allocated. D. examining the motiviation of actions.

" "C. determining how healthcare should be allocated. As well as telling the truth, maintaining confidentiality, privacy and fidelity and ensuring informed consent. Authority rules for ethical behavior include determining who should or should not carry out actions. Procedural rules for ethical behavior include establishing procedures to be followed.

" "Because of the increased use of social media by healthcare organizations, healthcare providers, and patients, a healthcare organization should: A. advise healthcare providers to avoid posting personal information B. post warnings about dangers of social media C. develop a formal social media guideline D. develop a set of informal rules about social media use

" "C. develop a formal social media guideline Including all staff members. Guidelines should clearly state what can and cannot be posted on personal or public social media sites and should provide guidance for all social media utilized by the organization for educational or other purposes, such as on Facebook or on an organiztaional website.

" "In order to protect hardware from heat damage, the cooling capacity for areas containing servers and critical equipment should be: A. equal to the heat load. B. 30% more than heat load. C. double the heat load. D. triple the heat load.

" "C. double the heat load With cooling systems supported by backup generators. The system should focus on containment of cold air through hot/cold enclosures for aisles and external ducting of exhaust as well liquid cooling, and the layout should be such that airflow is maximized for temperature control. The cooling systems should also contain filters to protect equipment from dust particles.

" "One of the primary goals of a CPOE is to: A. provide feedback to drug companies. B identify preventive measures. C. eliminate handwritten orders. D. ensure use of generic drugs.

" "C. eliminate handwritten orders. As inability to properly read handwritten orders and incompleteness of and errors in handwritten orders may result in medication errors. The CPOE with CDS sysem alerts physicians to drug-drug interactions, medication overlaps, the need for corollary orders and contraindicted orders as well as automatically calculating doses based on patient' weight and height or BSA. The sytem may also provide order sets.

" "Biometric authentication of employees requires a device that recongnizes: A. barcodes B. security token C. fingerprint, retina or facial patterns D. smart card

" "C. fingerprint, retina or facial patterns Some biometric devices also recognize signatures based on pressure and speed of writing. Eye scanners tend to be expensive and inconvenient. Facial pattern scanners assess basic facial features, such as the location and structure of the eye sockets and cheekbones. Finger print (the most commonly-used biometric authentication method) and palm scanners are easy to use, and the hardware has a small footprint.

" "The primary criteria to consider when selecting software are: A. cost, content, format and interface B. access, cost, content and update frequency C. format, content, style and strategy D. portability, cost, content and strategy

" "C. format, content, style and strategy Format (presentation system, text/graphic based, frames, interface design), content (current, reliable), style (tone, literacy level) and strategy (interactivity). While cost is always a concern, the cost should not be a primary criterion becasue the most expensive software may not meet the specific needs of an organiztion, and the least expensive software may end up being the most costly in the long run.

" "If the informatics nurse is preparing a performance checklist for usability testing, the most important consideration is: A. including actions to avoid. B. using simplified language. C. including every step. D. including expected timeframes.

" "C. including every step. Regardless of how minor it is, in order to determine if the users can understand the steps and follow them. The informatics nurse must not make assumptions about what users might already know (such as turning on the computer or adjusting the screen) because computer knowledge may vary widely. Adequate usability testing requires that the users all follow the same procedures.

" "An example of a peripheral biometric medical device is a: A. video camera B. pendant signaling emergency response device C. international normalized ratio (INR) meter D. uneducated popullace

" "C. international normalized ratio (INR) meter Peripheral biometric medical devices may be integrated with the computer information system and provide data into the EHR or may be stand-along devices, such as electronic BP monitors. These devices may also transmit information over landlines or cellphones. Other examples of peripheral biometric medical devices include pulse oximeters, peak flow meters, ECG monitors and blood glucose monitors.

" "In order to derive information from the data, the informatics nurse must utilize: A. motivation. B. awareness. C. knowledge. D. wisdom.

" "C. knowledge. A collection of data provides a set of information, but information alone has little meaning until it is assessed and meaning derived from it, and this requires knowledge, education, insight and experience, to determine which information is valuable and how the information can be utilized to determine which course of action or come to a decision.

" "Mining data and predictive analysis are particularly useful for hospitals to identify: A. avenues for increased revenue. B. need for increased staffing ratios. C. patient groups at risk for readmission. D. trends of hospital admissions.

" "C. patient groups at risk for readmission. Predictive analysis has been commonly used by insurance companies to predict the individual's healthcare costs, but it is now being utilized by hsoptials that are faced with decreased CMS reimbursement for readmissions within 30 days. By identifying groups at increased risk, based on various factor- such as age, education, co-morbidities, and/or income- the hospital can provide targeted preventive measures.

" "The primary purpose of performance appraisal should be to: A. determine compensation. B. identify areas of weakness. C. promote staff development. D. establish a basis for promotion/demotion.

" "C. promote staff development. By communicating the appraiser's perception of the staff member's strengths as an employee and helping the person to identify areas that need further development. The focus should remain postiive rather than negative. The performance appraisal may be utlized to determine compensation and to establish a basis for promotion or demotion as well because these actions, especially demotion or firing, require a paper trail that shows interventions.

" "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. C. query the state Board of Nurisng.

" "C. query the state Board of Nurisng. To determine rules and regulations about what an approved course must contain and how may 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.

" "When motivating staff members to participate in training for introduction of a new computer information system, the informatics nurse should consider the primary factors that motivate employees (1) autonomy, (2) salary, (3) recognition, and (4): A. communication. B. wit. C. respect. D. honesty.

" "C. respect. (1) Autonomy (allowing staff members to utilize their own ideas), (2) salary (compensation that is fair and equitable), (3) recognition (certification, continuing education crtedit), and (4) respect (listening, paying attention, acknowledging). If staff members have a positive perception of leaders, then staff members are more likely to cooperate.

" "If data become corrupted, the organization should have a policy in place to: A. revert to paper documentation B. notify patients C. revert to backup D. replace software

" "C. revert to backup Accessing data that was stored prior to the data becoming corrupted as this will result in minimal need for re-entry of data. Data must always be assessed and protected during any types of system changes, such as migration or data to another system, updates, new applications, new types of storage device, or changes in coding systems.

" "If a person posing as an IT staff member calls and asks an employee to verify the employee's user name and password in order to gain access to the computer information system, this is an example of: A. hacking B. intrusion C. social engineering D. malicious insider

" "C. social engineering Which is manipulating a relationship or impersonating an official or authorized person. Staff member should be cautioned to avoid giving any identifying informaiton, such as user name or password, over a telephone or e-mail unless the person requesting the information has been verified and to carefully check credentials.

" "The most common reason for staff developing workarounds for aspects of technical implementation in an EHR is: A. inadequate training of staff. B. staff resistance to use of the EHR. C. system design not congruent with work processes. D. errors in the system design.

" "C. system design not congruent with work processes. This poses a serious problem that should have been identified before implementation of the system but can result in increased errors as workarounds often result from alerts and hard stops. If possible, the system should be modified to better accommodate work processes or alternate processes developed.

" "During the process of interface design, describing tasks in terms of needed inputs and expected outputs is an example of: A. cognitive work analysis. B. cognitive task analysis. C. task analysis. D. strategic analysis.

" "C. task analysis. This analysis generates information needed to create a timeline and flow chart for development. Cognitive task analysis utilizes interviews and questionnaires to identify specific tasks and their frequency, examining the knowledge needed and how that can be represented. Cognitive work analysis is used for highly complex work situations and includes analysis of work domain, control tasks, strategies, social-organiztional and work compentencies.

" "According to the jobs characteristic model, the core dimenstion of a job that relates to the impact completion of the job has on others' well-being is: A. skill variety. B. task identify. C. task significance. D. autonomy.

" "C. task significance. People are more motivated to complete a job that impacts others positively, so when changes are instituted, such as a different comptuer information system, then the value of the others, such as the patients, should be stressed so that the staff members understand how their roles contribute. Other core job characteristics are skill variety, task identity, autonomy, and feedback.

" "If a personal health record (PHR) is web-based and tied to one specific system and EHR, the PHR is classified as: A. non-tethered. B. personal files. C. tethered. D. networked.

" "C. tethered. A secure portal is provided to the patient so that patient can access information (which may include all or part of the patients' records), usually including laboratory tests and medication lists. Patients may be able to upload data and add to the PHR. Non-tethered PHRs are usually carried on some type of storage device, such as a flash drive or DVD. Personal files, AKA paper files, are the least efficient as data may be unreliable and difficult to access.

" "The purpose of a modem is to allow connection to: A. input devices B. a printer C. the Internet D. plug-in devices.

" "C. the Internet A modem may be built into a computer or may be an external device. Connectivity is usually through a cable or telephone (DSL). The modem both encodes and decodes digital information to allow easy transmission of data. Modems are generally classified according to the number of bits per second (bps) or bytes per second (B/s) that they can transmit.

" "When instituting an EHR, it's important to ensure that the system: A. disallows any modifications B. uses only proprietary hardware and software C. utilizes a universal language D. is a standalone system

" "C. utilizes a universal language So that it can interface with other systems and so that data can be shared from one system to anotoher without corruption. Use of only proprietary hardware and software may impair interoperability and limit upgrades. All EHR system should allow some modifications to account for differences in workflow and changes in regulations, requirements and information.

" "If a patient has been hospitalized under the care of a hospitalist and is to be discharged to the care of a primary care physician, the discharge summary should be delivered to the primary care physician within: A. 6 hours. B. 12 hours. C. 24 hours. D. 48 hours.

" "D. 48 hours. Should include the Common Meaningful Use Data Set. Ideally, the discharge summary should be delivered electronically and should allow the primary care physician access to the patient's electronic records to that the physician has a clear picture of the patient's status and needs.

" "The wireless technology standard that utilizes UHF radio waves (ISM band, 2.4-2.485 GHz) to transmit data from mobile devices is: A. IEEE 802.11a B. ICCC 8001.16 C. HomeRF D. Bluetooth

" "D. Bluetooth Bluetooth transmission has short range, from 3 feet (class 1) to 33 feet (class 2) and 300 feet (class 3) with most devices in class 2. Bluetooth technology may be utilized with Bluetooth enabled devices to add external keyboards and to allow hands-free telephone communications. Other applications include headphones, intercoms, wireless connection to a printer and transfer of health data (such as cardiac montioring) to a device, such as a cell phone.

" "Which of the following best describes secondary data used for analysis? A. Data that are collected for a specific purpose B. Data that are discarded as not useful for analysis C. Incidental data that collected D. Data that were originally collected for another purpose.

" "D. Data that were originally collected for another purpose. Such as census data, governmental statistics and Worker's Compensation data. Secondary data is often readily available and free of charge or inexpensive and may cover multiple years. Research often involves a combination of primary data, which can provide targeted information, and secondary data.

" "Which of the following is true of the Affordable Care Act? A. It requires use of government-developed electronic health records. B. It prohibits the use of all paper health records. C. It outlines specifications of electronic health records. D. It requires EHRs and electronic exchange of information

" "D. It requires EHRs and electronic exchange of information In order to reduce both paperwork as well as overhead administrative costs and to ensure better quality of care and fewer medical errors. The ACA also requires mandatory reporting of certain measures, and the use of electronic health records facilitates gathering and reporting of these outcomes data. The ACA provides for incentives for transitioning to the EHR.

" "Which of the following is an example of productivity software? A. Music recording application (such as GarageBandK) B. Instant messaging application (such iChat) C. Internet browser (such as Safari) D. Presentation application (such as PowerPoint)

" "D. Presentation application (such as PowerPoint) Productivity software includes word processing, spreadsheets, e-mail and desktop publishing. These applications may be bundled, such as with Microsoft Office. Creative software includes music recording applications (such as GarageBand) as well as other types of graphic, music, sound and video programs. Communication software includes Internet browsers (such as Safari) and instant messaging (such as iChat) and conferencing (such as GoToMeeting).

" "Which of the following is true of mobile cellular cardiac telemetry patients? A. They must stay within 10 feet of a landline. B. They must telephone the monitoring company to request ECG reading. C. They can only be monitored when they manually begin a recording. D. They can go about their daily activities with minimal intrusion.

" "D. They can go about their daily activities with minimal intrusion. While systems vary, most involve application of one or more leads, which are connected to a pager-like device that can be attached to one's belt. Addtionally, the patient must usually be within 10 feet of the transmitting cellular phone. The physician sets the parameters for recording ECGs automatically, and the patient ususally can also manually press a button to have a recording sent. The device may store data for varying amounts of time up to 30 days.

" "Under CMS regulations, how long must a healthcare organization fulfill Meaningful Use criteria at one stage before moving on to the next stage? A. 90 days B. Six months C. One year D. Two years

" "D. Two years Although the criteria actually only has to be verified for a 90-day reporting period during the first year. For example, for stage 1, Meaningful Use requires that eligible professionals and eligible hospitals meet 13 core objectives and 10 additonal objectives. Stage 1 focuses on implementation of the EHR with CPOE and CDS.

" "If an automated dispensing cart (ADC) for medications is ""profiled"", this means that: A. the ADC has an identifying number and location that identifies paitents served B. the functions of the ADC have been outlined and indicated on the interface. C. a pharmacist evaluates and test the functioning of an ADC before use. D. a pharmacist reviews and validates new orders before medications are dispensed.

" "D. a pharmacist reviews and validates new orders before medications are dispensed. And that this validation is entered into the pharmacy computer. This is especially important for orders that are outside of standardized order sets in order to prevent medication errors. The Institute for Safe Medication Practices (ISMP) recommends that all ADCs be profiled and that any non-profiled ADCs contain only limited types and amounts of drugs.

" "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 disapper. 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. 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.

" "In order to protect the availability of network information, an organization should utilize a(n): A. virus scan. B. firewall. C. confidentiality policy. D. acceptable use policy.

" "D. acceptable use policy. Outlines the activities that users are allowed to do online and also outlines restrictions, such as Internet surfing, sending or receiving non-work-related e-mails and downloading music, video or other files. Most malicious code, which may seriously impede availability, is uploaded into a sytem through downloads. Policies should include restrictions on food and drink near keyboards and other methods of ensuring tht hardware is not damaged.

" "Before a software update is installed into a system and goes live, the software must be: A. guaranteed by vendor B. evaluated at other sites C. assessed for cost-effectiveness D. assessed in a testing environment

" "D. assessed in a testing environment So that any bugs can be identified without potential corruption or loss of data or functionality. The organization may utilize different types of testing, but the organization policies should explain the criteria for testing. Once software has been tested and goes live, it should again be retested in the live environment.

" "Orem's General Theory of Nursing states that the goal of nursing is to: A. establish a collaborative nurse-patient relationship B. understand how a patient responds to stress C. understand how a nurse's reaction and actions relate to patient behavior D. assist patients and help them provide self-care

" "D. assist patients and help them provide self-care This is achieved through three steps: (1) identify the reason that the patient needs care, (2) establish a plan of care, and (3) manage care of the patient. Orem's theory comprises 3 distinct theories: Self-Care: involves self-care agent (patient) and dependent care agent (nurse, other caregiver) and 3 categories of needs - universal, developmental and health Self-Care Deficit: requires nursing assistance through provision of care, guidance, instruction, support and environmental adjustment Nursing systems: may be completely compesatory, partially compensatory, or supportive

" "When designing a human-technology interface and considering usability, a focus group is most useful: A. periodically through the design process. B. immediately after the sytem goes live. C. immediately before the system goes live. D. at the beginning of the design process.

" "D. at the beginning of the design process. The focus group should be presented with potential interface designs (include possible layout, color schemes and fonts) as well as a review of content. The designer can then evaluate the response of the focus group to determine what might work best in the design and what may pose usability problems.

" "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(n): A. consultative leader. B. participatory leader. C. autocratic leader. D. bureaucratic leader.

" "D. 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 and bring about change because they may feel that their input is not valued.

" "In a management information system (MIS), a nursing workload management system (NWMS) is used primarily to: A. maintain a record of nurse workloads per unit. B. collect and store data about patients and length of stay. C. collect data about the workloads of individual nurses. D. calculate the patient hours needed based on acutiy.

" "D. calculate the patient hours needed based on acutiy. NWMS (nursing workload management system) is a form of patient classification sytem (PCS), which provides automated collection of data (based on predetermined criteria) that indicates the acuity level (severity of illness) of the patient. The NWMS evaluates the patient holistically, including not only symptomology and conditions but also such factors as coping ability and adherence.

" "Alerts that restrict or limit clinical practice, such as hard stops or alerts that cannot be overriden, should be developed for an EHR with: A. informatic nurses. B. external experts. C. administration. D. clinicians.

" "D. clinicians. Clinicians who will be using the system because they are in the best position to determine what is necessary and appropriate for their clinical environment. It's important to avoid including elements into an EHR that result in workarounds, as this may increase risk to patients and result in inaccurate outcomes data.

" "According to Norman's principles of design for human-technology interfaces (HITs), exploiting the power of constraints means to: A. obey the rules and regulations (constraints) that affect design. B. rank order the constraints affecting design. C. determine the limits of technology in the process of design. D. consider how constraints affect design.

" "D. consider how constraints affect design. Exploiting the ""power of constraints"" means to consider how constraints, both natural and artificial, affect design. For example, computer screens need to be placed within the range of vision of the user and must be within reach. Other restraints may be regulatory or organizational, but all of the restraints must be considered as part of the design process in order to facilitate use.

" "If applying the theory of cognitive flexibility to interactive technology used for training end users, the informatics nurse should ensure: A. simplification of content. B transfer of knowledge. C. independent instructional sources. D. content presented in mulitple ways.

" "D. content presented in mulitple ways. Ensure content is presented in multiple ways, such as through interactive computerized instruction and instructors, who contribute and facilitate learning. The theory focuses on the individual's ability to construct knowledge. Information should be contextual and avoid oversimplification and knowledge should be built rather than transferred. Instructional sources should be interconnected rather than independent.

" "According to the international technical standard ISO 18104:2003, for a nursing diagnosis to be valid, it must encompsass at least: A. action and target. B. subject and target. C. subject and judgment. D. focus and judgement.

" "D. focus and judgement. A nursing diagnosis (such as risk for aspiration) must encompass at least focus (aspiration) and judgment (risk). A nursing action (such as monitoring vital signs), by contrast, must encompass at least an action (monitoring) and a target (vital signs). ISO 18104:2003 provides basic reference terminology model for nursing statements. ISO 18104:2003 is used to evaluate and modify existing terminologies to ensure compliant composition.

" "In a computer, permanent data storage is a property of: A. CPU B. IDE C. RAM D. hard disk

" "D. hard disk Which was designated ""hard"" in comparison to ""floppy"" disks, which were used to store data in early personal computers. With the hard disk, a magnetic field is generated through drive heads. While data storage is considered permanent, the hard disk can fail, resulting in loss of data. By the same token, data that have been deleted can often be retrieved, posing a security risk for decommissioned equipment.

" "The most common method of ensusring that evidence-based practice is included into the EHR is to: A. provide popup alerts and reminders. B. require extensive free text documentation. C. provide staff education regarding evidence-based practice. D. imbed clinical practice guidelines.

" "D. imbed clinical practice guidelines. So that they are an integral part of the patient's plan of care. EBP utilizes the best available research to support nursing pracctice. The EBP may be included in different ways, sometimes with reminders, alerts and popups. Refereces should be easily available, such as by clicking a link to a research article.

" "A system with the fine granularity generally has: A. decreased fields. B. decreased costs of computing. C. decreased overhead. D. increased overhead.

" "D. increased overhead. Refers to a greater investment of time, effort and/or resources to carry out a process, such as retrieving data. Granularity is based on the metaphor of sand, so a system with coarse granularity has data in larger entities (components) while a system with fine granularity has the same entities subdivided. For example, with coarse granularity, all identifying information (name, birthdate, ID number) may be contained in one field, but with fine granularity each item is contained is a separate field.

" "If CPT codes are going to be incorporated into an organization's information management sytem for in-house use only, the required AMA license is: A. special license B. no license is required C. distribution license D. internal use license

" "D. internal use license The required American Medical Association (AMA) license is the internal use license. CPT codes were developed by the AMA and are trademarked by that association, so they are not in the public domain. Individuals or organizations that wish to utilize CPT must apply for either a distribution license or an internal use license.

" "The five elements of a single datum include (1) patient, (2) parameter, (3) value, (4) time and (5): A. evaluation. B. documentation. C. storage. D. method.

" "D. method. Patient: the individual to whom the datum applies Parameter: specific item being reported, such as temperature, weight, serum glucose level Value: relates specifically to the parameter, such as temperature, which may be assigned a value of 37C Time: time the datum was collected/observed Method: the manner in which the observation/collection was made (such as with BP cuff or blood draw)

" "According to Gerbner's General Model of Communication, a received message is not understood in the same way that the sent message intended. This exemplifies the: A. control dimension. B. means dimension. C. distortion of reality. D. perceptual dimension.

" "D. perceptual dimension. For example, if the informatics nurse transmits a message to staff members (receivers), the receiver cannot understand or receive all of the elemetns that went into the message- the negotiations, the research, the meetings, the thought process- so the receivers, in fact, only receive part of the message, so they may interpret it differently.

" "In most organizations, the primary ethical dilemma is balancing: A. treatment with right to death with dignity. B. nurse competency with patient need. C. confidentiality with need to know. D. provision of care with cost-effectiveness.

" "D. provision of care with cost-effectiveness. Often pitting clinical ethics (which focuses on providing high quality care to patients) and organizational ethics (which focuses on maintaining the viability of the organization through management of costs). This dilemma may result in understaffing or excessive floating of staff from one unit to another for which they aren not adequately trained. Both of these practices may result in increased patient adverse events, which may increase costs because of liability.

" "A network security tool that prevents staff members from directly accessing the Internet is a(n): A. firewall B. virus scan C. intrusion detection device D. proxy server

" "D. proxy server When a user wants to access the Internet, the request goes first to the proxy server, which acts as an intermediary and determines if the request is permitted or not. In some cases, proxy servers may block websites with certain key words, such as ""porn"" or ""sex"". Proxy servers may also provide anonymity to users through ""masks"".

" "In Juran's 4-step Quality Improvement Process (QIP), the quality trilogy that is necessary to manage for quality comprises: A. goal setting, recognition and corrective action B. quality awareness, quality councils, and quality measurements. C. prevention, appraisal and internal/external factors. D. quality planning, quality control, and quality improvements.

" "D. quality planning, quality control, and quality improvements. Juran's 4-step (defing, diagnosing, remediating and holding) Quality Improvement Process (QIP), the quality trilogy that is necessary to manage for quality comprises 3 parts. Quality Planning: identifying and assessing needs of internal and external customers and determining how to meet those needs and desgining the processes needed to do so Quality Control: choosing controls and measures, interpreting results and taking corrective action Quality Improvement: identifying needs, organizing, assessing for problems and causes, and providing solutions

" "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. So that data 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 simplifying. Three common forms of normalization are (1) first normal form (1NF), (2) second normal form (2NF) and (3) third normal form. Each form of normalization has more stringent requirements that the previous form. Fourth and fifth forms are rarely utilized. Databases may be compared in terms of normalization.

" "Working standards are most often changed because of: A. change in administrative focus. B. need to increase efficiency. C. need to improve safety measures. D. regulatory/accrediting requirements.

" "D. regulatory/accrediting requirements. Such as those instituted by the Joint Commission or CMS. These new working standards should be disseminated in a variety of ways and, when necessary, training should be initiated before the change in standards occurs so that staff is informed and prepared. Procedural changes are likely to occur as the result of a need to improve efficiency or safety measures, often because of outcomes analysis. Policy changes occur because of a change of administrative focus.

" "When utilizing force field analysis (Lewin) to analyze proposed change, a driving force would be: A. outdated equipment. B. financial instability. C. incentives. D. resistance.

" "D. resistance Lewin proposed that change is accompanied by driving forces (promoting change) and restraining forces (interfering with change). Restraining forces include outdated equipment, resistance and financial instability because these issues must commonly be dealt with in order to proceed with change. Steps for force field analysis include listing proposed change, brainstorming opposoing (driving and restraining) forces, and developing a plan to deal with restraining forces.

" "According to Maslow's Hierarchy of Needs, a nurse who is fearful of new technology and is experiencing anxiety about losing employment because of this is probably acting to fulfill: A. belonging needs. B. esteem needs. C. physiological needs. D. safety/security needs.

" "D. safety/security needs. Because loss of employment may pose a real threat to the person's way of life. Until the nurse feels safe and secure, these issues may be expressed in hostility and/or lack of cooperation as defense mechanisms. Some may overcompensate by trying to work extra hard to overshadow their technical deficits.

" "In control-flow workflow patterns, when two or more paths (each completed) merge into one, it is referred to as: A. sequential. B. parallel split C. exclusive choice. D. synchronization.

" "D. synchronization. Workflow is the description of a process in detail (such as outlined in a flows chart) that provides enough information for a workflow management system (WFMS). When completing a diagram, a pattern must be selected. Basic control flow patterns include sequential (one process leads to another), parallel split (one path splits into alternative choices), synchronization (multiple paths merge back into one with all merged paths completed before advancing), exclusive choice (one path must be chosen). A simple merge occurs when two or more paths merge but without synchronization so some paths may not be complete.

" "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 Which tests whether or not the interface between software programs (such as cardiac monitoring and the EHR) and the associated components fuction properly together. Integration testing techniques include (1) big bang (all components are integrated and tested at the same time), (2) top down (testing is done hierarchically, starting with the menu item and GUI), (3) bottom up (oppostie of top down), and (4) incremental testing.

" "When transferring data from one system to another, free text data must be: A. truncated. B. eliminated. C. tranferred only if critical. D. transferred intact.

" "D. transferred intact. Transferred intact with no data truncated or lost. System-to-system interfaces must be evaluated and tested before going live and after any changes to ensure that all data remains intact, utilizing a reference set of data that can be tested in the systems repeatedly to ensure that the interface is functioning as intended. Varying amount and types of data should be used in testing.

" "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 placement in the facility is probably: A. a dedicated room. B. the gift shop. C. the cafeteria. D. waiting areas.

" "D. waiting areas. 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.

" "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. C. negligence. D. work-around.

" "D. work-around. This problably represents work-around, a shortcut to the proper method of scanning, which generally requires scanning the patient and sometimes the mediation at the point of care. Workarounds 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.