PNC Exam #3
The nurse is caring for a client who has a foot wound that is not healing appropriately. How will accessing the clinical decision support (CDS) system help with this client's care? A) Allow the nurse to view options from experts B) Facilitate available medical research C) Make the decision for the next step D) Point the nurse in the next direction
Answer: A Rationale: A CDS system will offer options from experts for the client's situation. It remains up to the nurse to make a final decision, but the information obtained can be useful in assisting the nurse to select other options of care. The system will not point the nurse in any particular direction; the nurse views the information and determines the next step to take. The system will not make the decision for the nurse. The CDS system assists the nurse with nursing decisions, not medical decisions or information.
The nurse is facing a problem with a long-term-care client that is different from anything encountered by the nurse in the past. What should the nurse do before taking the problem to the research committee? A) Perform a review of the literature. B) Ask the client's family if this is a recurring issue. C) Bring the problem up for discussion in the next staff meeting. D) Ask the physician for assistance.
Answer: A Rationale: Prior to beginning a research study, the problem is defined, and then a search is conducted of possible existing studies that have been completed. This search is referred to as a review of the literature. Asking the client's family if the problem is recurring will not help the nurse determine the course of care; it simply tells the nurse that the issue is a recurring one. The physician is not consulted for nursing problems. A staff meeting may net some other opinions but will not give the nurse information regarding studies related to the client's problem.
A student nurse studying informatics would be aware that which are examples of clinical decision support tools? Select all that apply. A) Documentation templates B) Clinical guidelines C) Condition-specific order sets D) Budgeting spreadsheets E) Focused data reports
Answer: A, B, C, E Rationale: Clinical decision support systems are designed to give healthcare providers tools to supplement the decision-making process during and after client care. These tools can include diagnostic support, documentation templates, clinical guidelines, alerts and reminders, condition-specific order sets, reference information, and focused data reports. Budgeting spreadsheets are not included.
A student nurse studying informatics would be aware that which are examples of clinical decision support tools?Select all that apply. A) Documentation templates B) Clinical guidelines C) Condition-specific order sets D) Budgeting spreadsheets E) Focused data reports
Answer: A, B, C, E Rationale: Clinical decision support systems are designed to give healthcare providers tools to supplement the decision-making process during and after client care. These tools can include diagnostic support, documentation templates, clinical guidelines, alerts and reminders, condition-specific order sets, reference information, and focused data reports. Budgeting spreadsheets are not included.
The nurse is preparing a tool to teach clients how to determine the validity of content obtained from health-related Internet websites. What information should the nurse plan to include in this teaching tool? Select all that apply. A) Source for the information B) Sponsor of the website C) Ways to identify if the site is selling a product D) Number of visitors to the website E) Date the content was last reviewed
Answer: A, B, C, E Rationale: When analyzing online information the source of the information should be validated. The sponsor of the website should be clearly identified. The site should be studied to see if a product is being sold. A date when the data was last reviewed or updated should be visible. It is not necessary to locate the number of visitors to the website.
Secondary Prevention
Definition: Secondary prevention occurs after a disease, injury, or illness has occurred. It aims to slow the progression or limit the long-term impacts. It is often implemented when asymptomatic, but risk factors are present. Secondary prevention also may focus on preventing reinjury. Examples: •Telling those with heart conditions to take daily, low-dose aspirin •Screenings for those with risk factors for illness •Modifying work assignments for injured workers
The nurse is evaluating the components of the computer system used in the healthcare organization. What should the nurse realize about the functions of the clinical information system and administrative information system? Select all that apply. A) They serve as tools to manage finances. B) They are used to store demographics. C) The systems are separate. D) The systems support each other. E) They are two independent systems.
Answer: A, B, D, E Rationale: The clinical information system supports the administration system by inputting information for billing purposes such as procedures performed. The administration system admits the client and includes information that assists the clinical system such as client allergies. The systems function independently but are not separate. Finances and demographics are managed by the administrative function.
The clinical information system committee at a major healthcare organization is designing a plan to ensure the protection of client information. Which approach(es) should this committee include in the implementation plan? Select all that apply. A) Design policies to address password protection and log-in information. B) Determine how to handle clients who desire to "friend" staff through social media. C) Identify applications that interface with smartphones. D) Create interfaces so that health data can be inputted by the client. E) Identify a procedure if information is inputted in the incorrect client record.
Answer: A, B, E Rationale: The committee is creating a plan to ensure the protection of client information. The committee needs to design policies for password protection and log-in information, determine mechanisms to handle clients and staff who communicate through social media, and what to do if information is inputted into an incorrect medical record. Identifying applications that interface with smartphones and creating interfaces so that clients can input health data are not approaches to ensure the protection of client information.
The nurse administrator of a local hospital is attending training on the new informatics system the hospital will be implementing. What information will the nurse administrator be able to manage from the dashboard? Select all that apply. A) Quality initiatives B) Plans of care C) Clients D) Staffing E) Budgets
Answer: A, D, E Rationale: Many electronic health records give administrators tools to manage budgets, staffing, quality initiatives, and productivity information. The use of dashboards puts all of this information at the administrator's fingertips. The dashboard does not include patient-specific or identifying information, such as plans of care.
The nurse is providing care for a patient with a new diagnosis of hypertension. How can the nurse best promote the client's adherence to the prescribed therapeutic regimen? A) Screen the patient for visual disturbances regularly. B) Have the patient participate in monitoring his or her own BP. C) Emphasize the dire health outcomes associated with inadequate BP control. D) Encourage the patient to lose weight and exercise regularly.
Answer: B Rationale: Adherence to the therapeutic regimen increases when patients actively participate in self-care, including self-monitoring of BP and diet. Dire warnings may motivate some patients, but for many patients this is not an appropriate or effective strategy. Screening for vision changes and promoting healthy lifestyle are appropriate nursing actions, but do not necessarily promote adherence to a therapeutic regimen.
While being providing care, a client asks the nurse why the computer is being used. What should the nurse respond to the client? A) "The information that is uploaded is available for anyone to view." B) "Computers improve client care because information is readily available." C) "The computer decreases documentation time for nurses." D) "Computers allow you access to your medical record."
Answer: B Rationale: Nursing informatics is the science of using computers in nursing practice to improve client care by making client information easily accessible. Documenting client information by computer does not necessarily reduce charting time, depending on the system used. The client's information is protected by privacy laws. The client may read the chart, whether written or computerized, in the presence of a physician.
The nurse is planning care for a client who has recently been diagnosed with type 2 diabetes mellitus. In planning the client's care, the nurse determines that it would be best to utilize the Nursing Outcomes Classification (NOC) when forming client outcomes for which reason? A) The NOC looks more professional in the plan of care. B) The NOC allows better nursing communication. C) The NOC facilitates the collection of client care data. D) It would be easier than forming other types outcomes.
Answer: B Rationale: The standardized language of the NOC allows nurses to describe nursing problems, treatments, and outcomes in a consistent manner that is understood by all nurses. The NOC was not devised to make outcomes easier or more professional looking. Outcomes are based on data already collected and do not facilitate data gathering.
A rural home health nurse is caring for a client recovering from a myocardial infarction. The client is concerned that the community clinic does not have the ability to provide the necessary monitoring for the health problem. Which response by the nurse would be most appropriate? A) "It is not necessary for you to be monitored after a myocardial infarction." B) "Through technological advances such as telehealth, we can send your information to the cardiologist." C) "You are right. We will be sending you to the city every month." D) "We use an intranet in this facility."
Answer: B Rationale: Through telehealth advances, clients who live in remote areas can have their information monitored by specialists using computers. Because of this technology, clients do not need to make frequent visits to specialists for monitoring and evaluation of progress. A client who has experienced a myocardial infarction does require monitoring. The intranet is used within an agency or system and is not a tool that can be accessed from the outside.
The nurse is planning care for a client who has just recently undergone a below-the-knee amputation. How will the use of informatics help the nurse plan this client's care? A) Find out what was done on the previous admission B) Search for research to support evidence-based practice C) Look for standardized nursing language D) Search the Internet for information about the surgical procedure
Answer: B Rationale: To provide the best care, the nurse can access nursing research that would support evidence-based practice. The previous admission would not provide evidence-based results. Searching the Internet for information regarding the surgical procedure will not help the nurse learn what the latest nursing research is. Standardized nursing language is useful when forming plans but will not help the nurse provide evidence-based care.
The nurse educator at a hospital is conducting a class on the importance of uniform language within health care. Which statement regarding uniform language made by the one of the staff nurses would indicate the need for further instruction? A) "Uniform language refers to use of a standardized language across multiple disciplines." B) "The use of uniform language within the electronic health record only provides benefits to the profession of nursing and the health organization." C) "The Do Not Use abbreviation list is one example of uniform language." D) "Continuity of care improves for the client when standardized terminology is used."
Answer: B Rationale: Uniform language refers to use of a common or standardized language across multiple disciplines. The Joint Commission's list of Do Not Use abbreviations is one example of uniform language. The use of uniform language within the electronic health record can provide benefits to the client, the profession of nursing, and the health organization. Continuity of care improves for the client when standardized terminology is used.
A client being treated for cancer is receiving care through a facility that is 100 miles from the client's home. After explaining how telehealth will be used to enhance this client's care, which statement indicates that teaching about telehealth has been effective? Select all that apply. A) "I will have to move closer to the provider." B) "My health record can stay where I am." C) "I can participate in the videoconference." D) "I will have to change doctors." E) "This will help lower some costs of care."
Answer: B, C, E Rationale: Using telehealth, the client can live and stay in the home and does not need to move closer to the treatment or monitoring facility. The client will not be required to change healthcare providers. Telehealth allows for the client to participate in a videoconference, keep health records in the home agency, and lower many of the costs that could be incurred with frequent travel.
The nurse on the hospital research committee is assigned the task of reviewing literature on the impact of an electronic medical record when documenting client care. What should the nurse do to find the most appropriate information for this study? A) Look for articles at the medical library. B) Use Google to search for information. C) Access bibliographic databases online. D) Seek journals in the nursing library.
Answer: C Rationale: Accessing databases online can pinpoint those journals and projects that relate directly to the research project. Trying to find applicable articles and journals in any library is time consuming and may result in inappropriate material that cannot be filtered by hand the way it can by a computer. Google is not an efficient avenue for accessing nursing research.
In preparation for the next quality improvement committee meeting, the nurse manager accesses the clinical decision support system to run an outcomes report. How will the committee use this report? A) To eliminate unnecessary care B) To measure the length of hospital stays C) To assist in modifying policies and procedures D) To validate appropriate place of treatment
Answer: C Rationale: Outcome tracking helps identify faulty processes and assists in modifying policies and procedures to improve client outcomes for a particular diagnosis or department within a health organization. Utilization review is designed to eliminate inappropriate or unnecessary medical care, length of stay, and place of treatment.
What nursing action involves modifying a teaching program if a learner is not experientially ready?
Answer: Changing the wording in a teaching pamphlet so that a patient with a fourth-grade reading level can understand it.
The nurse is preparing discharge instructions for a client with a foot wound. How will the nursing information system support this client's learning needs? A) Improves documentation about the client's status B) Summarizes the list of charges that will appear on the client's bill C) Provides a record of all medications received while hospitalized D) Prints discharge instructions to use for teaching
Answer: D Rationale: A nursing information system must give the nurse the ability to access client information and provide data necessary to execute the nursing process of assessing, diagnosing, planning, implementing, and evaluating the care of the client; however, documenting information about the client's status will not help with discharge instructions. A nursing information system does not provide a list of charges from the hospital stay. Pharmacy information, such as medication, route, dose, and time, should be available in the client's chart in real time. The system should allow the nurse to print discharge instructions with medication information to review with the client.
The nurse manager is meeting with the director of human resources to review information about the current staff. How does the clinical decision support system support human resource functions? A) Determining if staff are correctly coding client care procedures B) Identifying staff who are incorrectly charging for resources used for client care C) Recognizing staff who are not discharging clients according to identified lengths of stay D) Evaluating the number of staff with licensure due to expire
Answer: D Rationale: Human resource departments can benefit from computerization by tracking personnel within the healthcare system. Professional licenses and credentials expire and must be renewed. It would be a daunting task to keep track of this information manually for a large facility that employs thousands of healthcare professionals. A computerized system can monitor license expiration and when recredentialing of a provider is required. Coding and charging for resources would be used by the billing department. Information about client discharges according to identified lengths of stay would be used in a utilization review.
Tertiary Prevention
Definition: Tertiary prevention focuses on managing complicated, long-term diseases, injuries, or illnesses. The goal is to prevent further deterioration and maximize quality of life because disease is now established and primary prevention activities have been unsuccessful. However, early detection through secondary prevention may have minimized the impact of the disease. Examples: •Pain management groups •Rehabilitation programs •Support groups
Primary Prevention
Definition: The goal is to protect people from developing a disease, experiencing an injury, or engaging in a behavior in the first place. Examples: •Immunizations against disease •Education promoting the use of automobile passenger restraints and bicycle helmets •Screenings for the general public to identify risk factors for illness •Controlling hazards in the workplace and home •Regular exercise and good nutrition Counseling about the dangers of tobacco and other drugs Since successful primary prevention helps avoid the disease, injury, or behavior and its associated suffering, cost, and burden, it is typically considered the most cost-effective.