NUR 407 Computer Technology Monitoring

3. Nurse Emily has received orders from Dr. Charger and is placing them in the patient's electronic medical record (EMR). After entering the orders Emily is notified that her patient, Sarah Smith is allergic to the medication ordered by Dr. Charger. Which system is Emily using? a. Clinical Decision Support Systems b. Provider Order Entry System c. Computer Based Reminder Systems d. Nurse Call Systems

Correct Answer: A Rationale: When an order for a medication is put into a patient's EMR, the computerized system can indicate that the patient is allergic to that medication by immediately sending an alert, stopping the order. Pg. 435 - Finkleman

4. Which of the following are true regarding electronic medical/health records... (Select all that apply)? a. Records are readily available b. Documentation is redundant c. Nursing productivity is improved d. Prevention of medication errors e. Nursing notes are uncategorized

Correct Answer: A,C,D Rationale: The following list identifies the projected and current advantages of using EMRs: Legible Records, Readily available records, Improved nursing productivity, Reduction in record tampering, Support of nursing process in the system, Reduction in redundant documentation, Clinical prompts, reminders, and warnings, Categorized nursing notes, Automatically printed reports, Documentation according to standards of care, Improved knowledge of outcomes, Availability of data, Prevention of medication errors, Facilitations of cost - defining efforts, Printed discharge information. Pg. 434 - Finkelman.

7. What is the most important role of the nurse in preventing drug errors? a. Always checking the patient's diagnosis before giving a drug b. Always following the "five rights" of drug administration c. Being the one defense for detecting and preventing drug errors d. Being most likely to detect a drug error that has occurred

Correct Answer: B Rationale: Always following the "five rights" of drug administration. Always check the right patient, drug, amount, route and time.

9. Nurse Stark has just received a patient from the PACU. After her initial assessment, she sets the patient up on the monitors and goes back to the desk to chart. 15 minutes later the monitor shows the patient's respirations are 7 and the blood pressure is 82/53. Which of the following is the most appropriate at this time? a. Turn off the alarm, it is obviously wrong. b. Assess the patient. c. Call the doctor immediately. d. Call the charge nurse to check on the patient, you are too busy charting.

Correct Answer: B Rationale: Assess that the patient is still hooked up on the monitor correctly. Assess that the respiratory rate and blood pressure are abnormal before calling the doctor.

8. The nurse is working on a unit that is equipped with electronic medication administration processes. This includes a computer at the bedside that allows for scanning a barcode on the medication order, the medication label, and the client's identification band. Which of the following is the BEST method for the nurse to practice regularly? a. The nurse should rely solely on the barcoding scanner because it promotes safer medication administration practices. b. The nurse should rely on a combination of nursing judgment and decision making along with the computerized system. c. The nurse should never give a medication that a bar-coding system scans as "incorrect medication." d. The nurse should override any medication that the machine scans as "incorrect medication" and administer it

Correct Answer: B Rationale: The nurse should rely on a combination of nursing judgment and decision making along with the computerized system. The nurse should always double check the computer system.

6. What information is included in a care flow sheet? a. Results of laboratory tests b. Wound dressing changes c. Plan of care d. Serial record of 24-hour intake and output (I & O)

Correct Answer: B Rationale: B is a direct nursing task that can be easily documented and reviewed by other professional at a later time. A, C, and D are all part of a nursing care plan or concept map.

1. Which of these statements related to information technology is accurate? a. Social networks and cell phone cameras pose low risk in terms of information technology security and confidentiality. b. The security of technological data and information in healthcare environments is most often violated by those who work there. c. The security of technological data and information in healthcare environments is most often violated by computer hackers. d. Computer data deletion destroys all evidence of the data.

Correct Answer: B Rationale: The security of technological data and information in healthcare environments is most often violated by those who work there. The vast majority of these violations occur as the result of inadvertent breaches with carelessness and the lack of thought on the part of employees. Technology is a double edged sword. Technological advances such as cell phone cameras, social networks like Facebook, telephone answering machines and fax machines pose great risk in terms of the confidentiality and the security of medical information. Computer data deletion does not always destroy all evidence of the data; data remains.

10. Which of the following would you expect to find in the hospital setting? Select all that apply. a. Hard bound drug guide b. Dopplers c. PYXIS d. Pagers/phones e. Paper charting

Correct Answer: B,C,D Rationale: A and E are incorrect because hospitals are now going to computer based charting.

2. Technology is designed to minimize errors and buffer the consequences of errors by: a. Eliminating errors and adverse events b. Reducing occurrence of errors/adverse events c. Detecting errors early, before injury occurs d. Mitigating the effects of errors after they occur to minimize injury

Correct Answer: C Rationale: Technology is designed to minimize errors and buffer the consequences of errors by detecting errors early, before injury occurs.

5. An advantage of computer charting is that: a. Computers are always up, running, and available b. Security of information is guaranteed with the computer system c. Others can see what is being input as the nurse works with the charting screens. d. It is more efficient because it saves nurses time compared with writing out notes.

Correct Answer: D Rationale: It is more efficient because it saves nurses time compared with writing out notes. A is incorrect because computers are not always up, running, and available. B is incorrect because security of information cannot be guaranteed. C is incorrect because other people cannot see what a nurse is inputting until after the information has been submitted.

15. What is a major difference between a problem-oriented medical record and a source-oriented medical record? a. The problem oriented medical system has a centralized part of the chart for interdisciplinary progress notes and the source oriented medical record has separate areas for each profession's progress notes. b. The problem oriented medical system consists of narrative progress notes and the source oriented medical record uses SOAP. c. The source oriented medical system uses charting by exception and the source oriented medical record system does not. d. The source oriented medical system has a centralized part of the chart for interdisciplinary progress notes and the problem oriented medical record has separate areas for each profession's progress notes.

Correct Response: A Rationale: The problem oriented medical system has a centralized part of the chart for interdisciplinary SOAP progress notes and the source oriented medical record has separate areas for each profession's progress notes. Although source oriented medical records can use SOAP, this is not a defining characteristic and most of these notes are free formed narrative notes. Charting by exception is a distinctly different medical system than source or problem oriented medical systems.

13. The nurse is working on a state-of-the-art nursing unit with completely electronic medical records. The rooms are semi-private, with two clients to a room, and equipped with a computer for each client. Which of the following actions by the nurse is the MOST important? a. After each use of the computer and upon leaving the client's room, log off from the computer b. After each use of the computer and upon leaving the client's room, face the computer away from where visitors would be able to see the screen. c. The nurse should not be concerned about the security of the information because there is a single computer for each client and therefore no risk of the information being seen. d. The nurse should pull the curtain to cover the computer screen so that visitors cannot view it.

Correct Response: A Rationale: To make sure that the patient's information is not seen by other people, it is appropriate to log off from the computer after each use and upon leaving the patient's room.

12. What are some of the advantages of having access to patient records at this point of care? Select all that apply. a. Reduces time spent returning to the nurse's station to obtain the information needed. b. Reduces errors because all providers know when care has been given. c. Documentation can be charted as soon as care is provided. d. Point of care access increases the chance that details may be forgotten, documented incorrectly, or not at all.

Correct Response: A,B,C Rationale: D is incorrect because it decreases the chance that details may be forgotten, documented incorrectly, or not at all. Finkelman pg 436

14. Patient Lisa asks Nurse Abby why an electronic health record (EHR) system is being used. Which response by the nurse indicates an understanding of the rationale for an EHR system? a. It includes organizational reports of unusual occurrences that are not part of the client's record. b. This type of system consists of combined documentation and daily care plans. c. It improves interdisciplinary collaboration that improves efficiency in procedures. d. This type of system tracks medication administration and usage over 24 hours.

Correct Response: C Rationale: (EHR) systems allow easy access to the patient's health records and also allows other team members to collaborate more efficiently.

16. Who should document care? a. The LPNs should document the care that they provided and the care that was given by unlicensed assistive staff. b. The registered nurse must document all of the care that is provided by the nursing assistants because they are accountable for all care. c. All staff members should document all of the care that they have provided. d. All staff should document all of the care that they have provided but the registered nurse, as the only independent practitioner, signs it.

Correct Response: C Rationale: All staff members, including unlicensed assistive staff like nursing assistants, document and sign, all of the care that they have personally provided. For example, the nursing assistants will document the vital signs that they have taken; the licensed practical nurses will document all of the treatments and medications that they have given to the patient; and the registered nurse will document nursing diagnoses and assessments that they have completed.

11. The nurse is receiving orders on a new patient admitted with CHF. Those orders include: Strict I&O's, Cardiac diet, telemetry, Activity as tolerated, Lasix 40mg IV Q 2 hours, and continue home medications. What is the best action by the nurse? a. Carry out the orders as prescribed. b. Place a foley catheter for more accurate I&O's. c. Call the doctor to clarify the Lasix order. d. Wait till the next shift comes in, they can finish the admission.

Correct Response: C Rationale: Even though the doctor put the orders in the computer, it is still the nurse's responsibility to critically think and determine if that order is safe and appropriate. While POES have many advantages, typos can still occur. Finkelman pg 435.

17. All of the following allow for improved and effective communication, except: a. Decision Support b. Nurse call Systems c. Computer-based reminder systems d. Yelling out for a healthcare staff member

Correct Response: D Rationale: Yelling out for a healthcare staff member is not an improved and effective form of communication.