N320 Prep U questions for Final
A nurse asks an informatics nurse, "How can I make sure that the passwords I create are strong enough to prevent a security problem?" Which action would be appropriate for the informatics nurse to suggest to the nurse? Select all that apply.
"Make sure that your password is at least eight characters long." "Try using a mnemonic that works only for you."
A nurse is demonstrating ethnocentrism. Which statement would reflect this concept?
"My Russian heritage is superior to all others."
A client being discharged from the hospital asks the nurse, "When I go visit my family out of state, should I take my living will with me, or do I need a new one for that state?" Which is the most appropriate response by the nurse?
"Take it with you. It is recognized universally in the United States."
The nurse is explaining charting by exception (CBE) to a client who is curious about documentation. Which statement by the nurse is most accurate?
"The benefit of CBE is less time needed on computer charting."
The unlicensed assistive personnel reports to the nurse that the client is refusing to eat the food on the meal tray. The nurse observes the client eating the food brought in by family members. How should the nurse respond?
"What type of food did your family prepare for you, and does it have special meaning?"
The nurse is educating a client of Chinese descent regarding the reduction and elimination of lactose in the diet. Which statement(s) made by the client indicates that the education was effective? Select all that apply.
"When I drink coffee or tea, I should use a non-dairy creamer instead of milk or cream." "I should replace 2% milk with lactose-free milk." "I can use kosher parve foods because they are prepared without milk."
The nurse is documenting an assessment that was completed at 9:30 p.m. The facility uses military time for documentation. What entry should the nurse make for the time care was given?
2130
A nurse caring for clients of different cultures in a hospital setting attempts to make eye contact with clients when performing the initial assessment. What assumption might the nurse make based on common cultural practices?
A Muslim-Arab woman refuses to make eye contact with her male nurse. Assumption: She is being modest.
Which scenario is an example of certification?
A nurse who demonstrates advanced expertise in a content area of nursing through special testing
Which nursing student would most likely be held liable for negligence?
A nursing student administers medication to a resident while working as an unlicensed assistive personnel (UAP) at a local nursing home.
Which example best describes feminist ethics?
An approach critiquing existing patterns of oppression and domination in society
Which ethical principle refers to the obligation to do good?
Beneficence
Which note includes all elements of a SOAP note?
Client reports nausea, including one episode of nausea yesterday. Also with diarrhea. Mucous membranes are moist, good turgor. Blood pressure of 130/85 mm Hg, heart rate of 92 beats/min. Nausea and vomiting of unknown etiology. Will give an antiemetic and reassess within 1 hour for effectiveness.
A nurse is preparing to document client care in the electronic medical record using the SOAP format. The client had abdominal surgery 2 days ago. How would the nurse document the "S" information?
Client states, "I have more pain in my belly today than I did yesterday. My pain is about a 7 out of 10."
Nurses are responsible for delivering culturally competent care for all clients. Culturally competent care does not account for:
Client's height
Which is true of the Occupational Safety and Health Act?
It helps to reduce workforce injuries and illness in the workplace.
Which statement about laws governing the distribution of controlled substances is true?
Nurses are responsible for adhering to specific documentation about controlled substances.
Which abbreviation is correct for use in documentation?
PO
The nurse documents that a client does not have pain prior to the administration of pain medication. The client, however, requested medication for increasing postsurgical pain. What is the appropriate action to correct the pain assessment documented in the client's paper medical record?
Place one line through the entry and initial it.
The nurse overhears a colleague state, "All people from that client's country are rude." What is the appropriate nursing response?
Respond by saying, "Stereotypes keep us from accepting others as unique individuals."
Which actions should the nurse take before making an entry in a client's record? Select all that apply.
Reviewing the agency's list of approved abbreviations Locating clients' files within an electronic health record system Identifying the form appropriate to be used for documenting
Nurse practice acts are examples of which type of laws?
Statutory laws
The nurse is reassessing a client after pain medication has been administered to manage the pain from a bilateral knee replacement procedure. Which statement most accurately depicts proper documentation of pain assessment?
The client reports that on a scale of 0 to 10, the current pain is a 3.
A student nurse is assisting an older adult client to ambulate following hip replacement surgery when the client falls and reinjures the hip. Who is potentially responsible for the injury to this client?
The student nurse, the nurse instructor, and the hospital
Nurses who value client advocacy follow what guideline?
They give priority to the good of the individual client rather than to the good of society in general.
Which documentation by the nurse best supports the PIE charting system?
Vomiting 250 mL undigested food, antiemetic given, no further vomiting
An informatics nurse specialist is engaged in evaluating a clinical information system. At which time would the nurse specialist anticipate the need to obtain help from a statistician?
When determining the data collection method
Which are examples of a nurse appropriately protecting a client's privacy? Select all that apply.
With the client's permission, the nurse explains the client's diagnosis to the client's spouse. The nurse moves the client from the emergency department waiting room to a private area to collect assessment data.
A nurse is arranging for home care for clients and reviews the Medicare reimbursement requirements. Which client meets one of these requirements?
a client who is homebound and needs skilled nursing care
Which word is best described as protection and support of another's rights?
advocacy
A client diagnosed with cancer has met with the oncologist and is now weighing whether to undergo chemotherapy or radiation for treatment. This client is demonstrating which ethical principle in making this decision?
autonomy
What ensures continuity of care?
communication
A nurse reports to the charge nurse that a client medication due at 9 am was omitted. Which principle is the nurse demonstrating?
integrity
During a recent visit to the clinic, a client tells the nurse, "I've been using my cell phone to track and record the foods that I eat so that I can better understand if I'm making healthy food choices." The nurse interprets the client's statement as reflecting which technology?
mHealth
A client says to the nurse, "Why don't you wear a white cap like nurses do on the soap operas?" This is an ethnocentric statement based on the:
media
The nurse is caring for a client who is postoperative 24 hours from an appendectomy. The client is hesitant to get out of bed. How should the nurse respond?
"Can you describe what you are feeling when you try to move?"
The nurse is caring for a client who is admitted for hypertension (HTN). The nurse notes that the client has not been eating the food provided, and family members have brought in homemade food. What would be the best response by the nurse?
"Can you tell me what foods you prefer to eat and what your family is bringing you?"
A nurse who usually works on the surgical unit is asked to float to the oncology unit because of staffing needs. Which statement by the nurse indicates the possibility of the nurse experiencing culture shock?
"I am very stressed now because I do not understand how things work on this unit."
Which statement made by the nurse providing care to a group of clients indicates that the nurse requires further education regarding negligence?
"I don't need to assess distal pulses on a client after a femoral arteriography."
Which is the proper way to document midnight in a client's record?
0000
Which scenario is an example of the laissez-faire approach to value transmission?
Allowing a child to decide not to have an intravenous line inserted
An informatics nurse specialist is working with a team to design a clinical information system. To ensure system usability, the team would make sure that the language meets which criterion? Select all that apply.
Conciseness Clarity Familiarity for the user
When recording data regarding the client's health record, the nurse mentions the analysis of the subjective and objective data, in addition to detailing the plan for care of the client. Which of the following styles of documentation is the nurse implementing?
SOAP charting
A nurse is caring for an older adult who has cancer and is experiencing complications requiring a revision of the plan of care. The nurse sits down with the client and the family and discusses their preferences while sharing the nurse's own judgments based on the nurse's expertise. Which type of healthcare decision making does this represent?
Shared decision making
An informatics nurse specialist is working with a team designing an update to a clinical information system being used by the nursing staff. When selecting the language to be used with the system, which characteristic would be most appropriate to address? Select all that apply.
Terminology is clear and concise for the nurses Terminology reflects the users work context Terminology is familiar to the user
Which organization audits charts regularly?
The Joint Commission
The nurse is caring for several clients of different cultures. Which client situation would the nurse recognize as the client with highest risk of culture shock?
The client from Ethiopia states, "All these machines attached to me scare me and I need to get them off."
Which best exemplifies malpractice?
The nurse administers amoxicillin to a client with known allergies to penicillin. The client has a seizure with resulting respiratory arrest.
Nurses complete incident reports as dictated by the agency protocol. What is the primary reason nurses fill out an incident report?
To improve quality of care
The nurse is reviewing charges to clients for surgical procedures and observes different charges dependent upon insurance status. The nurse immediately reports this bias in charges to the supervisor for action. What principle of bioethics is the nurse demonstrating?
justice
A nurse is of the Catholic faith and votes pro-life. This nurse is considered to have:
personal values
A nurse is most likely to experience ethical distress in which client situation?
Continuing intravenous fluids for a client who wants to die
The nurse documents a progress note in the wrong client's electronic medical record (EMR). Which action would the nurse take once realizing the error?
Create an addendum with a correction.
A nurse has applied soft wrist restraints to a client following endotracheal intubation. Documentation of which information is essential when using restraints on a client? Select all that apply.
Findings from patient assessment, performed every 2 hours Foley catheter draining clear yellow urine 0.9 normal saline infusing intravenously at 100 mL/hr
A nurse takes a client's pulse, respiratory rate, blood pressure, and body temperature. On which form would the nurse most likely document the results?
Graphic sheets
A nurse enters the client's room and finds the client lying on the floor experiencing a seizure. After stabilizing the client, the nurse informs the physician. The physician advises the nurse to prepare an incident report. What is the purpose of an incident report?
To evaluate the quality of care provided and assess the potential risks for injury to the client
While a client admitted to the medical-surgical unit is in the radiology department, a visitor claiming to be the client's cousin arrives on the medical-surgical unit and asks the nurse to provide a brief outline of the client's illness. Which response by the nurse would be most appropriate, both legally and professionally?
"I cannot give you that information due to client confidentiality."
Which statements made by a nurse would indicate to a nurse manager that the nurse requires further training? Select all that apply.
"If I make a mistake, I will not tell anyone." "I will have the supervisor fill out the incident report when I make an error."
The nurse is providing care to a client whose condition has progressively declined. The nurse assesses and makes appropriate interventions as well as notifies the health care provider. Despite the nurse's efforts, the client expires. What element of liability has the nurse demonstrated?
Duty
A nurse who is caring for a new mother realizes that the woman is not prepared to go home with her newborn after a hospital stay of only 24 hours. However, hospital policy dictates that the mother be discharged. This nurse may be faced with which moral problem?
Ethical distress
An informatics nurse is assisting with the evaluation of a newly implemented system for electronic documentation of client assessments. The nurse is planning to involve staff nurses in this process. When beginning the evaluation process, the informatics nurse would focus on which area first?
Identifying what will be evaluated
While caring for a client from a culture different from the nurse's, the nurse inadvertently offends the client. What is the best action by the nurse?
Learn from the mistake and do not repeat it.
A client informs the nurse that the client wants to discontinue treatment and go home. Later, the nurse finds the client dressed to leave. Which action should the nurse take in this situation?
Let the client go after signing a document stating that the client is going against medical advice.
A nurse witnesses a traffic accident and dresses the open wounds sustained by a child. Later, in the hospital, the child develops complications from an infection in the wound. The family holds the nurse responsible for the complications and attempts to file a lawsuit. Which statement is true regarding how the Good Samaritan law applies to this case?
The Good Samaritan law will provide legal immunity to the nurse.
Which traits are examples of virtues that can exemplify character and conduct as a professional nurse? Select all that apply.
Trustworthiness Humility Compassion
While riding in the elevator, a nurse discusses the HIV-positive status of a client with other colleagues. The nurse's action reflects:
invasion of privacy.
A nurse is providing care to an older adult client who was just diagnosed with cancer. The client together with the immediate family discuss their preferences with the health care providers involved. The health care providers offer their clinical recommendations about possible treatments. Ultimately, the group arrives at a decision. The nurse interprets this decision-making process as reflecting which type?
shared
A nurse, while off-duty, tells the physiotherapist that a client who was admitted to the nursing unit contracted AIDS due to exposure to sex workers at the age of 18. The client discovers that the nurse has revealed the information to the physiotherapist. With what legal action could the nurse be charged?
slander
Socialization into the nursing profession may have the most significant effect on:
values.
The nurse attorney provides an educational session to the nursing staff on acts of negligence. Which responses by the staff would indicate to the attorney that the staff can accurately identify acts of negligence? Select all that apply.
"I can be charged with negligence if I notify the health care practitioner about a change in a client's status but do not follow up or document. "I can be charged with negligence if I apply a heating pad to the client's skin and the client suffers a superficial or first-degree burn."
A charge nurse has implemented staff education on nursing values. The nurse would determine that further education is required when which statement(s) are overheard? Select all that apply.
"I can't believe the client is giving that precious baby up for adoption." "The gonorrhea test was positive. That's what the client gets for sleeping around." "If that was my mother, I sure wouldn't agree to a no-code."
An RN enters a client's room and observes the unlicensed assistive personnel (UAP) forcefully pushing a client down on the bed. The client starts crying and informs the UAP of the need to go to the bathroom. What action is the RN witnessing that should be immediately reported to the supervisor?
Battery
An informatics nurse specialist is interviewing several nurses who have participated in testing a new electronic assessment tool. The nurses report that the tool "feels so familiar, like we know exactly what it is that we're supposed to do." The nurse specialist interprets this as indicating which concept?
Naturalness
An informatics nurse specialist is preparing a presentation about patient portals for a group of primary care providers in an office practice. When describing the tasks that can be accomplished by clients using the portal, which activity would the informatics nurse specialist include? Select all that apply.
Paying their bill Checking their lab test results Scheduling appointments Receiving screening reminders
What is likely to have the greatest influence on an adolescent's formation of values during this developmental stage?
Peers
A nurse is reviewing the medical record of a client at the clinic. The nurse notes that the medication and dosage prescribed for the client was based on information gathered about the client's genetic makeup from the electronic health record. The nurse interprets this as:
Pharmacogenomics
A family brings the client to the emergency department in an unconscious state with a head injury. The client requires surgery to remove a blood clot. What would be the appropriate nursing intervention in keeping with the policy of informed consent prior to a surgical procedure?
The nurse confirms that the client's family has signed the consent form.
The nurse is documenting a variance that has occurred during the shift. This report will be used for quality improvement to identify high-risk patterns and, potentially, to initiate in-service programs. This is an example of which type of report?
incident report
An HIV-positive client discovers that the client's name is published in a research report on HIV care prepared by the client's nurse. The client is hurt and files a lawsuit against the nurse. Which offense has the nurse committed?
Invasion of privacy
When providing care to a client, the nurse refers to the client's ethnic group. Which aspects would the nurse include as pertaining to this concept? Select all that apply.
Language Religious beliefs Shared beliefs of origin
A nurse is working in a clinic that serves a community with a high population of immigrants. Which nursing assessment is the priority?
Language assessment
A client is scheduled for a CABG procedure. What information should the nurse provide to the client?
"A coronary artery bypass graft will benefit your heart."
A client was admitted to the emergency department with a confirmed diagnosis of tuberculosis. To whom should the nurse report this diagnosis?
the public health department
A student nurse is not looking forward to clinical rotation on a geriatric unit, stating "How can I get them to move faster? They always seem so slow!" How should the instructor respond?
"Be careful of the negative attitude in your approach. How fast an individual moves will depend on physical ability not necessarily age."
The nurse has just attended a seminar on concepts of cultural diversity. Which statement made by the nurse would require further education?
"Culture cannot be influenced, and you are born with your culture."
A nurse is transfusing multiple units of packed red blood cells. After the second unit is transfused, the nurse auscultates bilateral crackles at the bases of the client's lungs and the client reports dyspnea. The nurse telephones the health care provider and provides an SBAR report. Which statement represents the final step in this type of communication?
"I think the client would benefit from intravenous furosemide."
A nurse is providing a change-of-shift report on a client who has had a restless night, is experiencing anxiety, and requires frequent repositioning. Which statement indicates a correct way of conducting an effective handoff at change of shift?
"The client had a good deal of anxiety last night and requested to be turned and repositioned frequently."
Action has been taken against a nurse's license based on a claim that the nurse acted outside of nursing's scope of practice. The nurse's attorney determines that the nurse needs more education about the purpose of the board of nursing when the nurse makes which statement?
"The rules made by the board of nursing don't reflect my practice."
Which statement by the nurse is an example of deception?
"This injection of procaine will feel like a little pinch."
A nurse from the postanesthesia care unit (PACU) transports a client in the elevator with a nurse from the intensive care unit (ICU). There are staff members and visitors in the elevator as well. Which response from the ICU nurse is appropriate when the PACU nurse begins the report?
"Wait and give me a report in the room at the bedside."
The nurse is collecting the health history of a client and notes the client is apprehensive in answering questions. The client states, "My spiritual healer will be here soon." What is the best response by the nurse?
"We can wait until your spiritual healer arrives and work together to answer these questions."
The nurse is documenting morning care for a client with diabetes. Which documentation is most appropriate for this client?
0800: Consumed 80% of breakfast. Reports pain level of 3 on scale of 1-10.
A nurse is documenting client care using the SOAP format. Place the statements listed below in the order that the nurse would record them.
1. "I don't feel well. I've been urinating often, and it burns when I urinate." 2. Abdomen soft non-tender. Urine dark yellow and cloudy. Temperature 100.8 degrees F. Indwelling urinary catheter removed 2 days ago. 3. Fever, possible urinary tract infection 4. Notify Dr. Phillips of fever and client complaints. Encourage fluids, continue to monitor temperature.
An informatics nurse specialist is part of a team that is evaluating a clinical information system being used at the facility. Place the initial steps below in the correct order from first to last that reflect the steps necessary for the team to evaluate the system.
1. Determine what to evaluate. 2. Determine what data will need to be collected. 3. Conduct a literature review in peer-reviewed journals. 4. Determine specific data elements to be collected.
A nurse is following a clinical pathway that guides the care of a client after knee surgery. When the nurse observes the client vomiting, it creates a deviation from the clinical pathway. What should the nurse identify this event as?
A variance
Which process evaluates and recognizes educational programs as having met certain standards?
Accreditation
A nurse has completed 4 hours of an 8-hour shift on a medical-surgical unit when the nursing supervisor calls. The nursing supervisor directs the nurse to give a report to the other two nurses on the medical-surgical unit and immediately report to the telemetry unit to assist with staff needs on that unit. The nurse informs the supervisor that the nurse has been busy with client assignments and feels this will overwhelm the nurses on the medical-surgical unit. The supervisor informs the nurse that the need is greater on the telemetry unit. This is an example of which type of ethical problem?
Allocation of scarce nursing resources
A nurse is conducting an ethnographic interview with a client. Which step would the nurse do first?
Ask an open-ended, general question
A nurse is providing care to a client from a culture different from the nurse's own. The nurse is having difficulty relating to the client. What intervention by the nurse is most appropriate?
Ask the client how the client wants to be treated based on the client's values and beliefs.
Which behaviors demonstrated by the client would the nurse consider reflections of the client's pride in ethnicity? Select all that apply.
Asking to wear unique clothing Requesting native cuisine Listening to folk music and dance
The nurse admits a client to the critical care unit to rule out a myocardial infarction. The client has several family members in the waiting room. Which nursing action is most appropriate?
Assess the client's beliefs about family support during hospitalization.
A facility plans to implement a new electronic medication documentation system. An informatics nurse specialist conducts a focus group with staff nurses to gather information. The nurse specialist asks the group about the current system being used, including a step-by-step account of the actions they perform. The nurse specialist also asks the nurses how they see this new system affecting this process and their overall daily tasks. The informatics nurse specialist is demonstrating which ANA informatics competency?
Assessment
A nurse volunteers to serve on the hospital ethics committee. Which action should the nurse expect to take as a member of the ethics committee?
Assist in decision making based on the client's best interests.
Which behavior by the nurse is stereotyping?
Avoiding older adult clients because their care is time consuming
A nurse was informed that a family member was involved in a car accident and transported to the emergency department in the same facility. What action by the nurse best demonstrates understanding of client privacy?
Calling the client information desk to find out the room number of the family member
Which theory of ethics prioritizes the nurse's relationship with clients and the nurse's character in the practice of ethical nursing?
Care-based ethics
A nurse documents hypertension in a woman who is 5 months pregnant and then writes a narrative describing the situation. This type of abnormal status can be seen immediately with narrative easily retrieved in what documentation format?
Charting by exception
A client has asked that a nurse witness the signing of the client's will. What should the nurse do prior to witnessing this signature? Select all that apply.
Check to see whether state laws allow the nurse to witness this signature. Assess the client's state of mind. Review the client's medical record. Talk to the client about why the client is signing the will now.
Which statement about client records and documentation is correct?
Communication is the primary purpose of client records.
The home health nurse is conducting the health history interview with a client who does not speak the dominant language. What would be the best action made by the nurse?
Conduct the health history utilizing a telephonic interpreter (over-the-phone translation).
A nurse interviews a client to determine the client's health beliefs and behaviors. The nurse uses this information for which aspects of care? Select all that apply.
Conducting an assessment Developing client outcomes Providing client education
A staff nurse meets with the charge nurse and is reporting that all the new nurses are leaving messes on the unit. The staff nurse states, "These youngsters think they can waltz in here and get our jobs." What is this nurse demonstrating?
Cultural conflict
An informatics nurse specialist is describing the framework underlying informatics practice. Which component of the framework would the nurse specialist describe as discrete entities without interpretation?
Data
Which nursing situation is an example of an ethical dilemma?
Deciding whether to perform cardiac compressions against a client's wishes
Which example most accurately depicts the ethical principle of autonomy?
Describing a surgery to a client before the consent is signed
An informatics nurse specialist is working as part of a team that will be developing and implementing a new client assessment tool. During which phase of the system development lifecycle would the team be integrating information about workflow patterns, standard terminology, and recommendations for screen layout from supportive research?
Design and build
A client states that the client's recent fall was caused by his scheduled antihypertensive medications being mistakenly administered by two different nurses, an event that is disputed by both of the nurses identified by the client. Which measure should the nurses prioritize when anticipating that legal action may follow?
Document the client's claims and the events surrounding the alleged incident.
Six teenagers were killed in an accident following a night of drinking. The older brother of one of the victims bought beer for the group because none of them was old enough to purchase alcohol. Which statement(s) regarding the brother's action reflect customs rather than communal or personal ethical standards? Select all that apply.
Drinking alcohol is a rite of passage. Big brothers often introduce their younger siblings to alcohol.
The nurse is concerned about a potential malpractice or negligence lawsuit regarding a client who was cared for on the unit. What specific elements must be established to prove that malpractice or negligence has occurred in this client? Select all that apply.
Duty Breach of Duty Causation Damages
When maintaining health care records for a client, the nurse knows that a health care record also serves as a legal document of evidence. What should the nurse do to ensure legally defensible charting?
Ensure that the client's name appears on all pages.
A female client is brought to the emergency room with matted hair, bruising, and malnutrition. The nurse suspects physical abuse and neglect. The nurse states, "This happens to many women." Which type of ethical approach is the nurse exhibiting?
Feminist
A nurse is administering evening medications and notices that a medication was omitted during the day shift. Which statement demonstrates the principle of accountability?
Filling out an occurrence report and notifying the healthcare provider
An informatics nurse is teaching a clinic staff about a newly implemented patient portal being used. The informatics nurse determines that the teaching was effective when the staff identify which aspect as being the focus of this technology?
Greater client engagement
Which statement is not true regarding a medication administration record (MAR)?
If the client declines the dose, the nurse does not have to document this on the MAR.
Which nursing intervention reflects practice according to Madeline Leininger's transcultural nursing theory?
Incorporating the client's request for complementary treatment therapy
A nurse working in a primary care provider's office is using the clinical information system to review a client's health information. The nurse is able to review the client's last visit to the primary care provider as well as information from a recent hospitalization, and also a visit that the client made to the cardiologist last week. The nurse's ability to review this information is based on which aspect of the clinical information system?
Interoperability
A nurse is documenting a client's care in the electronic health record. This is the third entry being made by the nurse for the day. The nurse would sign the entry using which signature?
J. Smith, RN
A nurse is providing care to two clients who are sharing the same room. The nurse is preparing to give one of the clients a complete bed bath. Which action by the nurse would suggest liability related to invasion of the client's privacy?
Keeping the curtain between the two clients in the room open
A nurse working in a critical care unit has experienced personal tragedy, extreme shortage of staff in the work environment, and health issues. The nurse has overcome much of these hardships and is now mentoring other nurses in similar situations. What behavior is this nurse demonstrating?
Moral resilience
A nurse is caring for a client following endotracheal intubation. Before applying soft wrist restraints to prevent the client from pulling out the endotracheal tube, what is the most appropriate action of the nurse?
Obtain a medical order.
An informatics nurse specialist is involved with implementing strategies to improve the performance of the clinical information system being used. As part of this process, the nurse specialist is working on updating the plans of care in the system to reflect changes to a procedure based on new evidence. The nurse is also working to streamline the display screens to reduce the need to document the same information in three different areas. The nurse specialist is addressing which aspect of the system?
Optimization
Which principle should guide the nurse's documentation of entries on the client's health care record?
Precise measurements should be used rather than approximations.
An informatics nurse specialist is extracting data from the facility's electronic health record in an attempt to identify clients at risk for developing catheter-related bloodstream infections. When gathering this data, the nurse specialist is using which technique?
Predictive analytics
The nurse receives a verbal prescription from a health care provider during an emergency situation. Which action(s) should be taken by the nurse? Select all that apply.
Read back the prescription. Record the date and time of the prescription. Include V.O. with the health care provider's name on the prescription.
When the home care nurse visits a client, who is recently widowed, the nurse finds that the home is cluttered with trash. The client appears sad and disheveled. Which action would the nurse take based on the assessment findings?
Refer to the health care provider.
Several nurses on the same hospital unit communicate on the same social networking site. A nurse posts the following statement to the social networking page, "The lady in room 34 with heart failure was a train wreck!" In which manner has the nurse failed to apply the principles of confidentiality?
Sharing information about a client beyond the area of client care is unacceptable and breaches the client's confidentiality rights.
A Hispanic single parent is having difficulty finding employment due to a lack of a car and speaking primarily Spanish. Which factor is a barrier to health care?
Spanish as primary language
A newly hired young nurse overheard the charge nurse talking with an older nurse on the unit. The charge nurse said, "All these young nurses think they can come in late and leave early." What cultural factor can the new nurse assess from this conversation?
Stereotyping
The charge nurse is reviewing SOAP format documentation with a newly hired nurse. What information should the charge nurse discuss?
Subjective data should be included when documenting.
Which action by the nurse is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?
Submitting a written notice to all clients identifying the uses and disclosures of their health information
A family has immigrated and settled in a neighborhood that primarily speaks their native language. The nurse caring for this family recognizes that which family member will likely require the greatest amount of time to learn the dominant language?
The 45-year-old mother in the family who does not work outside the home
A nurse and the facility have been named as defendants in a malpractice lawsuit. In addition to the nurse's attorney, whom else would be appropriate for the nurse to talk with about the case?
The agency's risk manager
The nurse has an ethical conflict regarding the client's use of marijuana to control symptoms of advanced cancer. Which argument(s) regarding this conflict reflect a utilitarian approach? Select all that apply.
The client experiences significant reduction of cancer symptoms when using marijuana. The client is homebound and will not be driving. There is little opportunity for any other persons to divert or use the marijuana the client obtains.
A health care provider suggests that the nurse use the computer terminal that is available at the point of care or at the client's bedside. In what scenario is this most important?
The client has had a sudden change in status needing immediate attention.
The nurse is caring for a client who is experiencing hypotension. The nurse is concerned about the significant drop in the client's blood pressure and decides to contact the client's health care provider. When preparing a report for the health care provider using the SBAR format, what will the nurse include? Select all that apply.
The client's blood pressure trend over the past 24 hours. The primary reason the client was admitted to the hospital. Objective and subjective data from the most recent assessment. An explanation of what is needed to improve the hypotensive state.
Which example may illustrate a breach of confidentiality and security of client information?
The nurse provides information over the phone to the client's family member who lives in a neighboring state.
Which finding from a nursing audit reflects high standards for client safety and institutional health care?
The nurse documents clients' responses to nursing interventions.
After reporting to work for a night shift, the nurse learns that the unit is understaffed because two RNs called out sick. As a result, each nurse on the unit must provide care for four acute clients in addition to the nurse's regular clients. Which statement is true for this nurse when working in understaffed circumstances?
The nurse is legally held to the same standards of care as when staffing levels are normal.
Which strategy could be implemented by the nurse in ensuring the protection of electronic data at health care agencies?
The nurse locks out client information, except to those who have been authorized through appropriate security measures.
A family recently immigrated to a new country. The parent reports that the teenager is showing signs of fear, has vague reports of stomach pain, and feels humiliated by peers because of their culture. What is the priority assessment for the nurse?
culture shock
What situation would permit the nurse to disclose information without the client's approval?
The nurse suspecting that a client is being abused or neglected
The nurse is reviewing a client's chart. When reading the history, physical, and physician progress notes, the nurse anticipates finding which information?
The physician's assessment and treatment
Which is a characteristic of the care-based approach to bioethics?
The promotion of the dignity and respect of clients as people
An informatics nurse is participating in an online continuing education course about informatics, health information technology, and the use of standard terminology. The informatics nurse demonstrates understanding of the information presented in the course by identifying which aspect as a characteristic of nursing standard terminologies? Select all that apply.
The terminology identifies concepts related to the delivery of nursing care. The terminology is structurally organized to reflect nursing knowledge. The terminology provides a means to code the delivery of nursing care. The terminology aids in promoting interoperability.
Professional regulations and laws that govern nursing practice are in place for which reason?
To protect the safety of the public
Which is not a purpose of the client care record?
To serve as a contract with the client
A client has requested a translator to help understand the questions that the nurse is asking during the client interview. The nurse knows that what is important when working with a client translator?
Translators may need additional explanations of medical terms.
An informatics nurse specialist is part of a team working to design a new electronic documentation system for the facility. To ensure maximum usability, which information would the team need to consider? Select all that apply.
Use of color for meaning, not attractiveness Use of standard terminology to quantify nursing care
Nurses are occasionally asked to witness a testator's (person who makes the will) signing of a will. Which guideline is true regarding a nurse's role in witnessing a testator's signature?
Witnesses to a signature do not need to read the will.
A nurse is documenting care in a source-oriented record. What action by the nurse is most appropriate?
Write a narrative note in the designated nursing section.
A community health nurse provides information to a client with newly diagnosed multiple sclerosis about a support group at the local hospital for clients with the disease and their families. Providing this information is an example of:
a referral
A client tells the nurse that the client does not want to have a painful procedure. By respecting and supporting the client's right to make decisions, the nurse is demonstrating:
advocacy
To practice ethically, the nurse should avoid:
allowing the nurse's own personal judgment to guide practice.
A legal document that states a client's health-related wishes — such as a preference for pain management if the client becomes terminally ill — and also allows the client's adult child to direct the client's care, is:
an advance directive.
The nurse works in an urban hospital and cares for a diverse population of clients. Which action(s) by the nurse demonstrates the delivery of culturally sensitive care to clients? Select all that apply.
asking the client questions regarding health care beliefs related to the client's culture allowing the client to keep a religious necklace on until going into the operating room integrating the client's cultural practices when assisting with the creation of the plan of care
A client with end-stage renal disease decides against further treatment and requests a "Do Not Resuscitate" (DNR) order. The DNR status is part of the change-of-shift report. The client stops breathing and a nurse begins cardiopulmonary resuscitation. The family is upset and makes a complaint to the charge nurse. The charge nurse appropriately identifies that nurse has committed:
battery
The nurse is preparing the discharge plan for a new mother and her newborn son. Which new teaching should the nurse ensure is included after noting the family is Jewish?
care following the scheduled circumcision
The nurse is caring for a client with hypertension, and only documents a blood pressure of 170/100 mmHg when all other vital signs are normal. This reflects what type of documentation?
charting by exception
An informatics nurse specialist working at an ambulatory care center is interviewing clients about their experiences in using the center's patient portal. A majority of the clients have voiced dissatisfaction, stating that they "find the display screen confusing and are not sure what to click on to get the necessary information." They also talk about difficulties in trying to find their test results. Based on this information, the nurse specialist identifies a need to talk with the information technology team about ways to make the portal easier for clients to use. The informatics nurse specialist is demonstrating which ANA informatics competency?
collaboration
A nurse is caring for a client with bacterial pneumonia and a temperature of 104°F (40.0°C). Yesterday, the client's temperature was 102°F (38.9°C). The health care provider on call prescribes cool compresses for the client to help lower the fever. The client insists that the nurse bring warm blankets because they will help the client to recover more quickly. The nurse recognizes that the client's request is an example of:
cultural ritual.
A parent brings a newborn into the clinic for a 3-month wellness visit and when assessing the back, the nurse observes a dark blue area on the lower back resembling ecchymosis that does not elicit a pain response when pressure is applied. What action should the nurse take to address this finding?
documenting the finding as a "Mongolian spot"
When a home-bound client expresses the client's past-oriented ancestral heritage and family rituals, the nurse recognizes that the client is expressing:
ethnic identity.
When reviewing the chart of an older adult client, the nurse notes that the client identifies as Japanese. The nurse realizes the client is referring to which ancestral and cultural factor?
ethniciity
When an American client states, "I only want an American doctor," the client is expressing:
ethnocentrism
According to the Health Insurance Portability and Accountability Act (HIPAA) passed in 1996, clients:
have the right to copy their health records.
In the delivery of care, the nurse acts in accordance with nursing standards and the code of ethics and reports a medication error that the nurse has made. The nurse is most clearly demonstrating which professional value?
integrity
When charting the assessment of a client, the nurse writes, "Client is depressed." This documentation is an example of:
interpretation of data
Which consultation or referral by the nurse is most appropriate for a client who is obese and demonstrates poor wound healing?
nutritional consult
An informatics nurse specialist has been involved in obtaining feedback about a clinical information system recently implemented in the facility. The information gathered provided recommendations for improving the satisfaction of the end users when using the system. Which aspect is the informatics nurse specialist addressing?
optimization
A nurse obtains an order for a bed alarm for a confused client. This is an example of which ethical principle?
paternalism
A nurse is maintaining a problem-oriented medical record for a client. Which component of the record describes the client's responses to what has been done and revisions to the initial plan?
progress notes
What dual purpose does an audit serve?
quality assurance and reimbursement
A nurse who comments to coworkers at lunch that a client with a sexually transmitted infection has been sexually active in the community may be guilty of what tort?
slander
The labor and delivery nurse is getting report from the previous shift regarding a client with Asian heritage. The departing nurse states that the client did not ask for pain medication because "Asian people can handle pain." The nurse receiving report understands that this an example of what?
stereotyping
What is the term for the beliefs held by the individual about what matters?
values
A client made a formal request to review his or her medical records. With review, the client believes there are errors within the medical record. What is the most appropriate nursing response?
"According to HIPAA legislation, you have a right to request changes to inaccurate information."
A nursing student is making notes that include client data on a clipboard. Which statement by the nursing instructor is most appropriate?
"Clipboards with client data should not leave the unit."
The nurse is caring for a client whose spouse wishes to see the electronic health record. What is the appropriate nursing response?
"Only authorized persons are allowed to access client records."
A nurse helps a client who has cystic fibrosis prepare a stand-alone personal health record. Which statement by the nurse best explains this type of information?
"You can fill in information from your own records and store it on your computer or the Internet."
An informatics nurse specialist is working on a team that is considering a new technological system for the facility. Which aspect would be most important for the team to do as the first step?
Determine the need or problem to be solved
Which are appropriate actions for protecting clients' identities? Select all that apply.
Document all personnel who have accessed a client's record. Place light boxes for examining X-rays with the client's name in private areas. Have conversations about clients in private places where they cannot be overheard.
An informatics nurse specialist is part of a team that will be implementing a new clinical information system at the facility. The nurse specialist advocates to include staff nurses who will be using the system to be involved in the process. The nurse specialist advocates for this based on which reason?
Improve the chances that the system will meet the intended need
The health care provider is in a hurry to leave the unit and tells the nurse to give morphine 2 mg IV every 4 hours as needed for pain. What action by the nurse is appropriate?
Inform the health care provider that a written order is needed.
A health care provider approaches the nurse caring for the client in room 25 and states, "The client is a friend of mine. What treatment is being given?" Which response by the nurse is most appropriate?
Inform the health care provider that client permission is needed to release any information.
The nurse is calling a health care provider to give an update on a client's condition. The nurse receives a telephone order and, when requests that the order be read back to the provider for confirmation, the provider states, "I don't have time for this." What is the most appropriate action by the nurse?
Inform the provider, to ensure safety for the client, it must be read back
Which actions should the nurse perform to limit casual access to the identity of clients? Select all that apply.
Obscuring identifiable names of clients and private information about clients on clipboards Placing fax machines, filing cabinets, and medical records in areas that are off-limits to the public Keeping record of people who have access to clients' records
The nurse cared for a client admitted with uncontrolled hypertension. The client suffered a stroke shortly after the nurse's shift ended. Which information will determine if the nurse is liable?
Omitting documentation of blood pressure at the end of the shift
Which statement best conveys the relationship between race and ethnicity?
Race denotes physical characteristics, while ethnicity is rooted in a common heritage.
The nurse is caring for a client who requests to see a copy of the client's own health care records. What action by the nurse is most appropriate?
Review the hospital's process for allowing clients to view their health care records.
A nurse is using the SBAR technique for hand-off communication when transferring a client. Which scenarios are examples of using of this process? Select all that apply.
S: The nurse handling the transfer describes the client situation to the new nurse. B: The nurse gives the background of the client by explaining the client history. A: The nurse presents an assessment of the client to the new nurse. R: The nurse gives recommendations for future care to the new nurse in charge.
A nurse has a two-way video communication with the specialist involved in the care of a client in a long-term care facility. This is an example of what nursing informatics technology?
Telemedicine and mobile technology
The following statement is documented in a client's health record: "Patient c/o severe H/A upon arising this morning." Which interpretation of this statement is most accurate?
The client reports waking up this morning with a severe headache.
The nurse is using an interpreter to communicate with a client who speaks a different language. What would be the best way to choose an interpreter for this client?
The interpreter should understand the health care system.
The nurse is finding it difficult to plan and implement care for a client and decides to have a nursing care conference. What action would the nurse take to facilitate this process?
The nurse meets with nurses or other health care professionals to discuss some aspect of client care.
A new graduate is working at a first job. Which statement is most important for the new nurse to follow?
Use abbreviations approved by the facility.
An informatics nurse specialist has completed the evaluation of an update to a current clinical information system used by the staff at the local hospital and has documented the results. Documentation reveals the need for an improvement in the screen display. Which action would be next?
analyze and plan
With input from the staff, the nurse manager has determined that bedside reporting will begin for all client handoff at shift change to improve client safety and quality. When performing bedside reporting, what information should the nurse include? Select all that apply.
any abnormal occurrences with the client during the shift identifying demographics, including diagnosis current orders
An informatics nurse specialist has received an update from the vendor who is providing the electronic health record. During which phase of the system development lifecycle would this update be made?
maintain
A client has been diagnosed with PVD. On which area of the body should the nurse focus the assessment?
The lower extremities
In SBAR, what does R stand for?
recommendations
The nurse is interviewing a newly admitted client. Quoting statements made by the client will help in maintaining what type of assessment data?
subjectivity
Several nurses are discussing their impressions of the newly implemented electronic health record with an informatics nurse specialist. They say, "There is so much information on one screen, it hard to tell what we should do first. It's not really clear." The informatics nurse specialist interprets the comments as reflecting an issue with which area?
usability
A nurse manager is discussing a nurse's social media post about an interesting client situation. The nurse states, "I didn't violate client privacy because I didn't use the client's name." What response by the nurse manager is most appropriate?
"Any information that can identify a person is considered a breach of client privacy."
An informatics nurse specialist is presenting an in-service program for a group of staff nurses on using the electronic health record. As part of the presentation, the nurse specialist is emphasizing the need for maintaining security and privacy of the record. During a break in the program, the nurse specialist overhears a conversation among several of the staff nurses. Which statement would the nurse specialist identify as a cause for concern?
"I always put a sticky note on the computer terminal with my password on it in case I forget it."
Which nurse-to-provider interaction correctly utilizes the SBAR format for improved communication?
"I am calling about Mr. Jones. He has new onset diabetes mellitus. His blood glucose is 250 mg/dL (13.875 mmol/L), and I wondered if you would like to adjust the sliding scale insulin."
The parents of a hospitalized 10-year-old ask the nurse if they can review the health care records of their child. What is the appropriate response from the nurse?
"I will arrange access for you to review the record after you put your request in writing."
The nurse is caring for a client who requests to see one's medical record since admission to the hospital. What is the appropriate response by the nurse?
"I will have to review the policy that determines what procedure is in place for client access."
An informatics nurse specialist is conducting an in-service program for a group of staff nurses about this specialty. One of the nurses asks, "What exactly is nursing informatics?" Which response by the informatics nurse specialist would be most appropriate?
"It combines nursing science with information management and analytical sciences."
A nurse is requesting to receive the change-of-shift report at the bedside of each client. The nurse giving the report asks about the purpose of giving it at the bedside. Which response by the nurse receiving the report is most appropriate?
"It will allow for us to see the client and possibly increase client participation in care."
An informatics nurse is discussing the implementation of a new documentation system with a group of staff nurses who are using the system. Which response by the group would indicate to the nurse that the system's usability is effective? Select all that apply.
"We've noticed that this system really helps to save us valuable time." "Using the system is highly intuitive." "This system fits nicely into how we work."
The nurse calls the health care provider due to changes in the client's status. Using the SBAR, the nurse is about to address Recommendation. Which statement appropriately supports this part of the SBAR?
"Will you prescribe a complete blood count to check the white blood cell count and a culture?"
The nursing student is discussing the benefits of electronic charting with a precepting nurse who is frustrated with computerized documentation. Which statement by the student requires intervention from the nursing instructor?
"You can make extra money with overtime pay with end-of-shift charting."
Which clinical situation is addressed by the provisions of the Health Insurance Portability and Accountability Act (HIPAA)?
A client has asked a nurse if he can read the documentation that his physician wrote in his chart.
The parent of a 33-year-old client who is admitted to the hospital for drug and alcohol withdrawal asks about the client's condition and treatment plan. Which action by the nurse is most appropriate?
Ask the client if information can be given to the parent.
A group of nurses are participating in being the first group of staff to use a new electronic pain assessment tool. The group is discussing whether or not the system is easy to use. During the discussion, the group mentions that "the shortcuts provided are really helpful and save valuable time." The informatics nurse specialist interprets this statement as reflecting which concept?
Efficient interactions
An informatics nurse is evaluating a new clinical information system for usability. The nurse notes that the system requires the user to complete a maximum of 3 steps to complete a task. The system also provides shortcuts to frequent users of the system. The nurse would determine that which concept of usability is being addressed?
Efficient interactions
An informatics nurse is participating in an online continuing education course about nursing informatics. The nurse demonstrates successful comprehension of the course by identifying which individual as being considered the first informatics nurse?
Florence Nightingale
An informatics nurse specialist is recommending the addition of an alert system tool to the facility's patient portal. The tool would be designed to send alerts to the client to schedule routine screenings and immunizations. This recommendation most likely reflects which ANA informatics competency?
Health teaching and health promotion
An informatics nurse specialist is gathering data from electronic health records at the facility about clients who have had central venous catheters inserted for more than the recommended time as specified by the facility's protocol. The nurse specialist is collecting this data most likely for which purpose?
Identify clients at risk for infection
A nurse is reading a journal article about health information technology and the need for this technology to demonstrate meaningful use. Which information would the nurse anticipate reading about as reflective of meaningful use? Select all that apply.
Improvement in health care quality Greater client engagement Reduction in privacy breaches of client information
A client comes to see the cardiologist for a routine follow-up visit. At the visit, the nurse reviews the client's electronic health record. The nurse is able to access a report from the client's last visit to the primary care provider last month and the report from an emergency department visit two weeks ago for reports of shortness of breath. The record also lists two changes in the client's medication based on the emergency department visit. The nurse's ability to access this information reflects which concept?
Interoperability
Nurses at a health care facility maintain client records using a method of documentation known as charting by exception (CBE). What is a benefit of this method of documentation?
It provides quick access to abnormal findings.
The nurses at a health care facility were informed of the change to organize the clients' records into problem-oriented records. Which explanation could assist the nurses in determining the advantage of using problem-oriented records?
Problem-oriented recording emphasizes goal-directed care to promote the recording of pertinent data that will facilitate communication among health care providers.
The nurse hears an unlicensed assistive personnel (UAP) discussing a client's allergic reaction to a medication with another UAP in the cafeteria. What is the priority nursing action?
Remind the UAP about the client's right to privacy.
A nurse manager of a health care provider's office is responsible for obtaining signed authorizations for releasing client information to third parties. In which situations would it not be necessary for the nurse to obtain an authorization from the client? Select all that apply.
Reporting the incidence of an infectious disease to Centers for Disease Control and Prevention Releasing a medical record to the court when a nurse is being sued for negligence Facilitating organ donation of a deceased client Providing statistics related to the use of a dangerous piece of equipment
The nurse is caring for an older adult resident in a long-term care facility. The client is crying and states, "I don't want to live anymore. I am a burden on everyone. I don't feel like doing anything at all. I don't even want to get up today." Which of the following should the nurse record in his or her charting? Select all that apply.
The client is crying. The client states, "I don't want to live anymore. I am a burden of everyone. I don't feel like doing anything at all. I don't even want to get up today."
The nurse is providing in-home care for a client recently prescribed antihypertensive medication. Upon evaluation the nurse obtains a blood pressure reading of 92/58 mm Hg and alerts the provider. In which manner will the nurse execute verbal orders from provider?
The nurse can accept verbal orders to provide immediate care and record once the client is stable.
An informatics nurse specialist is collecting data from the clinical information system about the demographics of individuals diagnosed with heart failure admitted to the facility over the past five years. The nurse specialist is preparing a presentation to the facility's executive board. To promote understanding of this complex information, the nurse specialist prepares the data results using a pie chart and a bar graph. The nurse specialist is using which area of analytics?
data visualization
Besides being an instrument of continuous client care, the client's health care record also serves as a(an):
legal document
When documenting the care of a client, the nurse is aware of the need to use abbreviations conscientiously and safely. This includes:
limiting abbreviations to those approved for use by the institution.
An informatics nurse specialist is conducting an orientation for the staff of a primary care provider's office about a new web-based tool that they will be implementing. The goal of the tool is to promote patient engagement. The informatics nurse specialist is most likely orienting the staff to which system?
patient portal
An informatics nurse specialist is preparing a presentation for a local community group about advances in technology in health care. Part of the presentation will focus on technological advances to promote greater client participation in managing health. Which component would the nurse likely describe as playing a major role?
patient portal
The nurse is sharing information about a client at change of shift. The nurse is performing what nursing action?
reporting
An informatics nurse is assisting with the design of an clinical information system for use by the staff of a health center. The nurse is working to ensure that the system reflects usability by making sure that the screen display is visually clean and uncluttered and that it provides only the information needed for decision making. Which concept of usability is the nurse incorporating?
simplicity
An informatics nurse specialist is conducting an in-service education program for a group of staff nurses. The topic is ensuring electronic client data is secure and private. The specialist determines that the teaching was successful when the group identifies which aspect as essential to ensuring the security of electronic data when using clinical systems?
use of strong passwords
The nurse is caring for a client who has an elevated temperature. When calling the health care provider, the nurse should use which communication tools to ensure that communication is clear and concise?
SBAR
