ANCC Informatics Practice Test 2

Question 1

1. The classification system presently used for mortality statistics is:

A. ICD-9
B. ICD-10
C. ICD-10-CM
D. ICD-10-CM/PCS

Answer 1

B. ICD-10

The classification system used for mortality statistics is ICD-10 (International Classification of Diseases, tenth revision).
Both the underlying (primary) cause of death and non-underlying causes (other causes) are coded. ICD-9 was used between 1979 and 1998 for reporting of mortality statistics. ICD-9-CM (Clinical Modification) is usually just referred to as ICD-9 and is used for classification of diseases and procedures associated with hospitalization. ICD-9-CM was replaced with ICD-10-CM on October 1, 2015. ICD-10-CM/PCS is a transitional system.

Question 2

2. When an input device is connected to a system and the information of the device is present in the database and configured to the operating system, the state of the device is classified as:

A. Undefined
B. Defined
C. Available
D. Not available/stopped

Answer 2

C: Available

Devices can be in four different states when connected to a system:

Undefined: The system does not recognize the device.

Defined: Information about a specific device is present in the database but not available to the system.

Available: Information about a device is present in the database and configured to the operating system.

Not available/Stopped: Information about the device is present in its driver but the device is not available.

Question 3

3. With encryption of data, stickiness refers to:

A. A high level of encryption

B. The degree to which encryption persists when encrypted data are moved

C. The ability of encryption software to encrypt different types of data

D. Utilization of the same key to both encrypt and decrypt

Answer 3

B. The degree to which encryption persists when encrypted data are moved

With encryption of data, stickiness refers to the degree to which encryption persists when encrypted data are moved from one site to another, such as from one disk to another. Many types of encryption are only valid when the data are “at rest” or stored in one location or within one network. For example, a file that is encrypted in a network may lose encryption if it is sent as an email attachment, so the stickiness of encryption is an important consideration when data must be transmitted outside

Question 4

4. To ensure network security, the best current Wi-Fi encryption is:

A. WPA and AES
B. WPA2 and AES
C. WPA3
D. WPA2 and TKIP

Answer 4

C. WPA3

To ensure network security, the best current Wi-Fi encryption is WPA3. Wireless Equivalent Privacy (WEP) is the oldest security algorithm but has many security flaws and was retired in 2004; however, it may be present in older systems. Wi-Fi Protected Access (WPA) was adopted in 2003 and contained Temporal Key Integrity Protocol (TKIP), which provided better security than WEP, but again had security flaws. Wi-Fi Protected Access 2 (WPA2) was adopted in 2006 and contained the Advanced Encryption Standard (AES) and Counter Mode Cipher Block Chaining Message Authentication Code Protocol (CCMP) to replace TKIP. WPA3, the most recently adopted security algorithm in 2018, is considered the gold standard for Wi-Fi encryption and is recommended as the most protective security setting.

Question 5

5. Data should be transferred to an offsite data storage area at least:

A. Every 8 hours
B. Every 24 hours
C. Weekly
D. Monthly

Answer 5

C. Weekly

Data should be encrypted, backed up, and transferred to an offsite data storage area at least weekly.

Question 6

6 One of the essential components of an EHR is the administrative process. An example of an administrative process

A. The storage of patient demographic information
B. Electronic scheduling of outpatient visits
C. The ability to input medication orders
D. Emailing and wed messaging

Answer 6

B. Electronic scheduling of outpatient visits

An example of an administrative process is electronic scheduling for outpatient and inpatient visits. Other administrative processes include billing and claims management. The essential components of an EHR include health information/data (de-mographics, diagnoses, medication lists, allergies), results management (radiology and laboratory reports), order entry management (physician’s orders), decision support (alerts, reminders), electronic communication/connectivity (emailing and web messaging), patient support (education, home telemonitoring), administrative purposes, and reporting/population health management (tools to support mandatory reporting).

Question 7

7. How frequently should hard drives with solid-state technology be defragmented?

A. Weekly
B. Monthly
C. Annually
D. Defragmentation is not recommended.

Answer 7

D. Defragmentation is not recommended.

Hard drives with solid-state technology do not require defragmentation, and it is not recommended, although it will not harm the drive. Defragmentation is required for traditional hard disk drives to rearrange large files in order to speed up pro-cessing. Defragmentation should be done for these drives when processing slows and on a regularly scheduled basis, such as monthly. However, solid-state drives access files rapidly, so there is no benefit to defragmentation, which may actually slow processing.

Question 8

8. When an EHR system is in place, the percentage of verbal or paper orders should be below:

A. 2%
B. 5%
C.10%
D. 15%

Answer 8

C.10%

When an EHR system is in place, the percentage of verbal or paper orders should be below 10%. While it is not possible to completely eliminate verbal or paper orders, the potential for error is always increased if orders are entered into the system by ancillary personnel. Physicians should be encouraged to use the COE CDS system for orders whenever possible, but the efficiency of the CPOE CDS system may vary, and problems can arise if the system is insufficient.

Question 9

9. A system with fine granularity generally has:

A. Decreased fields
B. Decreased costs of computing
C. Decreased overhead
D. Increased overhead

Answer 9

D. Increased overhead

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

Question 10

10. An article that the informatics nurse wants to distribute has a Creative Commons license, Attribution-NonCom-mercial-NoDerivs. This means that the informatics nurse can:

A. Download and share noncommercially but credit the author.

B. Use the article in any way because it is in the public domain.

C. Download and share, commercially or noncommercially, but credit the author.

D. Use and share no more than 10% of the article.

Answer 10

A. Download and share noncommercially but credit the author.

Creative Commons licenses allow free distribution of copyrighted works under specific conditions, depending on the type of Creative Commons license. The Attribution-NonCommercial-NoDerivs license allows users to download and share a work, but the work cannot be used commercially nor can it be changed, and the author must be credited. With a Public Domain Dedication and License, the author waives all copyright and places the work in the public domain.

Question 11

11. A common benefit derived from the use of the EHR is:

A. Decreased costs
B. Increased staff satisfaction
C. Reduced medication errors.
D. Decreased rates of infection

Answer 11

C. Reduced medication errors.

A common benefit derived from the use of the EHR is reduced medication errors. Other benefits include increased use of guideline-based care because the guidelines are embedded in the EHR. The EHR also facilitates surveillance and monitoring because the databases can be more easily searched for information than when manual searches are required. An additional benefit is decreased utilization of care. Research does not clearly indicate that there are cost savings because the initial outlay to convert to an EHR and to perform maintenance may be very costly.

Question 12

12. The first step in the data validation process is:

A. Planning
B. Analysis
C. Assessment
D. Evaluation

Answer 12

C. Assessment

Data validation is the process that ensures that data is correct and meets all requirements. Date validation may be intrinsic (within the system itself), internal (in clinical use), or external (via outside auditing).

Steps to data validation include the fol-lowing:
Assessment of the tools, resources, content, and sources.
Planning, including methodology and approach.
Implementation includes looking for problems, defects, and patterns in a workflow.
Analysis includes categorizing problems, tracking issues, and communicating regarding findings.
Evaluation aims to improve validation, develop solutions for problems, and facilitate standardization.

Question 13

13. When utilizing FMEA (failure modes and effect analysis) to determine how a CPOE may fail, the interdisciplinary team should include at least personnel from:

A. Informatics, IT, and nursing staff from each unit

B. IT and informatics

C. IT, informatics, nursing, pharmacy, administration, and medical staff

D. IT, administration, informatics, and nursing, and experts in the field of computer information system

Answer 13

C. IT, informatics, nursing, pharmacy, administration, and medical staff

When utilizing FMEA (failure modes and effect analysis) to determine how a CPOE may fail, the interdisciplinary team should include at least personnel from IT, informatics, nursing, pharmacy, administration, and medical staff because all of these departments have a role in ensuring that orders are correctly entered and carried out. The process to be examined should be narrowed as much as possible because interdepartmental processes that involve many departments and personnel may be difficult to adequately assess.

Question 14

14. According to Gerbner’s General Model of Communication, a received message is not understood in the same way that the sent message intended. This exemplifies the:

A. Control dimension
B. Means dimension
C. Distortion of reality
D. Perceptual dimension

Answer 14

D. Perceptual dimension

According to Gerbner’s General Model of Communication, a received message is not understood in the same way that the sent message intended. This exemplifies the perceptual dimension. For example, if the informatics nurse transmits a message to staff members (receivers), the receiver cannot understand or receive all of the elements that went into the message— the negotiations, the research, the meetings, the thought processes-so the receivers, in fact, only receive part of the message, so they may interpret it differently.

Question 15

15. If the informatics nurse does not understand the recommended practice or worksheet on a SAFER guide, the next step is to:

A. Leave a message in “Assessment” notes.
B. Assign a score of “Not applicable.”
C. Refer to “Potentially Useful Practices.”
D. Refer to “Suggested Sources of Input.”

Answer 15

D. Refer to “Suggested Sources of Input.”

If the informatics nurse does not understand the recommended practice or worksheet on a SAFER guide, the next step is to refer to “Suggested Sources of Input.” For example, in the “High Priority Practices” SAFER guide, phase 1 is “Safe Health IT” and the first recommended practice is related to backing up data and application configurations. A rationale is given as well as a list of useful practices. Suggested sources of input include a list of those who may be able to provide useful information, such as clinicians, support staff, and health IT staff.

Question 16

16. The primary purpose of performance appraisal should be to:

A. Determine compensation.
B. Identify areas of weakness.
C. Promote staff development.
D. Establish a basis for promotion/demotion.

Answer 16

C. Promote staff development.

The primary purpose of performance appraisal should be to promote staff development by communicating the appraiser’s perception of the staff member’s strengths as an employee and helping the person to identify areas that need further devel-opment. The focus should remain positive rather than negative. The performance appraisal may be utilized to determine compensation and to establish a basis for promotion or demotion as well because these actions, especially demotion or firing, require a paper trail that shows interventions.

Question 17

17. If a new EHR system requires three additional steps to document a medication, resulting in increased errors, the first step to reducing errors should be to:

A. Provide more training for staff.
B. Place printed lists of steps on each computer.
C. Revert to the previous EHR system.
D. Determine if steps can be reduced.

Answer 17

D. Determine if steps can be reduced.

If a new EHR system requires three additional steps to document a medication, resulting in increased errors, the first step to reducing errors should be to determine if steps can be reduced because the greater the number of steps needed to carry out a process, the greater the chance of error. The number of steps as well as the number of different screens and hard stops should be carefully assessed. The system may also need to be modified in such a way as to more accurately predict and prevent errors.

Question 18

18. Which of the following is an appropriate CDS function or feature?

A. Identifying system errors
B. Signaling need for training
C. Predicting outcomes
D. Reverse allergy checking

Answer 18

D. Reverse allergy checking

An appropriate CDS function or feature is reverse allergy checking; that is, when a new patient allergy is entered into the system, it should check existing orders for the new allergy. Other CDS functions and features include checking for drug-drug interactions as well as food-drug interactions, abnormal laboratory results alerts, alerts for inappropriate drug-conditions (such as drugs contraindicated with pregnancy), inappropriate drug-age interactions (such as medications contraindicated for older adults), and maximal doses.

Question 19

19. During the orientation phase of the group process:

A. Members make group decisions.
B. Members are able to express their opinions and feelings.
C. Tasks are identified, and members explore their roles.
D. Members are able to work collaboratively.

Answer 19

C. Tasks are identified, and members explore their roles.

Group process phases:
• Orientation: Tasks are identified and members explore roles, depending on the leader at first and then exploring personal roles in the group.
• Organization: Members make group decisions regarding rules, limits, criteria, and jobs. Some resistance may occur.
• Flow of information: Members are able to express opinions and feelings, and interpersonal conflicts lessen.
Problem solving: Members are able to work collaboratively and think that goals can be met, while some may resist change.

Question 20

20. The primary threat to the security of a network is:

A. Technical errors
B. Social engineering
C. Spyware
D. A malicious insider

Answer 20

D. A malicious insider

The primary threat to the security of a network is a malicious insider, such as an unhappy employee or an employee who has been fired. Once a person is no longer employed, the person’s access to the computer system must be terminated immediately and the ID and password deactivated. Any ID badges issued by the organization should also be obtained so that the person is unable to gain access to secure areas of the organization.

Question 21

21. The informatics nurse is to lead an interdepartmental work group. The initial action in setting up the meetings is to:

A. Prepare a detailed agenda
B. Review members’ qualifications and areas of expertise
C. Contact members regarding their preferences
D. Review work schedules and venues

Answer 21

D. Review work schedules and venues

When setting up meetings for an interdepartmental work group, practical matters need to be dealt with first. This includes reviewing work schedules to determine a meeting time that is convenient for the majority of the group. Additionally, the leader needs to review meeting rooms or venues to determine which one will meet the needs of the group and allow members to sit around a table or in a circle to encourage communication. The leader must also determine what types of equipment or supplies are needed for meetings and whether the venue can provide for those.

Question 22

22. Which one of the following is essential to process excellence?

A. Cost-cutting measures
B. Continuous improvement mindset
C. Rapid implementation of changes
D. Focus on short-term gains

Answer 22

B. Continuous improvement mindset

Process excellence requires a continuous improvement mindset to improve processes, reduce waste and costs, and improve efficiency. Process excellence may involve the use of a methodology, such as total quality management (TQM). Key factors in process excellence include a focus on the needs of the customer, making decisions based on data, using standardized procedures, empowering employees, and adapting to market changes. Although cost cutting is important, it can lead to short-

Question 23

23. The business concept of “planned obsolescence” is utilized in the field of technology primarily to:

A. Ensure organizations modernize.
B. Prevent loss of functionality.
C. Comply with regulatory requirements.
D. Ensure market demand continues.

Answer 23

D. Ensure market demand continues.

The business concept of “planned obsolescence” is utilized in the field of technology primarily to ensure market demand for products continues. Thus, after a period of time (usually a few years), products may be sunsetted, or phased out, so that they are no longer supported by the vendor. Because of this, healthcare organizations are almost constantly in a planning phase for acquiring new technology-hardware and/or software—in order to maintain functionality.

Question 24

24. During the phase of technical development, a constructive assessment of the cognitive aspects could evaluate the response to:

A. The effort needed to document in the EHR while interviewing a patient
B. The number of screens the user must access to transfer a patient
C. The number of mouse clicks needed to complete an activity
D. The eye strain from looking at a screen for prolonged periods

Answer 24

A. The effort needed to document in the EHR while interviewing a patient

During the phase of technical development, a constructive assessment of the cognitive aspects could evaluate the response to the effort needed to document in the EHR while interviewing a patient because the user’s attention must be focused in two different areas-the patient and the computer terminal. Ergonomic aspects include direct dialog with the sys-tem, the number of screens that must be accessed in order to carry out an activity, and the number

Question 25

25. If applying the theory of cognitive flexibility to interactive technology used for training end users, the informatics nurse should ensure: A. Simplification of content B. Transfer of knowledge C. Independent instructional sources D. Content is presented in multiple ways

Answer 25

D. Content is presented in multiple ways If applying the theory of cognitive flexibility to interactive technology used for training end users, the informatics nurse should ensure content is presented in multiple ways, such as through interactive computerized instruction and instructors who contribute and facilitate learning. This theory focuses on the individual's ability to construct knowledge. Information should be contextual and avoid oversimplification, and knowledge should be built rather than transferred. Instructional sources should be interconnected rather than independent.

Question 26

26. The type of information system report that contains data about the system, hardware, software, workstations, and servers is: A. Informational B. Error/exception C. Baseline D. Configuration

Answer 26

D. Configuration A configuration report contains data about the system, hardware, software, workstations, and servers. Because system information is stored in various areas, a utility is utilized to automatically generate a configuration report. An informational report includes data derived from databases. An error/exception report is issued for faults or abnormal data results. A baseline report (usually generated automatically) shows how the system or parts of the system compare

Question 27

27. When conducting a usability study to compare new practice with older practice, an essential component is: A. Asking users to assign usability ratings B. Focusing on one aspect of use C. Administering questionnaires to assess satisfaction D. Determining measures of equivalency

Answer 27

D. Determining measures of equivalency Steps to conducting usability studies include: Defining purpose Evaluating constraints such as time, staff, and resources Refining components based on evaluation of human-computer interaction (HCI) framework, determining each component and to whom or what it applies, including choosing the most appropriate staff, determining the most important step in a process, determining measures of equivalency, and choosing the setting Determining emphasis, which may focus on one or more aspects Selecting methods, which must match purpose and take account of constraints and HCI

Question 28

28. Passwords used to access patient data should be changed every: A. 7 to 14 days B. 30 to 60 days C. 90 to 120 days D. Year

Answer 28

B. 30 to 60 days Passwords used to access patient data should be changed every 30 to 60 days. More frequent changes make it hard for people to remember their passwords, so they are more likely to write them down, increasing the risk of security breaches. Strong passwords should be required because they are more difficult to break than dictionary words. Strong passwords include combinations of letters (capital and lower case), numbers, and symbols/signs, such as the ampersand (&).

Question 29

29. According to the ANA, Informatics Nurse Specialist Standards of Professional Performance include: A. Identification of alternatives B. Performance appraisal C. Implementation of solutions D. Identification of issues

Answer 29

B. Performance appraisal In 2008, the ANA revised The Scope and Standards of Nursing Informatics Practice, which includes standards of professional performance and standards of practice. Informatics Nurse Specialist Standards of Professional Performance include (I) quality of practice, (II) performance appraisal, (III) education, (IV) collegiality, (V) ethics, (VI) collaboration, (VII) research, (VIII) resource utilization, and (IX) communication. Informatics Nurse Specialist Standards of Practice include (1) Identify the issue or problem, (II) identify alternative solutions, (III) choose and develop a solution, (IV) implement solutions, and (V) evaluate and adjust solution.

Question 30

30. A parallel port is usually used to connect a(n): A. External modem to a computer B. Plug-in devices, such as a digital camera, to a computer C. Digital video device to a computer D. Printer to a computer

Answer 30

D. Printer to a computer A parallel port is an interface that connects a printer to a computer (although it is being surpassed by the USB port or Bluetooth enabled printers). Serial ports connect a computer to an external modem. Universal serial bus (USB) ports are an industry standard that connects various types of plug-in devices to a computer, including keyboards, digital cameras, graphic tablets, and light pens. FireWire is an interface for fast connection often used to connect video devices.

Question 31

31. The majority of adult learning is: A. Self-directed B. Experiential C. Teacher-directed D. Transformative

Answer 31

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

Question 32

32. The Standards for Privacy of Individually Identifiable Health Information in support of HIPAA applies to: A. Healthcare providers only B. Health plans and healthcare providers only C. Healthcare providers, health plans, healthcare clearinghouses D. Healthcare providers and healthcare clearinghouses only

Answer 32

C. Healthcare providers, health plans, healthcare clearinghouses The Standards for Privacy of Individually Identifiable Health Information ("privacy rule") in support of HIPAA applies to healthcare providers, health plans, and healthcare clearinghouses. The privacy rule was issued by HHS in order to implement requirements of HIPAA and regards use and disclosure of protected health information (PHI). PHI includes the person's physical or mental health condition (past, present, future), provision of health care, and payment for provision of care (past, present, future). Restrictions do not apply to de-identified health information.

Question 33

33. In project management, the purpose of payback analysis is to determine: A. When benefits will exceed costs B. The overall costs of the project C. Long-term costs of maintenance D. The time value of money

Answer 33

A. When benefits will exceed costs Payback analysis is carried out to determine when the benefits that are accrued exceed the costs of the project, helping determine the potential return on investment and whether the project is viable. Payback analysis helps determine how long it will take to recoup costs and gives insight into risk assessment because a shorter payback period poses fewer risks than a longer one. Payback analysis can help project managers make decisions and assess the ability of an investment to generate income.

Question 34

34. An entity relationship diagram is used to show the relationship of: A. Personnel entities within an organization B. Entities within a database C. Patient care providers D. Components of a virtual private network

Answer 34

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

Question 35

35. When testing hardware and software in the "live" environment, the informatics nurse should include: A. Clearly identified "test" patients B. Anonymous "test" patients C. Individual monitoring of users D. Backup documentation in paper format

Answer 35

A. Clearly identified "test" patients When testing hardware and software in the "live" environment, the informatics nurse should include clearly identified patients. Both hardware and software must undergo testing before and after going live. When the system first goes live, a command center should be available to provide communication, exercise control, and coordinate all activities.

Question 36

36. When confidential patient data are contained on mobile devices, such as smartphones or PDAs, these devices should: A. Contain locking and tracking software B. Not leave a secure facility C. Be utilized by only one person D. Contain only de-identified health information

Answer 36

A. Contain locking and tracking software When confidential patient data are contained on mobile devices, such as smartphones or PDAs, these devices should contain locking and tracking software so that the data cannot be accessed, and the device can be located. Some software is also available that allows distance deletion of data if the device is misplaced or stolen.

Question 37

37. Role-based access refers to: A. Limits on abilities to access or input data B. The categories of staff who can access the EHR C. Types of equipment that can be installed as components D. Hardware versus software applications

Answer 37

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

Question 38

38. If an internal audit identifies a Medicare overpayment resulting from incorrect coding, the healthcare organization must notify CMS within: A. 15 days B. 30 days C. 45 days D. 60 days

Answer 38

D. 60 days CMS must be notified within 60 days of identification of overpayment, and the overpayment must be reimbursed. The Medicare Administrative Contractor sends a demand letter for overpayments of $25 or more. The demand letter explains the reason for overpayment, interest that will accrue if the amount is not repaid in full within 30 days of receipt of the demand let-ter, options for extended repayment, and rights to rebuttal and appeal.

Question 39

39. The purpose of a system-wide impact analysis is to: A. Assess the microlevel details of an organization. B. Assess the need for resources associated with change. C. Determine the need for an organizational change. D. Assess the effects of an organizational change.

Answer 39

D. Assess the effects of an organizational change. System-wide impact analysis is carried out to assess the effects of an organizational change, especially negative effects or unexpected consequences. System-wide impact analysis may be done before a change to assess the potential problems or after a change has occurred. Additionally, routine system-wide impact analyses may be done as part of risk management. Systemwide impact analysis may be used to improve decision making, mitigate risks, enhance system reliability, optimize resource uti-lization, and improve stakeholder confidence.

Question 40

40. When displaying patient data for clinical decision-making, which type of display tends to slow cognitive processing of the data? A. Line graph B. Table C. Pictorial displays D. Multiple displays on one screen

Answer 40

D. Multiple displays on one screen The effective display of patient data for clinical decision-making requires that information be rapidly available with minimal cognitive effort. Multiple displays on one screen are distracting and slow cognitive processing of data. The decision tree is a common presentation with potential options, consequences, and expected outcomes. Other types of presentations include tables, various types of graphs, and icons. In most cases, multiple modes of presentation of data provide the best information. Visual indicators, such as colors, may be used to highlight information, such as abnormal lab results, and pictorial displays can be effective.

Question 41

41. The purpose of an "acceptable use" policy is to: A. Inform staff what computer use is permitted. B. Prevent damage to hardware. C. Outline the life expectancy and depreciation of equipment. D. Explain the steps needed to retrieve information from an EHR.

Answer 41

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

Question 42

42. A primary difference between radiofrequency identification (RFID) and barcode is that RFID: A. Has greater read range B. Has lower read rate C. Is more labor intensive D. Can identify type but not unique characteristics

Answer 42

A. Has greater read range A primary difference between radiofrequency identification (RFID) and barcode is that RFID has greater read range. While the read range for barcode ranges from inches to a few feet, passive ultra-high frequency (UHF) RFID ranges up to 40 feet if readers are fixed or up to 20 feet if readers are handheld. Active RFID has a read range hundreds of feet. Active RFID tags are battery powered and emit a signal while passive RFID tags require activation by a reader.

Question 43

43. An experienced informatics nurse has volunteered as a mentor for new hires. The informatics nurse's primary responsibility is to: A. Supervise B. Educate C. Support D. Advise

Answer 43

C. Support C: The primary role of a mentor is to provide support to new hires through listening and encouraging. The role of mentor should not include direct supervision because the resulting power dynamic can prevent the new hire from expressing concerns or frustrations or asking for help. The mentor may give advice if asked; however, he or she should focus on helping the new hire understand the culture of the workplace. The duration of mentorship varies but often ranges from 2-6 months.

Question 44

44. The informatics nurse must design a user manual for software applications. The first step in developing the manual is to: A. Take screenshots and organize data. B. Create an outline of the user manual. C. Assess gaps in knowledge. D. Define the audience or the user manual.

Answer 44

D. Define the audience or the user manual. Defining the audience for a user manual is especially important because it will be of little help to the user if it is written in the wrong tone or if it is too technical or too simplified. Once the audience is defined, the informatics nurse can begin to develop a general outline of the topics and the order of the material that needs to be covered. As the manual develops, screen-shots, illustrations, and diagrams should be added to help users understand what needs to be done. When a rough draft is com-pleted, the informatics nurse should ask for feedback from selected users before publishing and sharing the manual.

Question 45

45. In terms of communication devices for networks, a hub: A. Brings network data together B. Connects networks at the data link level C. Determines data's destination D. Sends data to the correct destination

Answer 45

A. Brings network data together A hub serves as a connecting device and brings network data together. For example, a typical configuration is a hub connecting workstations, printers, and a server. A bridge connects networks at the data link level. A router determines data's desti-nation. Another communication device is a gateway, which is utilized to connect different networks operating under different protocols. A switch, which may comprise a router or a gateway, sends data to the correct destination.

Question 46

46. The database management system (DBMS) best suited to handle a variety of data types, which include graphic: audio, and video files, is A. Object-oriented DBMS B. Network DBMS C. Relational DBMS D. Hierarchical DBMS

Answer 46

A. Object-oriented DBMS The database management system (DBMS) (software utilized to manage databases) best suited to handle a variety of data types, which include graphics, audio, and video files, is object-oriented DBMS. While expensive, object-oriented DBMSs have superior multi-media functionality. The choice of DBMS depends on the type of database.

Question 47

47. When determining the burden of proof for acts of negligence risk management would classify wilfuly providing inadequate care while disregarding the safety and security of others as. A. Negligent conduct B. Gross negligence C. Contributory negligence D. Comparative negligence

Answer 47

B. Gross negligence Negligence indicates that proper care has not been provided, based on established standards. Reasonable care uses rationale for decision-making in relation to providing care. Types of negligence: • Negligent conduct indicates that an individual failed to provide reasonable care or to protect/assist another, based on standards and expertise. • Contributory negligence involves the injured party contributing to their own harm. Comparative negligence attempts to determine what percentage amount of negligence is attributed to each individual involved.

Question 48

48. With a digital communication system, information is represented using: A. Audio B. Text C. Binary digit D. Symbol

Answer 48

C. Binary digit Binary digits (i.e., bits) are used to represent information in a digital communication system. The binary digits, which are values of 0 or 1, encode different types of data, such as text, audio, and video. Information is transmitted along with control information to detect and correct errors so that transmitted information is accurate. Communication protocols, such as transmission control protocol and internet protocol, are used to ensure that different devices and systems have interoperability.

Question 49

49. An upgrade of the information system is scheduled, and it will require downtime. Immediately before beginning the downtime, it is critically important to: A. Backup data and verify data recovery procedures. B. Carry out routine maintenance procedures. C. Ensure the continued ability to input critical and noncritical data. D. schedule the employee training regarding the upgrade

Answer 49

A. Backup data and verify data recovery procedures. When a system upgrade is scheduled and will require downtime, immediately before beginning the downtime, data should be backed up and data recovery procedures should be verified in the event that something goes wrong with the update and data is lost. Planning should begin well in advance of the downtime, and it should be scheduled when patient activity is low -for example, at night or on weekends. Staff should be notified and prepared for any alternate procedures that will be necessary during the downtime. The upgrade should be tested in a small isolated environment before applying it to the entire sys-

Question 50

50. A disadvantage of a freestanding personal health record (PHR) is that: A. Only the patient enters information. B. Only the doctor enters information. C. It is difficult to access. D. The information cannot be altered.

Answer 50

A. Only the patient enters information. A disadvantage of a freestanding personal health record (PHR) is that only the patient enters information, so the information may not always be accurate. Freestanding PHRs are sometimes offered to patients by insurance companies, physicians, or local hospitals. A PHR linked to the patient's EHR at the hospital allows the provider to view not only the information the patient has entered into the PHR but also the EHR. In some cases, a PHR may be linked to several EHRs so that the patient and multiple healthcare providers can access the information.

Question 51

51. According to Maslow's Hierarchy of Needs, a nurse who is fearful of new technology and is experiencing anxiety about losing employment because of this is probably acting to fulfill: A. Belonging needs B. Esteem needs C. Physiological needs D. Safety/security needs

Answer 51

D. Safety/security needs According to Maslow's Hierarchy of Needs, a nurse who is fearful of new technology and is experiencing anxiety about losing employment because of this is probably acting to fulfill safety/security needs because loss of employment may pose a real threat to the person's way of life. Until the nurse feels safe and secure, these issues may be expressed in hostility and/or lack of cooperation as defense mechanisms. Some may overcompensate by trying to work extra hard to overshadow their technical deficits.

Question 52

52. If the informatics nurse is considering driving and restraining factors in relation to proposed changes, this is based on the theory of: A. Force field analysis B. PESTEL analysis C. Stakeholder analysis D. SWOT analysis.

Answer 52

A. Force field analysis 52. A: Force field analysis (Lewin) is used to analyze factors that drive and restrain certain changes: Driving forces: forces responsible for instigating and promoting change, such as leaders, incentives, and competition Restraining forces: forces that resist change, such as poor attitudes, hostility, inadequate equipment, or insufficient Steps to using force field analysis include (1) list the proposed change, (2) create two subgroups (of the driving and restraining forces), (3) brainstorm and then list the driving and restraining forces, (4) discuss the value of the change, and (5) develop a plan to eliminate or diminish the restraining forces.

Question 53

53. The correct elbow angle for a person when sitting in a chair and using a computer keyboard is: A. 45 degrees B. 60 degrees C. 90 degrees D. 120 degrees

Answer 53

C. 90 degrees When a person is sitting and working at a computer, the elbows should be bent at a 90-degree angle and wrists held straight. The seat of the chair should be adjusted so that the person's feet are flat on the floor (or on a foot stool if the person is short) with the knees also bent at a 90-degree angle. The chair should provide support in the lower back, and the angle of the back of the chair to the seat should be 90 degrees.

Question 54

54. Which of the following is an example of a qualitative approach to obtaining user feedback about a computer information system? A. Obtaining error rates from the database B. Surveying with a ranking scale C. Obtaining usage rates from the database D. Conducting a one-on-one interview

Answer 54

D Conducting a one-on-one interview A one-on-one interview is an example of a qualitative approach to obtaining user feedback about a computer information system. Qualitative data are narrative rather than numerical (quantitative) although some quantitative approaches may be applied to qualitative data. Qualitative feedback is utilized to determine the users' perceptions of the information system and to help provide cause. For example, if quantitative data show increased documentation errors, qualitative research may be able to help ascertain the reason.

Question 55

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

Answer 55

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

Question 56

56. The first step in establishing accountability among team members is to: A. Outline clearly defined roles and responsibilities. B. Ensure that all team members understand the team goals and objectives. C. Set a clear timeline and deadlines for tasks. D. Provide ongoing constructive feedback.

Answer 56

A. Outline clearly defined roles and responsibilities. A team leader must outline clearly defined roles and responsibilities for all team members so that the members understand exactly what they need to do, and accountability is established at the beginning of the team process. All members should understand the goals and objective as well as the timelines and deadlines for tasks. The leader's role is to provide ongoing constructive feedback regarding accountability. Mutual respect and collaboration are essential to ensuring that team members carry out their responsibilities.

Question 57

57. The most common reason for staff developing workarounds for aspects of technical implementation in an EHR A. Inadequate training of staff B. Staff resistance to use of the EHR C. System design not congruent with work processes D. Errors in the system design

Answer 57

C. System design not congruent with work processes The most common reason for staff developing workarounds for aspects of technical implementation in an EHR is the system is not congruent with the workflow

Question 58

58. The purpose of the Network Interface Card is to connect: A peripheral device to a computer B. A modem to a computer C. computer to a network D. Multiple networks

Answer 58

C. computer to a network The purpose of the Network Interface Card (NIC) (also known as network interface controller or LAN adapter), which is installed or built into the motherboard of a computer, is to allow the computer (and its modem) to connect to a network. NICs may be configured for a specific type of network or may allow access to multiple net-works. Networks within a hospital, usually local area networks (LANs), may be open to the internet or closed.

Question 59

59. Which type of application software is an encoding program? A. Productivity B. Specialty C. Education and reference D. Entertainment

Answer 59

B. Specialty An encoding program is an example of a specialty software designed for a specific type of business or indus-try. Productivity software includes applications for word processing, accounting, database management, and most office and home applications. Education and reference software includes such things as encyclopedias and library search programs, such as Medline. Entertainment software includes all different types of gaming, audio, and video applications.

Question 60

60. In most organizations, the primary ethical dilemma is balancing: A. Treatment with right to death with dignity B. Nurse competency with patient need C. Confidentiality with need-to-know D. Provision of care with cost-effectiveness

Answer 60

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

Question 61

61. If data stored in one provider's cloud service must be moved back to the organization's site and unmodified before the data can be transmitted to another cloud service, this is an example of data: a. Lock-in b. Corruption c. De-identification d. Retrieval

Answer 61

a. Lock-in If data stored in one provider's cloud service must be moved back to the organization's site and unmodified before the data can be transmitted to another cloud service, this is an example of data lock-in (AKA vendor lock-in). This lack of interoperability, which prevents easy transfer of information from one vendor to another, is a problem not only with cloud services but also with many EHRs. Data lock-in may occur because of the use of proprietary technology, inadequate contractual agreements, or inadequate processes.

Question 62

62. Considering cloud architecture, if software applications are hosted by the vendor and then distributed to the organization via the internet, this model is referred to as: a. Platform as a service (PaaS) b. Infrastructure as a service (laaS) c. Software as a service (SAS) d. Storage as a service (SAS)

Answer 62

c. Software as a service (SAS) Considering cloud architecture, if software applications are hosted by the vendor and then distributed to the organization via the internet, this model is referred to as software as a service (SAS). (The SAS designation can be confusing because it can also refer to storage or security as a service.) With infrastructure as a service, the vendor hosts not only the software applications but also hardware, servers, and storage. With platform as a service, the vendor provides hardware and software tools needed for running or developing applications.

Question 63

63. From the clinical nurse's perspective, NANDA-I is generally found to be most useful for: a. Planning care of patients b. Ensuring appropriate outcomes c. Retrieving information about disease d. Providing appropriate interventions

Answer 63

a. Planning care of patients According to research, from the clinical nurse's perspective, NANDA-I (North American Nursing Diagnosis Association International) is generally found to be most useful for planning care of patients. NANDA-I is a terminology that allows nurses to identify and classify patient problems in terms of nursing diagnoses. Utilizing this information to generate appropriate interventions and to ensure appropriate outcomes are other uses, although retrieving information is found to be less useful because many EHRs do not allow this type of information retrieval.

Question 64

64. Before conducting a clinical information system (CIS) needs assessment, the informatics nurse should complete a(n): a. Financial status review b. End-user survey c. Project plan d. Planning budget

Answer 64

a. Financial status review Before conducting a clinical information system (CIS) needs assessment, the informatics nurse should complete a financial status review, including the current information system budget and analysis of cash flow to determine if the organization has the financial means to obtain a clinical information system. Policies, controls, and infrastructure needs should be considered as well. An assessment of computer literacy and needs for training may also be done as part of preliminary planning.

Question 65

65. In Claude Shannon's information theory, channel capacity is: A. The ratio between the magnitude of a signal and that of interfering "noise" B. The amount of energy, code or bits, required to communicate or store one symbol in the communication process C. The determining factor in the amount of information that can be transmitted with the smallest rate of error D. The ability to encode a message utilizing code or bits

Answer 65

c. The determining factor in the amount of information that can be transmitted with the smallest rate of error Channel capacity determines the amount of information that can be transmitted with the smallest rate of error. Signal-to-noise (S/N) indicates the ratio between a signal's magnitude and the magnitude interfering "noise". Entropy refers to the amount of energy, code or bits, required to communicate or store one symbol in the communication process. The lower the entropy, the more efficient the process of communication. The information theory (Shannon) identified three steps in communication: encoding, transmitting, and decoding.

Question 66

66. A "warm" site is a site: A. With patient data that can be activated within 8 hours B. With a database that has become corrupted C. With patient data that has experienced a security breach D. Where paper patient records are stored

Answer 66

A. With patient data that can be activated within 8 hours A "warm" site is a site with patient data that can be activated within 8 hours. This backup system should be capable of running the EHR if the home system fails. This warm site should be located at a distance as part of disaster planning, such as system failure that may result from natural events, such as hurricane, tornado, and flooding, as well as terrorist attacks. The location should be more than 50 miles away and more than 20 miles from the coast to lessen the chance that the same disaster would strike both facilities.

Question 67

67. Which one of the following clinical processes involves the revenue cycle? A. Insurance verification and authorization B. Organizational financial strategies C. Facilities management and operation D. Administrative processes

Answer 67

A. Insurance verification and authorization Insurance verification and authorization involve the revenue cycle because they ensure that services provided to patients are covered and will be reimbursed. Other clinical processes that involve the revenue cycle include patient registration, scheduling of procedures, accurate and timely documentation, submission of claims, and management of claims denials. Almost all aspects of care can affect the revenue cycle. Organizational financial strategies, facilities management and operation, and administrative processes may also affect the revenue cycle, but they are not clinical processes.

Question 68

68. Downtime drills should be carried out at the organization at least: A. Monthly B. Biannually C. Annually D. Biennially

Answer 68

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

Question 69

69. When evaluating staff members' readiness to learn in preparation for training, the factors to consider include physical factors, knowledge and education, psychological and emotional status, and which of the following? A. Financial security B. Professional experience C. Intellectual investment D. Self-determination

Answer 69

B. Professional experience When evaluating staff members' readiness to learn in preparation for training, the four factors to consider include (1) physical factors (ability to see and hear, physical abilities and impairments, manual dexterity, pain), (2) knowledge and education (general, cognitive ability, topic-specific knowledge, general literacy, health literacy), (3) psychological and emotional status (stress, confidence, anxiety, depression, ability to cope with stress), and (4) experience (various life factors, such as cultural background, work history, and personal experiences as well as previous experience with learning).

Question 70

70. An input activity in an information system is: A. Performance monitoring B. Display C. Validation D. Visualization

Answer 70

C. Validation Information systems manage and process data into a useful form that can be used for decision making. Information system activities include: • Input: Data entry, data acquisition, validation (i.e., ensuring accurate data and format), and transformation into a usable format. • Processing: Use data to make calculations, comparisons, and selections. • Output: Display information, print, export data, communicate, visualize data (e.g., with charts or graphs), and report. • Storage: Hard disk or cloud. • Controlling: Monitor the performance of the system.

Question 71

71. When decommissioning a computer information system (CIS), one of the purposes of the Records Management Plan (RMP) is to: A. Ensure disposition of data corresponds to federal/state regulations. B. Identify activities/tasks associated with shutdown of the system. C. Identify components of the budget that must be transitioned. D. Identify contractual obligations in relation to termination.

Answer 71

A. Ensure disposition of data corresponds to federal/state regulations. When decommissioning a computer information system (CIS), one of the purposes of the Records Management Plan (RMP) is to ensure disposition of data corresponds to federal/state regulations so that data are retained or disposed of correctly. All stored data must be evaluated and disposition determined and outlined in a plan that includes policies and procedures. Intellectual property rights should be evaluated to determine if these rights will affect disposition of data.

Question 72

72. If a personal health record (PHR) is web-based and tied to one specific system and EHR, the PHR is classified as: A. Non-tethered B. Personal files C. Tethered D. Networked

Answer 72

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

Question 73

73. When changes have been made to a computer system, such as updates to the soft-ware, it is most important to conduct: A. Usability testing B. Load testing C. Scalability testing D. Regression testing

Answer 73

D. Regression testing When changes have been made to a computer system, such as updates to the software, it is most important to conduct regression testing to ensure that errors in the new code do not interfere with functioning. Regression testing is done to ensure that functions available in the older version of the software are still viable with the new version. A series of test cases (also known as test bucket) are run utilizing the new version of the software and then evaluated to ensure that the new program performed correctly.

Question 74

74. The help desk for computer problems should: A. Notify the informatics nurse of all calls and requests. B. Keep records of all calls and requests. C. Make recommendations regarding informatics. D. Ask the informatics nurse for guidance.

Answer 74

B. Keep records of all calls and requests. The help desk for computer problems should keep records of all calls and requests so that the informatics nurse can review them to determine if a pattern emerges, such as similar repair issues or an increase in problems. The informatics nurse should advise on the use of a standardized request form that can be filled out online, which can help track and quantify issues of con-cern. The informatics nurse should interview help desk staff and end users for their input in order to make recommendations.

Question 75

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

Answer 75

D. Two years Under CMS regulations, a healthcare organization must fulfill Meaningful Use criteria for 2 years at one stage before moving on to the next stage, although the criteria actually only has to be verified for a 90-day reporting period during the first year. For example, for stage 1, Meaningful Use requires that eligible professionals and eligible hospitals meet 13 core objectives and 10 additional objectives. Stage 1 focuses on implementation of the EHR with CPOE and CDS.

Question 76

76. When utilizing force field analysis (Lewin) to analyze proposed change, a driving force would be: A. Outdated equipment B. Financial instability C. Incentives D. Resistance

Answer 76

C. Incentives When utilizing force field analysis (Lewin) to analyze proposed change, a driving force would be incentives. Lewin proposed that change is accompanied by driving forces (promoting change) and restraining forces (interfering with change). Restraining forces include outdated equipment, resistance, and financial instability because these issues must commonly be dealt with in order to proceed with change. Steps to force field analysis include listing proposed change, brainstorming opposing (driving and restraining) forces, and developing a plan to deal with restraining forces.

Question 77

77. A primary advantage of tiered archival storage is: A. Cost effectiveness B. Faster access C. Decreased management needs D. Compliance with the FDA approval process for image storage

Answer 77

A. Cost effectiveness A primary advantage of tiered archival storage is cost effectiveness. With tiered storage, different storage devices are used for different data with data most important to an organization stored on faster equipment and older or less important data stored on slower and less expensive equipment. Software programs are used to automate movement of data from one tier to another or to remove data, such as when federal or state regulations no longer require storage of the data.

Question 78

78. Biometric authentication of employees requires a device that recognizes: A. Barcodes B. Security token C. Fingerprint, retina, or facial patterns D. Smart card

Answer 78

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

Question 79

79. HL7 CDA is a standard utilized for: A. Document exchange B. Security provisions C. Data mining D. Data warehousing

Answer 79

A. Document exchange HL7 CDA (Clinical Document Architecture) is a standard utilized for document exchange and is appropriate for any clinical document that might contain a signature, such as the discharge summary, prescriptions, and history and physical examination. HL7 CDA utilizes XML language, which allows for documents to be read by human beings (textual) or processed electronically (structured). However, use of HL7 CDA is not currently mandated in the United States, so its use is limited but expected to expand.

Question 80

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

Answer 80

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

Question 81

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

Answer 81

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

Question 82

82. Which of the following is the most currently relevant interface that provides the means for attachment of additional hardware devices, such as a scanner, to a computer? A. IDE B. SCSI C. USB D. SAS

Answer 82

C. USB 82. C: IDE (Integrated Drive Electronics Controller), also known as ATA, was the primary parallel interface for the hard drive, CD-ROM, and DVD drive first created in 1986, but has been replaced with more advanced Serial ATA (SATA). SCSI (Small Computer System Interface) was a parallel interface introduced in 1986 that provided the means for attachment of additional hardware devices, such as a scanner, to a computer. It was then replaced by Serial Attached SCSI (SAS) that allows controllers to link directly to up to 128 devices and functioned at a higher speed (3 Gb/s). While SAS is still used in some formats, most common and effective is the USB interface, first created in 1996, with updated versions released since. USB is economical and self-configuring, allowing for more universality and ease of use. It can be used with a wide variety of devices and is a standard in all modern computers.

Question 83

83. When system integration testing is planned to first test the higher-level components and then test the lower-level components, it is referred to as: A. Big bang B. Bottom ur C. Top down D. Stubs and drivers

Answer 83

C. Top down System integration testing is done to assess whether hardware and software applications can work together effectively. Types include the following: Big bang: All components of the system are tested at the same time. • Top down: Higher-level components are tested before lower-level components. • Bottom up: Lower-level components are tested before higher-level components. Stubs are simplified implementations of low-level components, and drivers are simplified implementations of high-level components. Stubs and drivers are sometimes used to test simulations of components that have not yet been integrated.

Question 84

84. When considering transitioning to cloud storage and assessing vendors, the most critical assessment relates to: A. Cost analysis B. Monitoring mechanisms C. Interoperability D. Regulatory compliance

Answer 84

D. Regulatory compliance When considering transitioning to cloud storage and assessing vendors, the most critical assessment relates to compliance with regulatory requirements because if the vendor cannot verify that the company meets HIPAA requirements and satisfies the Code of Federal Regulations Title 21, Part 11 (which provides regulations regarding electronic records and electronic sig-natures), then security of patient data may be inadequate. Other important considerations include cost analysis (including cost of implementation and ongoing costs), monitoring mecha-nisms, and interoperability.

Question 85

85. As part of the American Recovery and Reinvestment Act (ARRA), the Office of the National Coordinator for Health Information Technology (ONC) established 62 Regional Extension Centers (RECs). The purpose of the RECs is to: A. Assist healthcare organizations to adopt EHRs. B. Ensure compliance with Meaningful Use requirements. C. Monitor organizations that have implemented EHRs. D. Conduct research utilizing data mining of health records.

Answer 85

A. Assist healthcare organizations to adopt EHRs. As part of the American Recovery and Reinvestment Act (ARRA), the Office of the National Coordinator for Health Information Technology (ONC) established 62 Regional Extension Centers (RECs) in order to assist healthcare organizations to adopt EHRs. The REC assists healthcare providers to enroll in the REC program, implement an EHR, and achieve stage 1 of meaningful use. The REC assists in health IT training, selection of vendors, workflow redesign, privacy and security issues, and technical issues.

Question 86

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

Answer 86

A. Password and security token An example of two-factor authentication utilized for access to a system is a password and security token. Two-factor authentication requires use of two identifiers of different types. The three types include something that the person accessing knows, such as a user name or pass-word; something the person has or carries, such as a security token or ID badge; and something intrinsic to the person, such as a thumbprint or a retina scan.

Question 87

87. For a large healthcare organization with multiple satellite offices and clinics and many mobile devices, the best choice for help desk is probably a(n): A. Automated cloud-based hosted service B. In-house telephone request system C. In-house email request system D. In-house help desk with paper request forms

Answer 87

A. Automated cloud-based hosted service For a large healthcare organization with multiple satellite offices and clinics and many mobile devices, the best choice for help desk is probably an automated cloud-based hosted ser-vice. The advantage to an automated system is that help tickets are automatically generated to fit the request for service and sent to the appropriate person with requests ordered in accordance

Question 88

88. According to HIPAA's Breach Notification Rule, organizations must notify individuals of a breach of protected health information within: A. 14 days B. 21 days C. 30 days D. 60 days

Answer 88

D. 60 days According to HIPAA's Breach Notification Rule, individuals must be notified of a breach of protected health information within 60 days by First-Class Mail or email if the individual has agreed to electronic notices. If unable to reach 10 or more individuals, then a notice must be posted on the organization's website for a minimum of 90 days or a notice must be placed in a major print or broadcast media outlet, listing a toll-free number to call for further information about the breach.

Question 89

89. In the Foundation of Knowledge model, the element that interacts with all other elements is: A. Resources B. Feedback C. Time D. Input

Answer 89

B. Feedback In the Foundation of Knowledge model (Mastrian), the element that interacts with all other elements is feedback. The base of the model is random data, bits, bytes, and information. Out of this base, the four primary elements, expressed as transparent expanding cones of light, develop the following: knowledge acquisition, knowledge generation, knowledge dissemination, and knowledge processing. The model is dynamic and interacting, constantly evolving, with feedback critical to all of the elements of the model.

Question 90

90. According to Knowles theory of andragogy, adult learners are: A. Unmotivated B. Self-directed C. Deficient in knowledge D. Impractical

Answer 90

B. Self-directed According to Knowles theory of andragogy, adult learners are self-directed (needing little direction from an instructor), practical and goal-oriented (wanting to know the end goal), knowledgeable (having many years of varied experience to draw from), relevancy-oriented (needing to understand how education is to be used), and motivated (wanting to learn for the sake of achievement or to meet a goal). Adult learners like to be actively involved and are able to relate new information to that previously learned but need a clear understanding of how information will be applied and clear objectives.

Question 91

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

Answer 91

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

Question 92

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

Answer 92

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

Question 94

94. In Juran's four-step Quality Improvement Process (QIP), the quality trilogy that is necessary to manage for quality is: A. Goal setting, recognition, and corrective action B. Quality awareness, quality councils, and quality measurement C. Prevention, appraisal, and internal/external factors D. Quality planning, quality control, and quality improvement

Answer 94

D. Quality planning, quality control, and quality improvement In Juran's four-step (defining, diagnosing, remediating, and holding) Quality Improvement Process (QIP), the quality trilogy that is necessary to manage for quality comprises three parts: • Quality planning: Identifying and assessing needs of internal and external customers, determining how to meet those needs, and designing the processes needed to do so. • Quality control: Choosing controls and measures, interpreting results, and taking corrective action. • Quality improvement: Identifying needs, organizing, assessing for problems and causes, and providing solutions.

Question 95

95. According to Tuckman's group development stages, during which stage is there a divergence of opinions related to management, power, and authority? A.Forming B. Storming C. Norming D. Performing

Answer 95

B. Storming Tuckman's group development stages: Forming: The group leader takes an active role, lists goals and rules, and encourages communication. • Storming: There is a divergence of opinions related to management, power, and authority and increased stress and resistance. • Norming: The group becomes attached, and members express positive feelings. • Performing: The leader's input decreases. • Mourning: Members feel sad at discontinuation or at the loss of the leader or team mem-bers.

Question 96

96. If the informatics nurse provides computers and a test version of software for staff nurses to use during training, this would be classified as: A. Low fidelity simulation B. High fidelity simulation C. Virtual reality D. Modeling

Answer 96

B. High fidelity simulation High fidelity simulation involves use of actual target equipment such as computers and test software as part of training so that the users have a realistic training experience. High fidelity simulations usually provide the best learning experience but are the most expensive because of equipment costs. To reduce costs, the test software may be placed on computers that also use a live version of the software and are utilized for patient care. However, the test software and user interface must be easily identifiable and distinguishable from the live version.

Question 97

97. In project management, the purpose of the work breakdown structure is to: A. Determine the time needed for each phase of the project. B. Determine the costs associated with each phase of the project. C. Determine the goal/product to be completed in each phase of the project. D. Determine the manpower needed to complete each phase of the project.

Answer 97

C. Determine the goal/product to be completed in each phase of the project 97. C: In project management, the purpose of the work breakdown structure is to determine the goal/product to be completed in each phase of the project. The goal/product must be approved at the end of the phase, and then the team moves on to the next phase. Projects vary somewhat, but they are temporary by nature and time-limited, so the phases should be carefully planned so that every phase is completed by the target completion date.

Question 98

98. As a project manager, the informatics nurse may use a swim lane diagram (Rumm-ler-Brache) to show: A. Processes and individual/departmental responsibilities B. Costs associated with each phase of a project C. The timeframes for different phases of the project D. The project manager's personal responsibilities during the project

Answer 98

A. Processes and individual/departmental responsibilities As a project manager, the informatics nurse may use a swim lane diagram (Rummler-Brache) to show the processes and individual/departmental responsibilities. The horizontal rows indicate individuals/departments and both horizontal and vertical lines and arrows are used to show the workflow separating tasks, which are named in rectangles on the horizontal planes. The diagram clearly indicates steps to the processes and responsible individuals. Before creating the swim lane diagram, it is necessary to determine the purpose and the process or processes to focus on.

Question 99

99. Which of the following represents the purpose of a functionality assessment of an information system? A. To determine if users are able to navigate the interface B. To determine if the system responds as intended C. To determine if the system complies with the work processes D. To determine if the system demonstrates adequate interoperability

Answer 99

C. To determine if the system complies with the work processes The purpose of a functionality assessment of an information system is to determine if the system complies with the work processes and if it supports the workflow of the users. If, for example, the system is unable to adequately handle a particular kind of data, this may jeopardize the entire system. Testing for functionality may include validating software through third parties as well as conducting integration tests and non-regression tests. All different functions should be tested.

Question 100

100. In an EHR, orderable items, such as radiology tests and medications, should be requested by: A. Conducting a free text search B. Browsing through an alphabetical listing C. Querying with a Boolean search D. Sending an interdepartmental message

Answer 100

B. Browsing through an alphabetical listing In an EHR, orderable items, such as radiology tests and medications, should be requested by browsing through an alphabetical listing. Queries and key word searches using free text should not be necessary. For medications, the listings should include both generic names and brand names, and various word orders should be used for treatments, such as "ultrasound, blad-der" or "bladder ultrasound." Users should be able to simply click on the item of choice to generate an order.

Question 101

101. According to Belbin's team role theory, which one of the following team roles is action oriented? A. Coordinator B. Resource investigator C. Specialist D. Shaper

Answer 101

D. Shaper Belbin's team role theory states that there are three categories of teams and nine team roles: • Action-oriented: implementer (turns ideas into action), shaper (pushes the team to achieve its goals), and completer/finisher (pays attention to detail, prevents errors) • Thought-oriented: monitor/evaluator (makes decisions based on facts and figures), plants (generate unconventional ideas), and specialist (provides expert knowledge) • People-oriented: resource investigator (connects team to outside resources), teamworker (maintains harmony), and coordinator (sets objectives, delegates, and resolves conflicts)

Question 102

102. The primary focus of Weiner's attribution theory is on: A. Identifying belief systems B. Communicating C. Learning D. Explaining behavior

Answer 102

D. Explaining behavior The primary focus of Weiner's attribution theory is on explaining behavior. Weiner believed that people attribute cause for behavior on (1) observing behavior, (2) judging that the behavior was intentional, and (3) attributing the cause for the behavior on internal or external causes. Weiner attributed achievement to individual effort, ability, task difficulty, and luck (good or bad). Weiner further classified attributions according to three factors: locus of control, stability of behavioral causes, and ability to control causes.

Question 103

103. When managing a project, the most resources are typically allocated to: A. Planning B. Executing C. Monitoring D. Closing

Answer 103

B. Executing Projects typically comprise a number of process groups: • Initiating: identifying key stakeholders and doing initial planning Planning: developing a team, preparing schedules, planning a budget, prioritizing, and creating the Gantt chart • Executing (the most resource intensive): carrying out the work of the project, doing sur-veys, designing, constructing, promoting, and implementing • Monitoring: producing progress reports • Closing: presenting the final project, preparing a report

Question 104

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

Answer 104

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

Question 105

105. Alerts that restrict or limit clinical practice, such as hard stops or alerts that cannot be overridden, should be developed for an EHR with: A. Informatics nurses B. External experts C. Administration D. Clinicians

Answer 105

D. Clinicians Alerts that restrict or limit clinical practice, such as hard stops or alerts that cannot be overridden, should be developed for an EHR with clinicians who will be using the system because they are in the best position to determine what is necessary and appropriate for their clinical environment. It's important to avoid including elements into an EHR that result in workarounds, as this may increase risk to patients and result in inaccurate outcomes data.

Question 106

106. The primary purpose of system integration testing is to determine: A. Whether hardware and software can adequately function together B . Whether wrappers need to be applied to software C. Whether existing hardware needs to be replaced D. Whether the software is adequate for current needs

Answer 106

A. Whether hardware and software can adequately function together The primary purpose of system integration testing is to determine whether hardware and software can function together adequately. Unit testing is done before system integration testing and system integration testing is followed by system testing and acceptance testing. System integration testing is a type of black box testing (functional testing done to determine if an input results in the correct output) and is conducted to identify problems within the component parts of a system or with the system itself. System integration testing should evaluate load, volume, and usability, and may utilize test cases and test data.

Question 107

107. Intrusion detection systems and encryption are mitigating factors in: A. Physical threats B. Cybersecurity threats C. Human threats D. Biological threats

Answer 107

B. Cybersecurity threats Cybersecurity threats related to the security of patient data and information systems include data breaches, ransomware, phishing, insider threats, medical device vulnerabilities, internet of things vulnerabilities, distributed denial-of-service attacks, supply chain attacks, social engineering attacks, and zero-day exploits. In order to mitigate these threats, the healthcare organization must carry out ongoing risk assessment, use intrusion detection systems and encryption, conduct routine safety audits, use email filtering systems and multifactor authenti-cation, and assess third-party security.

Question 108

108. HIPAA and the HITECH Act require that clinical data that is to be transmitted over the internet must first be: A. Encrypted B. Compressed C. Cleaned D. De-identified

Answer 108

A. Encrypted The HIPAA and HITECH Acts require that clinical data that is to be transmitted over the internet must first be encrypted in order to protect confidentially and protected health information (PHI). Because patient health records often contain not only health information but also other identifying information, such as address, telephone number, birthdate, social security number and sometimes even credit card numbers, patients may be very vulnerable if data are obtained and misused.

Question 109

109. As part of promoting a safety culture in a healthcare organization, management has established a just culture to help identify areas of risk and to reduce errors. Under just culture guidelines, if a nurse fails to wear safety goggles because they are uncomfortable and then sustains a mild eye injury, an appropriate response would be to: A. Console the individual and provide support. B. Coach and educate the individual. C. Take punitive action against the individual. D. Carry out a root cause analysis.

Answer 109

B. Coach and educate the individual. A just culture considers the need to change the system rather than the individual and differentiates among the following: Human error: Inadvertent actions, mistakes, or lapses in proper procedure (e.g., wrong medication/dosage/patient). Consider processes, procedures, training, and/or design to determine the cause of the error and console the person. At-risk behavior: Unjustified risk or choice (e.g., failure to wear appropriate personal protective equipment). Provide incentives for correct behavior and disincentives for incorrect behavior, and coach and educate the person. Reckless behavior: Conscious disregard for proper procedures (e.g., drunk on duty). Insti- tute remedial action and/or punitive action.

Question 110

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

Answer 110

B. Ensuring the links are to valid sources When developing an interactive website for a healthcare organization and including links to other sources of information, the most important consideration is ensuring that the links are to valid sources, such as government sites or healthcare organization sites. Fair use allows linking to another organization's home page without permission, but if deep linking (linking to content beyond the home page) or framing (importing information from another website into one's own), then the person linking or framing should ask permission because copyright laws are less clear about this type of linkage.

Question 111

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

Answer 111

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

Question 112

112. How many contact hours of continuing education must the informatics nurse complete to renew certification? A. 30 B. 45 C. 60 D. 75

Answer 112

D. 75 For renewal of American Nurses Credentialing Center certification, the informatics nurse must complete 75 contact hours of continuing education. At least 60 of these hours must be formally approved by an accredited provider. A course can only be counted one time even if taken multiple times (such as a cardiopulmonary resuscitation class). Academic courses that apply to informatics nursing may be converted to contact hours. One semester unit is equal to 15 contact hours, and one academic quarter credit is equal to 12.5 contact hours. Certification is good for five years.

Question 113

113. Peplau's theory of nursing stresses the importance of: A. The mechanisms people use to react to stress B. Serving patients and promoting self-care C. Collaboration between the nurse and patient D. Patient behavior, nursing response, and nursing actions

Answer 113

C. Collaboration between the nurse and patient Peplau's theory of nursing stresses the importance of collaboration between the nurse and patient. Peplau's interpersonal relations model of nursing (1952) focused on the relationship and interactions between the nurse and patient, stating that patients should be cared for by educated nurses who show them respect. The nurse is to serve as a "maturing force" to help the patient deal with illness as a maturing opportunity. The phases of the nurse-patient relationship include orientation, problem identification, explanation of possible solutions, and problem reso-lution.

Question 114

114. The most critical software on a computer is the: A. Operating system software B. Communication software C. Graphics software D. Data management software

Answer 114

A. Operating system software The most critical software on a computer is the operating system software because if the operating system is not functioning properly, nothing else will work. The operating system software loads first when a computer is turned on and manages both hardware and software applications. Software must be compatible with the type of operating system in order to func-tion. Operating systems include Apple Mac OS X, Unix, Microsoft Windows, and Linux.

Question 115

115. The standardized nursing terminology system that includes nursing diagnoses, out-comes, interventions, and actions is: A. NANDA B. OMAHA C. CCC D. NOC

Answer 115

C. CCC The standardized nursing terminology system that includes nursing diagnoses, outcomes, interventions, and actions is the Clinical Care Classification (CCC), which was initially developed to document home health care. CCC is used for documenting at point-of-care in all types of healthcare settings. CCC combines two terminologies, one for diagnoses and outcomes and the other for interventions and actions. CCC was the first national nursing terminology recognized by HHS and is accepted by the ANA.

Question 116

116. When designing a human-technology interface and considering usability, a focus group is most useful: A. Periodically through the design process B. Immediately after the system goes live C. Immediately before the system goes live D. At the beginning of the design process

Answer 116

D. At the beginning of the design process When designing a human-technology interface and considering usability, a focus group is most useful at the beginning of the design process. The focus group should be presented with

Question 117

117. In over-the-shoulder instruction, most instruction is per: A. Demonstration B. Group interaction C. Lecture D. Computer-assisted instruction (CAI)

Answer 117

D. Computer-assisted instruction (CAI) Over-the-shoulder instruction is a learner-centered strategy in which the instructor moves about the classroom monitoring the learner's progress rather than standing at the front of the classroom and lecturing or providing instructor-focused teaching. Most instruction is per computer-assisted instruction (CAI). This strategy allows for one-on-one instruction with individual learners as the instructor sees the need or the learner requests, and the instructor is better able to monitor individual progress. However, many learners may have the same questions, so the instructor may waste time answering the same questions multiple times to individual stu-dents.

Question 118

118. Data minimization refers to: A.Using data compression B. Limiting access to data C. Storing data offsite D. Collecting only necessary data

Answer 118

D. Collecting only necessary data Data minimization means to collect only as much data as is necessary for the intended purpose, in order to protect patients' privacy—an ethical concern. For example, forms and questionnaires should be designed to collect only essential personal information (i.e., privacy by design), and data should be deidentified when possible. Personal data should be secured, and informed consent should be obtained regarding the use of data. Data minimization is an element of data protection laws and regulations.

Question 119

119. A hospital survey of nurses and clinicians showed that 88% used their smartphones for some work-related activity, such as looking up information or texting patient infor-mation. The best solution is to: A. Prohibit all smartphones in the work environment. B. Develop an acceptable use policy for personal devices. C. Advise staff to avoid breaching patient confidentiality. D. Provide hospital-owned smartphones to all staff.

Answer 119

B. Develop an acceptable use policy for personal devices. Smartphones are ubiquitous, and trying to ban them from a hospital is not practical; how-ever, an acceptable use policy for personal devices should be developed with strict guidelines. Numerous informational applications (such as drug guides) are available for smartphones and these pose little risk, but texting a physician with a patient update may violate not only federal regulations but State Board of Nursing regulations. Most personal smartphones do not have adequate passwords or encryption or the ability to remotely destroy data if the phone is stolen or lost.

Question 120

120. Working standards are most often changed because of: A. Change in administrative focus B. Need to increase efficiency C. Need to improve safety measures D. Regulatory/accrediting requirements

Answer 120

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

Question 121

121. Considering ethical implications for data dissemination, data that contain ID codes that are linked to names, which are not divulged, would be classified as: A. De-identified B. Potentially identifiable C. Identifiable D. Anonymous

Answer 121

B. Potentially identifiable Considering ethical implications for data dissemination, data that contain ID codes that are linked to names, which are not divulged, would be classified as potentially identifiable because a data user could ostensibly obtain a list of codes and names to identify individuals. Anonymous data contain no identifying information whatsoever because none was collected. Identifiable data contain names and/or other identifying information. De-identified data has had identifying information removed.

Question 122

122. Computer competencies that are expected of an informatics nurse include: A. Diagnostic coding B. Preparing process flowcharts C. Developing computer programs D. Enabling data sharing

Answer 122

B. Preparing process flowcharts The informatics nurse is expected to have computer competencies in many areas, including preparing process flowcharts, conducting searches, and retrieving patient data. Additionally, the informatics nurse must be knowledgeable about the use of telecommunication devices and various types of information technologies, computers, and networks and should be able to develop new methods of interpreting data. The informatics nurse is not expected to carry out diagnostic coding, develop computer programs, or enable data sharing.

Question 123

123. Case management information systems focus on providing: A. Preventive care B. Access to patient data C. Management of healthcare D. Direct patient care

Answer 123

A. Preventive care Case management information systems focus on providing preventive care. Case management systems look at both current and historical case files and search for trends to which preventive measures can be applied. For example, if a patient has had repeated rehospitalization for nonadherence, the preventive plans may focus on educating the patient, providing home health supervision, or simplifying medication regimens. Case management information systems

Question 124

124. BI-RADS criteria are used to store: A. Radiology results B. Culture and sensitivity results C. ECG results D. Mammography results

Answer 124

D. Mammography results BI-RADS (Breast Imaging Reporting and Data System) criteria, developed by the American College of Radiology, are used to store and report mammography results so that the results are standardized. BI-RADS provides mammography assessment categories that range from 0 (in-conclusive) to 6 (proven malignancy with biopsy). BI-RADS also has categories for breast compo-sition: (a) fatty, (b) scattered density, (c) dense, and (d) extremely dense.

Question 125

125. Which of the following queries would pull up articles about wound care that involved the use of povidone-iodine without antibiotics? A. "wound" AND "povidone-iodine" B. "wound" NOT "antibiotics" C. "wound" AND "povidone-iodine" NOT "antibiotics" D. "wound" OR "povidone-iodine" OR "antibiotics"

Answer 125

C. "wound" AND "povidone-iodine" NOT "antibiotics" The query must include both wound and povidone-iodine and exclude antibiotic. This can be accomplished with the use of AND operator in conjunction with the NOT operator.

Question 126

126. Which of the following is an example of a disconnected token? A. Smart card B. Radio frequency identification (RFID) device C. Personal identification number (PIN) D. USB token

Answer 126

C. Personal identification number (PIN) A PIN is an example of a disconnected token because no additional equipment is required. Smart cards and USB tokens are connected tokens and an RFID device is contactless. Tokens are items used to authenticate a person's identity and allow access to a system. They commonly require the use of not only the token but also a PIN or user name and password Some devices, such as the SecurelD token by RSA generate one-time passwords (OTPs). Tokens may be in the form of access cards, which may utilize different technologies such as photos, optical coding, electric circuits, and magnetic strips.

Question 127

127. When using the EHR for data mining, it is essential to: A. Increase accessibility of the data. B. Deidentify the data. C. Rely solely on raw data. D. Input the data manually.

Answer 127

B. Deidentify the data. When carrying out data mining, the informatics nurse is using data that is protected by Health Insurance Portability and Accountability Act (1996) (HIPAA) regulations regarding privacy and confidentiality, making it imperative that the data be deidentified. The HIPAA Privacy Rule allows two forms of deidentification: • Expert determination: applying statistical or scientific principles • Safe harbor: removing 18 types of identifiers including names, geographic information, zip codes, telephone numbers, license numbers, account numbers, fax numbers, serial numbers of devices, email addresses, URLs, full-face photographs, dates (except the year), and biometric identifiers

Question 128

128. According to Peplau's Interpersonal Relations Model of nursing, the nurse-patient relationship goes through overlapping phases that include orientation, problem identi-fication, explanation of potential solutions, and: A. Problem evaluation B . Patient recovery C. Nurse-patient collaboration D. Problem resolution

Answer 128

D. Problem resolution According to Peplau's Interpersonal Relations Model of nursing, the nurse-patient relationship goes through overlapping phases that include orientation, problem identification, explanation of potential solutions, and problem resolution. Peplau believed that collaboration between the nurse and patient was especially important and that the nurse acts as a "maturing force" to help the patient. Peplau also stressed the importance of the patient being treated with dignity and respect and believed that a positive or negative environment could affect a patient accordingly.

Question 129

129. User-acceptance testing (UAT) should begin with: A. Designing the testing plan and test cases, considering risks and the skills of the end users B. Analyzing the basic requirements of the system and the organization C. Identifying the end-user acceptance scenarios D. Describing a testing plan, including different severity levels based on real-world condi-

Answer 129

B. Analyzing the basic requirements of the system and the organization User acceptance testing (UAT) is done to determine the end user's willingness to utilize computer technology and software in the way in which they are designed, and should begin with analyzing the basic requirements of the system and the organization. Subsequent steps include: • Identifying the end-user acceptance scenarios • Describing a testing plan, including different severity levels based on real-world conditions • Designing the testing plan and test cases, considering risks and the skills of the end users • Conducting the tests • Evaluating and recording results

Question 130

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

Answer 130

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

Question 131

131. The nursing theory that focuses on how people react to stress through mechanisms of defense and resistance is the: A. Total-Person Systems Model (Neuman) B. General Theory of Nursing (Orem) C. Science of Unitary Beings (Rogers) D. Nursing Process Theory (Orlando)

Answer 131

A. Total-Person Systems Model (Neuman) The nursing theory that focuses on how people react to stress through mechanisms of defense and resistance is the Total-Person Systems Model of Betty Neuman (1972). According to this theory, stressors may be intrapersonal, interpersonal, or extrapersonal, and the nurse carries out primary (preventive steps taken before reaction to stress), secondary (facilitation of the internal ability to resist and to remove the stressor), and tertiary interventions (supportive actions) to assist the patient to stabilize and to avoid negative effects resulting from stressors.

Question 132

132. In respect to patient data in a database, the most important factor is: A. Accessibility B. Relevance C. Transferability D. Security

Answer 132

D. Security In respect to patient data in a database, the most important factor is security, although accessibility, relevance, and transferability are also important factors. Unauthorized users must be blocked from gaining access to patients' records in order to protect confidentiality, but authorized users must be able to easily access those same records. Both physical security (preventing damage to or loss of equipment) and informational security (protecting the data) must be con-sidered. Data must be protected during storage and during transfer.

Question 133

133. Two megabytes of memory is sufficient to produce: A. One typewritten page of text B. One high resolution 5"x7" printed photograph C. One minute of high-fidelity sound D. One digital mammogram

Answer 133

B. One high resolution 5"x7" printed photograph 2 megabytes of memory are sufficient to produce 1 high resolution 5"x7" printed photograph while 2 kilobytes can produce a typewritten page of text, 10 megabytes can produce 1 minute of high-fidelity sound, and 50 megabytes can produce 1 digital mammogram.

Question 134

134. In Cognitive Work Analysis (CWA), the specific type of analysis that identifies the different responsibilities of various users so HCI can support collaboration is: A. Strategies analysis B. Social organizational analysis C. Worker competencies analysis D. Control task analysis

Answer 134

B. Social organizational analysis In Cognitive Work Analysis (CWA), the specific type of analysis that identifies the different responsibilities of various users so human-computer interaction can support collaboration is social organizational analysis. CWA was designed for complex environments in which staff members need some degree of flexibility. Strategies analysis evaluates the manner in which work is actually carried out by users. Worker competencies analysis considers design restraints associated with the users. Control task analysis considers the control structure with which the user must interact. Work domain analysis evaluates system functions and the information needed by users.

Question 135

135. When instituting an EHR, it's important to ensure that the system: A. Disallows any modifications B. Uses only proprietary hardware and software C. Utilizes a universal language D. Is a standalone system

Answer 135

C. Utilizes a universal language When instituting an EHR, it's important to ensure that the system utilizes a universal language so that it can interface with other systems and so that data can be shared from one system to another without corruption. Use of only proprietary hardware and software may impair interoperability and limit upgrades. All EHR system should allow some modifications to account for differences in workflow and changes in regulations, requirements, and information.

Question 136

136. If planning to use pilot implementation for conversion from paper documentation to EHR at an acute hospital, the best choice for the pilot program is: A. A standalone unit with minimal interaction with other units B. Multiple units in different parts of the hospital C. Units with extensive interaction with other units D. The smallest possible unit in terms of patient census

Answer 136

A. A standalone unit with minimal interaction with other units If planning to use pilot implementation for conversion from paper documentation to EHR at an acute hospital, the best choice for the pilot program is a standalone unit with minimal interaction with other units because units with extensive interactions will be unable to use some features of the EHR, such as importing or exporting data to other units that are not live. Pilot implementation requires ongoing evaluation and interviews with users to determine what problems may exist in the systems before full implementation. In some cases, those initially trained for the pilot implementation may be used to train others.

Question 137

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

Answer 137

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

Question 138

138. Leapfrog Safe Practices score is used as a basis for: A. Promoting evidence-based practice through funding of 14 Evidence-based Practice Centers (EPCs) B. Providing collaborative training within the network related to safe clinical practice C. Providing fellowships to help professionals gain experience and expertise in health-related fields D. Assessing the progress a healthcare organization is making on 30 safe practices

Answer 138

D. Assessing the progress a healthcare organization is making on 30 safe practices Leapfrog Safe Practices Score assesses the progress a healthcare organization is making on 30 safe practices that Leapfrog has identified as reducing the risk of harm to patients. Leapfrog is a consortium of healthcare purchasers/employers and has developed a number of initiatives to improve safety. Leapfrog provides an annual Hospital and Quality Safety Survey to assess progress, releases regional data, and encourages voluntary public reporting. Leapfrog has instituted the Leapfrog Hospital Recognition Program (LHRP) as a pay-for-performance program to reward organizations for showing improvement in key measures.

Question 139

139. Which of the following provides the core medical terminology used in recording clinical data in the EHR? A. RxNorm B. NDF-RT C. LOINC D. SNOMED CT

Answer 139

D. SNOMED CT SNOMED CT (Systemized Nomenclature of Medicine - Clinical Terms) provides the core medical terminology used in recording clinical data in the EHR. SNOMED CT (1999) was created from a merger and further development of two previous terminologies: SNOMED RT (Reference Terminology) by the College of American Pathologists and Clinical Terms Version 3 (CTV3) by the National Health Service of the UK. Property rights now rest with the International Health Terminology Standards Development Organization (IHDTSO), which promotes use of SNOMED CT internationally. Components of SNOMED CT include concepts (clinical meanings arranged hierarchically), descriptions (linking to concepts), and relationships (linking concepts).

Question 140

140. Which of the following is a primary advantage of using coded data instead of free text? A. Coded text allows for a fuller description. B. Coded text is more flexible. C. Coded text ensures consistent and standardized vocabulary. D. Coded text eliminates errors.

Answer 140

C. Coded text ensures consistent and standardized vocabulary. A primary advantage of coded data over free text is that coded data ensure consis-tent/standardized vocabulary. The coded entries allow improved capture for data mining with no loss of data, such as may occur with illegible or incomplete narrative documentation or lost paper documents. However, the limitations of the vocabulary may result in a less complete picture than free text narrative documentation. While systems generally allow the option of free text, this information is not coded, so this may affect data analysis.

Question 141

141. According to the Institute of Medicines Steep principle of redesigning healthcare, key factors Safe, Timely, Effective, Efficient, Equitable, and: A. Paper-free B. Patient-centered C. Participatory D. Predictable

Answer 141

B. Patient-centered According to the Institute of Medicine's STEEP principles for redesigning healthcare, principles include Safe, Timely, Effective, Efficient, Equitable, and Patient-centered. These recommendations were proposed in Crossing the Quality Chasm, the second IOM report, which outlined deficiencies in medical care in the United States. Crossing the Quality Chasm followed publication of the first report To Err is Human, which focused on the high numbers of Americans that die each year because of medical errors.

Question 142

142. Use of free text for documentation on the EHR can: A. Improve documentation. B. Provide inadequate documentation. C. Increase speed of documentation. D. Improve retrieval of outcomes data.

Answer 142

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

Question 143

143. A feature of high-level system design is: A. Detailing specifications of components B. Creating flow sheets to illustrate steps in data processing C. Planning for handling errors D. Allocating resources

Answer 143

B. Creating flow sheets to illustrate steps in data processing High-level system design (aka logical, or macrolevel, design) is used in the beginning of a project in order to develop a plan for a system that meets the requirements of an organization. High-level system design includes defining an overview of the system architecture, creating flow sheets to illustrate steps in data processing, and determining system-wide specifications and interactions. The informatics nurse must also consider performance issues, such as processing speed. Low-level design (aka physical design), on the other hand, focuses on physical details, such as detailed specifications of components and interfaces, plans for handling errors, allocation of resources, and security concerns.

Question 144

144. For archiving data, federal regulations require that clinical health records of living adults be maintained for at least: A. 2 years B. 6 years C. 10 years D. 14 years

Answer 144

B. 6 years For archiving data, both federal and state regulations (which sometimes require longer storage than federal regulations) may apply, and they may be different. Federal regulations per the HIPAA Privacy Rule require that clinical health records of living adults be maintained securely for at least 6 years, although records must be maintained for only 2 years after a patient's death. Records of infants born in a healthcare facility must be maintained until the child is 18 years old. The FDA requires that mammography records be stored for 10 years or until the time another mammogram is taken.

Question 145

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

Answer 145

C. Assessment, diagnosis, outcomes/planning, implementation, and evaluation According to the ANA, the steps to the nursing process include: • Assessment: Collecting and analyzing patient data, including physical as well as psychosocial and economic data. • Diagnosis: Nursing diagnosis based on the clinical judgment of the nurse. • Outcomes/Planning: Identifying expected outcomes and developing the plan of care. • Implementation: Acting on the plan of care and documenting provisions of care. • Evaluation: Determining the patient's status and effectiveness of the plan of care.

Question 146

146. The data representation method that can be used across multiple platforms to represent text for most languages, including Asian, is: A. Binary code B. Hexadecimal code C. Unicode Standard code D. Extended Binary Coded Decimal Interchange Code

Answer 146

C. Unicode Standard code The Unicode Standard coding scheme, used with the Universal Character Set (UCS), is a standardized coding system that has a larger capacity and can be used to represent text for most languages, including Asian languages. Coding is available to represent technical characters, punctuation, and mathematic symbols. Unicode provides a specific numeric value for each character and can be used across multiple platforms. Unicode comprises approximately 110,000 characters representing all alphabets in the world languages, ideographic sets, and symbols, as well as 100 scripts, and is particularly valuable for making coding accessible internationally. Unicode is utilized in many technologies and operating systems.

Question 147

147. Oversight and decision-making regarding changes in the CDS system should primarily lie with: A. Clinicians B. Administrators C. The board of directors D. Vendors

Answer 147

A. Clinicians Oversight and decision-making regarding changes in the clinical decision support system (CDSS) should primarily lie with clinicians, including physicians, nurses, and pharmacists, because they are in the position to understand the needs of the organization and the staff. Support from the board of directors and administration is essential in ensuring a culture of safety. Responsibilities should be clearly outlined and committee structures in place.

Question 148

148. The wireless technology standard that utilizes UHF radio waves (ISM band, 2.4-2.485 GHz) to transmit data from mobile devices is: A. IEEE 802.11a B. IEEE 801.16 C. HomeRF D. Bluetooth

Answer 148

D. Bluetooth The wireless technology standard that utilizes UHF radio waves (ISM band, 2.4-2.485 GHz) to transmit data from mobile devices is Bluetooth. Bluetooth transmission has a short range, from 3 feet (class one) to 33 feet (class 2) and 300 feet (class 3) with most devices in class 2. Bluetooth technology may be utilized with Bluetooth enabled devices to add external keyboards and to allow hands-free telephone communications. Other applications include head-phones, intercoms, wireless connection to a printer, and transfer of health data (such as cardiac monitoring) to a device, such as a cell phone.

Question 149

149. If developing a communication tree for emergencies, the most effective method of rapidly reaching employees is probably: A. Email B. Telephone call C. Instant message D. Social media

Answer 149

C. Instant message A communication tree is the hierarchical system used to notify staff during an emer-gency. Instant messaging is an effective method of rapidly reaching employees because almost everyone has a smart phone, people often do not read emails promptly, and telephone calls are time-intensive and may be unanswered. Additionally, an instant message can be directed to many people at one time and allows for rapid acknowledgement of receipt of the message so that administration can make plans based on the response.

Question 150

150. Which of the following is a CDS intervention that targets preventive care? A. A recommendation for immunization B. A list of possible diagnoses associated with patient symptoms C. Reminders for drug interactions D. An alert that prescribed medication is not in the formulary

Answer 150

A. A recommendation for immunization The CDS intervention that targets preventive care is a recommendation for immuniza-tion. Immunization recommendations may target all patients or specific types of patients. CDS may also provide a list of possible diagnoses associated with patient symptoms, reminders of drug interactions, alerts that a prescribed medication is not in the formulary (a cost reduction intervention), planning guides (such as treatment guidelines and drug alerts), and care plans and order sets (to improve efficiency).