Informatics/Evidence-Based Practice NCLEX

The nurse researcher is giving a presentation about the applications of geographic information system​ (GIS) technology. Which statement is appropriate for the nurse researcher to include in the​ presentation?
a
a. "GIS technology is used strictly within the healthcare system."

b. "GIS technology is not useful for tracking acute health problems."

c. "GIS technology can be used to plot and analyze lifestyle​ choices, such as improper nutrition."

d. "GIS technology is not dependent on satellite imaging or global positioning systems ​(GPSs)."
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The nurse researcher is giving a presentation about the applications of geographic information system​ (GIS) technology. Which statement is appropriate for the nurse researcher to include in the​ presentation?
a
a. "GIS technology is used strictly within the healthcare system."

b. "GIS technology is not useful for tracking acute health problems."

c. "GIS technology can be used to plot and analyze lifestyle​ choices, such as improper nutrition."

d. "GIS technology is not dependent on satellite imaging or global positioning systems ​(GPSs)."
c. "GIS technology can be used to plot and analyze lifestyle​ choices, such as improper nutrition."

Rationale
GIS technology has been used both inside and outside of health care. To capture geographical​ data, GIS relies on satellite imaging and global positioning systems​ (GPSs). The many uses of GIS technology include plotting and analyzing lifestyle​ choices, such as improper​ nutrition, and tracking acute health problems.
The nurse administrator is presenting an educational session about telehealth. Which item should be included when discussing the most significant potential​ barriers?

a. Healthcare provider licensure

b. Access to care

c. Cost of services

d. Healthcare quality
a. Healthcare provider licensure

Rationale
Benefits of telehealth include the potential to decrease​ costs, improve quality of​ care, and increase access to care for clients in​ rural, urban,​ community, and international settings. Barriers to telehealth include healthcare provider licensure​ restrictions, such as medical boards limiting telemedicine licenses that permit this practice across state lines.
The nurse informaticist is delivering a webinar about electronic medical records​ (EMRs). Which statement should be included in the​ webinar?

a. "EMRs are not useful in identifying the need for routine preventive maintenance."

b. "The EMR is also called the administrative information system."

c. "EMRs focus on diagnosis and treatment."

d. "Most EMRs are designed to be portable."
c. "EMRs focus on diagnosis and treatment."

Rationale
Electronic medical records​ (EMRs), which are similar to electronic​ charts, help track client data and identify when routine preventive health maintenance​ (such as vaccines or​ mammograms) is needed. EMRs focus is on diagnosis and treatment. Most EMRs are designed to stay within a clinical​ setting, so clients who are referred to other care providers may need printed versions of the EMR to take with them. An administrative information system provides support and management for the business aspects of health care.
The nurse informaticist is summarizing the function and findings of the Technology Informatics Guiding Educational Reform​ (TIGER) Summit for a group of staff nurses. Which statement should be included in the​ presentation?

a. "TIGER is developing plans to include informatics in all baccalaureate nursing programs."

b. "TIGER concluded that knowledge of informatics is important for certain healthcare professionals."

c. "TIGER was attended mainly by nurse administrators from major healthcare institutions."

d. "TIGER is examining ways to reach out to nurses who lack the informatics skills that are needed to practice."
d. "TIGER is examining ways to reach out to nurses who lack the informatics skills that are needed to practice."

Rationale
The 2006 Technology Informatics Guiding Educational Reform​ (TIGER) Summit was attended by nursing informatics leaders from major nursing organizations.​ TIGER's findings included that knowledge of informatics is mandatory for all healthcare professionals. TIGER is developing plans to include informatics courses in all levels of nursing education. TIGER is also examining the best ways to reach out to nurses who lack skills needed to practice in a healthcare environment that is becoming increasingly more interactive and reliant on technology systems.
The nursing student is designing a poster that outlines strategies through which informatics can address the increasing national problem with prescription opioid addiction and overdose. Which strategy should be included on the​ poster?

a. Linking computerized written orders with client electronic health records to identify and monitor healthcare providers who prescribe opioids

b. Increasing efforts to enhance electronic tracking of opioid prescriptions at the community level

c. Improving the ability to identify individuals who engage in "doctor shopping" to obtain narcotics for abuse or illegal sale

d. Monitoring data to identify clients who sell opioids and their buyers
c. Improving the ability to identify individuals who engage in "doctor shopping" to obtain narcotics for abuse or illegal sale

Rationale
Strategies through which informatics can address the increasing national problem with prescription opioid addiction and overdose include increasing efforts to enhance electronic tracking of opioid prescriptions at the state​ level; linking computerized written orders with client electronic health records regionally and​ nationally, to identify and monitor individuals who are at risk for opioid​ abuse, and potentially to decrease the prevalence of opioid misuse and​ overdose; improving the ability to identify individuals who engage in "doctor shopping" to obtain narcotics for abuse or illegal​ sale; and identifying healthcare providers who write bogus opioid prescriptions in exchange for payment from sellers.
The staff nurse is planning an educational session about computer systems and infection control. Which item is the most appropriate for the nurse to include in the educational​ session?

a. Disinfect computer keyboards and mice daily.

b. Avoid using sealed computer keyboards with​ built-in covers.

c. Wear gloves when using a computer keyboard or mouse.

d. Use a diluted bleach solution to clean computer keyboards.
a. Disinfect computer keyboards and mice daily.

Rationale
Because keyboards carry the highest risk for​ contamination, some manufacturers have built sealed keyboards that can be easily cleaned or can be equipped with covers for easier cleaning and protection of the electronic equipment. Guidelines for preventing the spread of infection due to contaminated computer systems include disinfecting keyboards and mice daily and when visibly soiled with body​ fluids, and following manufacturer recommendations for cleaning equipment. The nurse should not touch keyboards or mice with gloved hands.
The nurse educator asks a group of nursing students how the government affects the process of transitioning to the use of electronic medical records​ (EMRs). Which student​'s statement is most​ accurate?

a. "The Center for Medicare and Medicaid Services​ (CMS) is primarily responsible for monitoring achievement of meaningful use objectives"

b. "The Office of the National Coordinator for Health Information Technology​ (ONC) is the sole agency responsible for overseeing the process of transitioning to the use of electronic medical records ​(EMRs)."

c. "The Center for Medicare and Medicaid Services​ (CMS) is responsible for monitoring the transition to the use of electronic medical records​ (EMRs) at the federal level."

d. "The Office of the National Coordinator for Health Information Technology​ (ONC) is responsible for authorizing financial reimbursement."
c. "The Center for Medicare and Medicaid Services​ (CMS) is responsible for monitoring the transition to the use of electronic medical records​ (EMRs) at the federal level."

Rationale
On a federal​ level, the Center for Medicare and Medicaid Services​ (CMS) and the Office of the National Coordinator for Health Information Technology​ (ONC) oversee the process of transitioning to the use of electronic medical records​ (EMRs). ONC monitors achievement of meaningful use​ objectives, which are reported to CMS to authorize financial reimbursement.
The clinical nurse educator is designing an online course about the use of patient portals for consumer and client​ e-health. Which item should be included when designing the online​ course?

a. To use the​ portal, the client must first register in person at the healthcare facility.

b. Prescription refill requests are not permitted when using a portal.

c. Clients must provide a user identification and password for each portal visit.

d. Protected health information is encrypted and securely transmitted via the portal.
c. Clients must provide a user identification and password for each portal visit.

Rationale
Patient portals require online​ registration, and a user identification and password are needed for each visit. Not all portals are encrypted to allow secure transmission of protected health information. Functions offered by certain patient portals include scheduling routine​ appointments, requesting prescription​ refills, and communicating electronically with a healthcare provider.
A student nurse asks the nursing instructor how nurses use informatics when they practice nursing. What is the best response by the nurse instructor?

a. "Nurses use computers to chart medication administration only."

b. "Nurses do not need to be proficient in informatics to care for clients."

c. "Nursing informatics is an important science used daily in the care of clients."

d. "Physicians use computers more than nurses."
c. "Nursing informatics is an important science used daily in the care of clients."

Rationale
Nursing informatics is the science of using computers in the practice of nursing, from daily assessments to nursing research. Medication administration is only one aspect of computer use by nurses. Nurses do need to become proficient in the use of computers. All medical disciplines use informatics in the care of clients.
The nurse is learning about the computer system at a new job. Which system would the nurse expect to use when charting client care?

a. The DVD system

b. The clinical information system (CIS)

c. The administrative information system (AIS)

d. A secondary memory storage system
b. The clinical information system (CIS)

Rationale
Large healthcare organizations have two systems: The CIS is used by various medical professionals to input data, such as assessments or treatments, into the client's electronic record; the AIS is demographics, insurance, and other administrative information added on admission that the professional rarely adds to but views for information regarding the client's history. A DVD is a recording system. Secondary memory storage is part of the computer's hard drive.
A small hospital is installing computers for the nursing department. Several nurses are on the committee that is evaluating various systems because: a. The system adopted must support nurses in their practice. b. The system must be compatible with the administrative system. c. The system should not contain medical information. .d. Nurses will be teaching everyone else how to use the system.a. The system adopted must support nurses in their practice. Rationale A goal of this type of system should be the support of the practice of nursing and nurses should have input. Nurses may or may not teach others the system as the IT department usually conducts these teaching sessions. The system does not have to be compatible with the administrative system, but it is easier when these systems are compatible. Having medical information that nurses can use as a reference is a definition of supporting nurses in their practice.A new aspect of the informatics system that the nurse finds helpful when caring for clients is: a. Ability to look up client phone numbers b. E-mails from the manager c. An intranet that has access to medical and nursing information d. Use of passwords for access to the computer systemc. An intranet that has access to medical and nursing information Rationale Intranets within a system offer nurses access to information about treatment and disease that enables them to become more informed about client conditions. Being able to look up the client's phone number is not new nor all that helpful when delivering care. E-mails from the manager have more to do with unit policies and changes than with client care. The intranets offer a wide range of medical and nursing information, which is very helpful for newer nurses when dealing with rare conditions. Passwords do not help the nurse to provide better care other than ensuring protection of the client's privacy.A student nurse asks the preceptor the difference between the terms Electronic Health Record (EHR) and Electronic Medical Record (EMR). The best explanation by the nurse preceptor is: a. "The EMR tracks only your medications." b. "The EHR is your entire health history." c. "The EMR is used only by physical therapy." d. "The EHR is a small part of the EMR."b. "The EHR is your entire health history." Rationale The EHR refers to the client's whole health record, and the EMR is a record of the current treatment that is added to the client's EHR. The EMR is a part of the whole health record. EMR is used by all professionals giving care to the client and documents all care including, but not limited to, medications.A diabetic client who lives 50 miles from the endocrinologist is able to send information from the glucose meter via the phone to the doctor. The home health nurse tells the client that this is useful for the client in that: a. It saves the physician's time. b. The client is getting up-to-the-minute monitoring. c. The nurse does not have to visit as often. d. The system saves charting time for professionals.b. The client is getting up-to-the-minute monitoring. Rationale For the client who lives at a long distance from the physician, this type of system allows for up-to-the-minute monitoring by the physician. Whether the client comes to the office or sends the information, the physician still needs to review results. The nurse would continue to visit because physical assessment is imperative. Saving charting time for professionals is not really a benefit to the client.During the unit tour, the new nurse notes which ergonomic measure to prevent injuries to the staff that use nursing informatics? a. Notebook computers b. Wrist supports on the keyboard d. Lumbar supports on the chairs d. Computer monitors above eye leveld. Lumbar supports on the chairs Rationale Lumbar supports on the chairs help avoid back fatigue and injury. Wrist supports actually aggravate carpal tunnel syndrome, whereas a flat surface for the palm is helpful. Computer monitors should be just below eye level. Notebooks encourage poor posture.The nurse is critically appraising a research study. Which statement is reflective of an appraisal of the​ study's reliability? a. ​"Although the study was supposed to measure the​ client's wound​ healing, it really measured the​ client's satisfaction with​ care." ​b. "The study's results are applicable to clinical​ practice." c. ​"The original study was repeated three​ times, but it did not produce consistent​ results." d. ​"The study's results are not applicable to clinical​ practice."c. ​"The original study was repeated three​ times, but it did not produce consistent​ results." Rationale Reliability is the​ study's ability to produce consistent results with each use. Validity is the degree to which the study measured what it intended to measure. Usefulness is reflective of the​ study's application to clinical practice.The nurse is participating in conducting a research study and needs to determine if an individual qualifies to be a participant. Which criteria must be met for inclusion in a research​ study? ​(Select all that​ apply.) a. The individual has given informed consent. b. The individual receives payment for participation. c. The individual meets all the inclusion criteria. d. The individual must waive the right to anonymity. e. The individual is informed of all aspects of the study.a. The individual has given informed consent. c. The individual meets all the inclusion criteria. e. The individual is informed of all aspects of the study. Rationale Research participants are defined as volunteers for a specific study project who meet all the inclusion​ criteria, have been informed of all aspects of the​ study, and have given informed consent. Adherence to the ethical principle of justice requires protection of the research​ participant's anonymity. Payment is not a mandatory condition of participation in research.A group of nursing students are discussing clinical research questions. In describing the difference between background questions and foreground​ questions, which student​'s statement is the most​ appropriate? a. "The answer to a foreground question addresses multiple clinical issues." b. "Background questions address a range of clinical issues." c. "Answers to background questions may be found in drug guides." d. "Foreground questions are ​knowledge-based."c. "Answers to background questions may be found in drug guides." Rationale Background questions are​ knowledge-based and seek more information about a​ topic, such as medications or diseases. Answers to background questions can be found in​ textbooks, drug​ guides, medical​ dictionaries, and other education resources. Foreground questions are​ practice-based and, compared to background​ questions, they are narrower in scope. Foreground questions focus on a specific clinical issue and their answers identify useful information about direct client care that may guide the formulation of nursing interventions that improve client outcomes.During a class about research​ methods, a nursing student asks the​ instructor, open double quote"What is the difference between qualitative and quantitative ​research?close double quote" Which response by the instructor is the most​ appropriate? a. "Quantitative research explores individuals​' subjective experiences." b. "Quantitative research uses precise measurement to collect data and analyze it statistically." c. "Qualitative research is used to test relationships between variables." d. "Qualitative research does not use the scientific method.b. "Quantitative research uses precise measurement to collect data and analyze it statistically." Rationale Quantitative research uses precise measurement to collect data and to analyze it​ statistically; this method is used to test relationships between variables. Qualitative research investigates a question through narrative data to explore the subjective experiences of human​ beings; this method is used to clarify the​ nurse's understanding of the​ client's perspective. The scientific method may be applied to both the qualitative method and the quantitative method of research.The nursing student is giving a presentation about nursing research. Which statement is most appropriate for the student to include in the​ presentation? a. "Nursing research is illustrated by the client​'s choice to use an alternative treatment." b. "Nursing research combines the best evidence from current​ studies, clinical nursing​ expertise, and client preferences." c. "Nursing research tests hypotheses about​ health-related conditions and nursing care." d. "Nursing research is clinical​ knowledge, expert​ opinion, or information resulting from research."c. "Nursing research tests hypotheses about​ health-related conditions and nursing care." Rationale Nursing research tests hypotheses about​ health-related conditions and nursing care. ​Evidence-based practice​ (EBP) combines the best evidence from the most current research studies​ available, the​ nurse's clinical​ expertise, and the​ client's preferences, including​ needs, values, and choices. Choosing an alternative treatment is an example of a client preference. Evidence is clinical​ knowledge, expert​ opinion, or information resulting from research.The nursing instructor is explaining​ evidence-based practice​ (EBP) to nursing students. Which statements are appropriate to include in the​ explanation? ​(Select all that​ apply.) a. "EBP considers the client​'s ​needs, values, and choices." b. "EBP incorporates the nurse​'s clinical expertise." c. "EBP tests hypotheses about​ health-related conditions." d. "EBP promotes generalization of client care." e. "EBP is reflective of the best evidence from current research."a. "EBP considers the client​'s ​needs, values, and choices." b. "EBP incorporates the nurse​'s clinical expertise." e. "EBP is reflective of the best evidence from current research." Rationale ​Evidence-based practice​ (EBP) combines the best evidence from the most current research​ available, the​ nurse's clinical​ expertise, and the​ client's preferences, including​ needs, values, and choices. EBP promotes individualization of client care. Nursing research tests hypotheses about​ health-related conditions and nursing care.When formulating the plan of care for a new admission, the nurse recognizes that evidence-based practice is most helpful to the nurse when: a. Collecting data regarding the client's current medications b. Determining the client's dietary needs c. Evaluating the client's outcomes of care d. The nurse determines the client's nursing diagnoses.c. Evaluating the client's outcomes of care Rationale A goal of evidence-based practice is to improve client care, and the best way to justify care is by evaluating the client's response to care by examining outcomes. Nursing diagnoses are formulated after the client has been assessed and are not necessarily found in nursing research. Collecting data about the client's medication is not enhanced by evidence-based practice. The client's dietary needs are usually determined by the physician.A nurse preceptor explains to a graduate nurse that the hospital uses evidence-based practice (EBP) because: a. EBP provides credibility to the profession. b. EBP assists in the evaluation of nurses' performance. c. Care cannot be given unless it is backed by research. d. EBP helps determine the client's preferences of care.a. EBP provides credibility to the profession. Rationale Evidence-based care provides credibility for the profession because the profession can demonstrate through research that client outcomes are positive. Some agencies do not use EBP but deliver care based on experience or trial and error. EBP is not designed to evaluate a nurse's performance. EBP will not determine a client's preferences; a nursing assessment will.In order to overcome some of the barriers to evidence- based practice (EBP), the nurse manager plans to: a. Have the nurses petition the administration for support. b. Ask the nurses on the unit to go back to school. c. Ask the nurses to read articles and report to the unit. d. Buy computers for the nursing staff.c. Ask the nurses to read articles and report to the unit. Rationale There is a wealth of knowledge and research in nursing journals. The manager could ask each nurse to read an article and then report a summary during staff meetings. It would not be reasonable to ask nurses to go back to school although supporting nurses who do is good practice. Most hospitals have computers available that the nurses can use to access information during down time. It would not be necessary to have administrative support if the nurses read articles.The nurse preceptor tells the nursing student that participation in nursing research will most likely help the student: a. Develop a better attitude about work. b. Improve daily practice. c. Improve the development of skills. d. Improve communication with clients.b. Improve daily practice. Rationale Nursing research aims to help nurses improve daily practice by increasing nursing knowledge. Research will not necessarily help nurses have a better attitude, improve skills, or improve communication.The new nurse is interested in learning more about nursing research. The nurse preceptor would describe a literature review as all except: a. Is part of the evidence retrieval process of the research process b. A means for the student nurse to identify past research findings on the research topic c. A non-essential part of the research process d. A way to look for clinical evidence from research sourcesc. A non-essential part of the research process Rationale Looking for clinical evidence from research sources usually includes a review of the pertinent literature related to the subject. It provides a means to identify past research finding on the research topic, is a part of the evidence retrieval process of the research, and is an essential part of the research process.The nurse is caring for a client who continues to develop pressure sores despite the trial and error measures the nurses have taken to protect the client's skin. What can the nurse do to provide evidence-based care ? a. Call the physician for advice on wound care. b. Use the most expensive wound care supplies to improve client's outcome. c. Mandate the client change his own dressing. d. Incorporate research to improve client's outcome.d. Incorporate research to improve client's outcome. Rationale Trial and error is a means of attempting to gain knowledge. It is not necessarily based on research because it is not a systematic or scientific approach to the problem. Evidence-based nursing is based on research to improved client outcomes. While the nurse may call the physician regarding the client's condition, this action is not evidence-based. Using the most expensive wound care supplies and mandating the client change the wound dressing is not appropriate.Regarding research and nursing care, the ANA expects that all nurses will: a. Report findings to clients. b. Integrate research findings into care. c. Improve assessment skills. d. Create research questions.b. Integrate research findings into care. Rationale The ANA established research standards with the goal that nurses will integrate findings into improved care for the client. Individual nurses would not be responsible for reporting findings to clients. Assessment skills are gained through education and experience. Some nurses will participate in research by designing questions, but not all nurses will.To provide optimized individual clinical care to clients, the nurse understands that the components of evidence-based care include all except: a. Clinical expertise b. Client perspectives c. Current strong evidence d. Managerial expertised. Managerial expertise Rationale To provide optimized individual clinical care to clients, nurses use three components that provide the framework for evidence-based practice: current strong evidence, client perspectives, and clinical expertise. Managerial expertise, while important to nursing care, is not a component to the framework of evidence-based practice.To impact cost containment in the delivery of health care, the nurse suggests the need for future research studies. The nurse would look to studies that would: a. Promote healthy lifestyles. b. Examine end-of-life care. c. Improve client safety. d. Evaluate the emergency response to disaster.a. Promote healthy lifestyles. Rationale Nurses can help with health cost containment by concentrating on wellness, healthy lifestyles, and disease prevention. It is more cost effective to prevent illness than to treat illness. Improving client safety would not have much impact on cost containment. End-of-life care is a study need but would not produce cost containing results. Evaluating emergency response is more appropriate at the government level.When performing a literature review for evidence, nurses look for scientific elements in the journal article, including all except: a. A written conclusion b. Names of patients involved in the data collection c. The abstract d. An overview of the study conductedb. Names of patients involved in the data collection Rationale Looking for clinical evidence from research sources usually includes a review of the pertinent literature. When doing a literature review for evidence, nurses look for scientific elements in the journal article including the abstract, an overview or summary of the study conducted, a written conclusion. Revealing the names of patients involved in the data collection is a violation of HIPAA laws and does not occur.A graduate nurse is instructed to use the mnemonic PICOT to define and formulate a clinical question that will contribute to Evidenced Based Practice (EBP). The nurse understands that this question will include all except: a. Population of clients b. Implementation of hypothesis c. Comparison of interventions d. Outcomesb. Implementation of hypothesis Rationale The nurse utilizing the PICOT format to formulate a clinical question understands that the mnemonic includes: Population of clients, Issue of interest, Comparison of interventions, Outcomes, and Time frame. Implementation of hypothesis is not a part of the PICOT format.According to research design, once the research problem is defined, what is the next step in the process? a. Define variables. b. Review the literature. c. Formulate a hypothesis. d. Select a design.b. Review the literature. Rationale Before progressing with the research design, the researcher determines what is known and not known about the problem. A thorough review of the literature provides the foundation on which to build new knowledge. Next, a hypothesis is formulated, variables are defined, and the research design is selected.