NR599 FINAL EXAM (ACTUAL QUESTIONS AND CORRECT ANSWERS) LATEST UPDATE 2024/2025, Exams of Nursing

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Smart documenta-on forms Forms that are tailored based on pa-ent data to emphasize data elements per-nent to the pa-ent's condi-ons and healthcare needs. Order sets, care plans and protocols Structured approaches to encourage correct and efficient ordering, promote evidence-based best prac-ces, and provide different management recommenda-ons for different pa-ent situa-ons. Parameter guideline Algorithms to promote correct entry of orders and documenta-on. Cri-ques and "immediate warnings" Alerts that are presented just aHer a user has entered an order, a prescrip-on or a documenta-on item, to show a poten-al hazard or a recommenda-on for further informa-on. Relevant data summaries A single-pa-ent view that summarizes, organizes and filters a pa-ent's informa-on to highlight important management issues. Mul-ple monitors A display of ac-vity among all pa-ents on a care unit, which helps providers priori-ze tasks and ensures that important ac-vi-es are not omiMed while providers are mul-tasking among pa-ents. Predic-ve and retrospec-ve analy-cs:

NR599 FINAL EXAM (ACTUAL

QUESTIONS AND CORRECT

ANSWERS) LATEST UPDATE

2024/

Analy-c methods that combine mul-ple factors using sta-s-cal and ar-ficial intelligence techniques to provide risk predic-ons, stra-fy pa-ents and measure progress on broad ini-a-ves. "Info" buMons Filtered reference informa-on and knowledge resources within fields or "buMons" where info is provided to the end user in the context of the current data display also referred to as metadata, or "data about data". Expert workup and management advisers Diagnos-c and expert systems that track and advise a pa-ent workup and management of the pa-ent based on evidence-based protocols. Event-triggered alerts Warnings triggered within the system based on data that alert the clinical user to a new event occurring asynchronously, such as an abnormal lab result. Reminders Time-triggered events within the system reminding the clinical user of a task needed to be based on predetermined -me within the system. Clinical transforma-on Rela-ve to workflow redesign; it is a complete altera-on of the clinical environment and should be used cau-ously to describe redesign efforts; transforma-on is defined as "a radical change approach that produces a more responsive organiza-on that is more capable of performing in unstable and changing environments that organiza-ons con-nue to be faced with";

• this would imply that the manner in which work is carried out and the outcomes achieved are completely different from the prior state. Which is not always true when the change involves implemen-ng technology
• technology can be used to launch or in conjunc-on with a clinical transforma-on ini-a-ve but the implementa-on of technology alone is not

considered transforma-onal.

Op-miza-on

• when workflow analysis occurs post implementa-on, it is oHen referred to as

---

• it is the process of moving condi-ons past their current states and into more efficient and effec-ve methods of performing tasks.
• it is considered to be the act, process, or methodology of making something (as a design, system or decision) as fully perfect, func-onal, and effec-ve as possible. Process Analysis Breaking down the work process into a sequen-al series of steps that can be examined and assessed to improve effec-veness and efficiency; explains how work takes place, gets done, or how it can be done. Workflow analysis Observa-on and documenta-on of workflow to beMer understand what is happening in the current environment and how it can be altered is referred to as this process.
• it requires careful aMen-on to detail and the ability to moderate group discussions, organize concepts, and generate solu-ons.
• this is part of every func-onal area the INS engages in. Process Map A typical output of workflow analysis is a visual depic-on of the process called a ______ ________; this provides an excellent tool to iden-fy specific steps in the workflow analysis process.
• it also provides a vehicle for communica-on and a tool upon which to build

educa-onal material, procedures and policies.

• an example is the swim-lane technique Workflow
• a term used to describe the ac-on or execu-on of a series of tasks in a prescribed sequence.
• a progression of steps (tasks, events, interac-ons) that consitute:

1. a work process
2. involves two or more persons
3. creates and adds value to the organiza-ons ac-vi-es.

• also known as a process or process flow par-cularly in the context of implementa-on. Swim-lane technique Because workflow crosses many different care providers, it may be useful to construct the process map using this technique, which uses categories such as func-onal work groups and roles to visually depict groups of work and to indicate who performs the work. Value-added ac-vity
• is a step that brings the process closer to comple-on or changes the product or service for the beMer.
• an example is placing a label or name tag on a specimen sample, The name tag is necessary for the laboratory personnel to iden-fy the specimen. Non-Value-Added Ac-vi-es Does not alter the outcome of a process or product
• ac-vi-es such as handling, moving, and holding. These ac-vi-es should be evaluated during workflow analysis.
• ex: manipula-ng papers, moving through computer screens, and walking or transpor-ng items.

• Tasks that are not necessary for the purpose of compliance or regulatory reasons should be eliminated. Waste A key underpinning of the lean philosophy is the removal of _____ ac-vi-es.
• Seven forms:

1. Overproduc-on
2. Wai-ng
3. Transport
4. Inappropriate processing
5. Unnecessary inventory
6. Unnecessary mo-on
7. Defects Varia-on In workflow this is considered the enemy of all good processes and should be eliminated when possible.

• this occurs when workers perform the same func-on in different ways.
• it usually arises because of flaws in the way a process was originally designed, lack of knowledge about the process, or inability to execute a process as originally designed due to disrup-on or disturbances in the workflow Gap analysis Necessary to move from the current state to the future state;
• zeros in on the major area most affected by the change--namely, technology.
• generates ideas from the group about how best to u-lize the technology to transform prac-ce. 6 techniques to overcome resistance to change

1. Educa-on and Communica-on
2. Par-cipa-on and Involvement

3. Support and Facilita-on
4. Nego-a-on and Agreement
5. Manipula-on and Co-opta-on
6. Explicit and Implicit Coercion Metrics Provide an understanding about the performance of a process or func-on.

• within clinical technology projects, we iden-fy and collect ___________ about the performance of the technology or capture the level of par-cipa-on or adop-on.
• should focus on the variables of -me, quality, and costs.
• examples include: turnaround -mes, cycle -mes, throughput, change-over -me, set-up -me, system availability, pa-ent sa-sfac-on, and employee sa-sfac-on The goal of workflow analysis Is to create a future-state solu-on that maximizes the use of technology and eliminates non-value added ac-vi-es. Health Informa-on exchange/Medical Home model
• requires the NI to visualize how pa-ents move through the en-re con-nuum of care and not just a specific pa-ent care area.
• an informa-on technology plahorm that enables the seamless exchange of important pa-ent informa-on among many providers in a healthcare system.
• Typically the pcp (__________ _____________) ini-ates the collec-on of pa-ent data, coordinates the care of the pa-ent and helps to maintain the accuracy of such data.
• other care providers access the informa-on and add to it as they provide services to pa-ents. Big Data

Many different types - including indexes; images and videos; social networks such as TwiMer and Facebook; surveillance data; company records including medical records; and data heavy fields such as astronomy; gene-cs and economics.

• the masses of unstructured textually rich data within the EHR are among the prime examples. 5 Uses of Big data in the healthcare industry 1.) Big data explora-ons and mining techniques to improve decision making. 2.) 360-degree view of the customer, extending the ability to view the healthcare consumer by internal and external data sources. 3.) Security and intelligence to lower risk, detect fraud and monitor cybersecurity. 4.) Opera-onal and clinical analysis to improve healthcare outcomes, quality and cost. 5.) Ability to augment data warehouse capabili-es to integrate and use big data to increase efficiencies and improve outcomes. Data mining A method in computer science that is used to discover paMerns and trends within large data sets. Anomaly detec-on A data mining technique
• paMern detec-on of data errors or unusual devia-ons from the norm - ex: detec-on of disease outbreaks. Associa-on rule learning A data mining technique that iden-fies associa-on between variables to predict outcomes.

• Iden-fies rela-onships in variables associated with an outcome of interest; can be preliminary work to predic-ve modeling Cluster Analysis
• Discovering groups or structures in the data
• a data mining technique that discovers groups or structures in the data, such as clusters of pa-ents who tend to go to one hospital in a given ZIP code or county. Classifica-on A data mining technique
• Generalizing known structure to new data or informa-on
• Classifying pa-ent safety errors related to HIT can support taxonomy development Regression Modeling A data mining technique
• Modeling data for predic-on or explaining some phenomenon with the least amount of error as possible
• oHen used for predic-ve analy-cs such as predic-ng factors that are associated with mortality or 30-day readmission. Summariza-on A data mining technique
• business intelligence (BI) tools that aggregate cubic views of data or report certain outcomes.
• tools allow an end user to drag and drop and quickly iden-fy paMerns and trends in the data based on the summariza-on of tables. Mobile health (mhealth)
• the use of wireless communica-on to support efficiency in public health and clinical prac-ce.

• genera-on, aggrega-on, and dissemina-on of health informa-on via mobile or wireless device.
• examples of areas of growth are:

1. Preven-on medicine and health promo-on can be leveraged through educa-on and awareness applica-ons.
2. Portable diagnos-c devices that allow monitoring of human condi-ons in clinical sekngs or offsite loca-ons.
3. Applica-ons for data management, training medical personnel and mobile payments. Mobile applica-ons To facilitate mhealth;

• can be executed on either a mobile plahorm( i.e. A handheld commercial off the shelf compu-ng plahorm, with or without wireless connec-on) or on a web-based soHware applica-on that is tailored to a mobile plahorm but is executed on a server Mobile medical applica-ons
• incorporates device soHware func-onality that meets the defini-on of devices intended to be used as an accessory to a regulated medical device or are soHware that transforms a mobile plahorm into a regulated medical device.
• these mobile devices may include mobile phones, smartphones, tablet computers, smartwatches and point of care tes-ng (POC). Medical Applica-ons

1. Apps providing access to electronic copies.
2. Apps for general pa-ent educa-on.
3. Generic aids or general purpose apps.
4. Apps as educa-onal tools.
5. Apps automa-ng office opera-ons.

Medical device "an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related ar-cles, including any component, part or accessory that is intended for use in performing a func-on for diagnosis of disease or other condi-ons or the cure, mi-ga-on, treatment of preven-on of disease" FDA regulated devices An intended use of a mobile app determines whether it meets the defini-on of a "device" - "intended" use may be shown by labeling claims, adver-sing materials, or oral or wriMen statements by manufacturers or their representa-ves. When the intended use of the mobile app is for the diagnosis of disease or other condi-ons, or the cure, mi-ga-on, treatment, or preven-on of disease or is intended to affect the structure or any func-on of the body of man, the mobile app is a device under sec-on 201h of the FD&C act ;

• if a soHware func-on is intended for use in performing a medical device func-on it is a medical device, regardless of the plahorm on which it runs. Ex: mobile apps intended to run on smartphones to analyze and interpret EKG waveforms to detect heart func-on irregulari-es would be considered similar to soHware running on a desktop computer that serves the same func-on, which is regulated by the FDA.
• FDA applies oversight and regula-on only to those soHware applica-ons whose func-onality could pose a risk to a pa-ent's safety if the soHware applica-on were to no func-on as intended. Examples of regulated medical devices Glucose test system, calculator processing module for clinical use, monitoring spirometer, esophageal stethoscope with electrical conductors, apnea monitor, blood pressure computer, etc.

Apps providing access to electronic copies Mobile apps that are intended to provide access to electronic "copies" (e.g. E- books, audio books) of medical textbooks or other reference materials with generic text search capabili-es. NOT considered medical devices because they are intended to be used as reference materials and not for diagnosis, tx, mi-ga-on, cure, preven-on of disease or to replace clinical judgment. Examples of apps providing access to electronic copies. Ex: Medical dic-onaries, medical textbooks and literature ar-cles such as the physician's desk reference or diagnos-c and sta-s-cal Manual of Mental Disorders; library of clinical descrip-ons for disease and condi-ons, encyclopedia for first-aid and emergency care informa-on; medical abbrevia-ons and defini-ons; transla-ons of medical terms across mul-ple languages. Apps for general pa-ent educa-on Mobile apps that facilitate pa-ent access to commonly used reference informa-on; These apps can be pa-ent-specific (i.e. Filter info to pt-specific characteris-cs), but are intended for increased pa-ent awareness, educa-on, and empowerment and ul-mately to support pa-ent-centered care.

• NOT considered a medical device because they are intended generally for pt educa-on. Examples of mobile apps for general pa-ent educa-on
• provide a portal for healthcare providers to distribute educa-onal informa-on (e.g., interac-ve diagrams, useful links and resources) to their pa-ents regarding their disease, condi-on, treatment, or up-coming procedures.
• help guide pa-ents to ask appropriate ques-ons to their provider relevant to their par-cular disease, condi-on, or concern.

• provide informa-on about gluten-free food products or restaurants
• help match pa-ents with poten-ally appropriate clinical trials.
• provide tutorials or training videos on how to administer first-aid or CPR.
• Allow users to input pill shape, color or imprint and display pictures and names of pills that match this descrip-on.
• find the closest medical facili-es and providers.
• provide lists of emergency hotlines and physician/nurse advice lines.
• provide and compare costs of drugs and medical products at pharmacies in the user's loca-on. Generic aids or general purpose apps examples
• use a mobile plahorm as a magnifying glass (but are not specifically intended for medical purposes)
• use a mobile plahorm for recording audio, note-taking, replaying audio with amplifica-ons.
• allow pa-ents or healthcare providers to interact through email, web-based plahorms, video or other communica-on mechanisms
• provide maps and turn-by-turn direc-ons to medical facili-es
• allow health care providers to communicate in a secure and protected method (for ex, using a hipaa compliant app to send messages between health care providers in a hospital)
• translate unintelligible speech for beMer clarity. Apps as educa-onal tools Intended for healthcare providers to use as educa-onal tools for medical training or to reinforce training previously received.
• may have more func-onality than electronic copy of text (e.g. Video, interac-ve diagram), but are not devices because they are intended generally for user educa-on.

Examples of apps as educa-onal tools

• medical flashcards with medical images, pictures, graphs
• Ques-on/Answer quiz apps
• interac-ve anatomy diagrams or videos
• surgical training videos
• medical board cer-fica-on or recer-fica-on prepara-ons apps
• Games that simulate various cardiac arrest scenarios to train health professionals in advanced CPR skills. Apps automa-ng office opera-ons Mobile apps that automate general office opera-ons in a health care sekng. Examples of apps automa-ng office opera-ons
• Determine billing codes like ICD- 10
• enables insurance claims data collec-on and processing and other apps that are similarly administra-ve in nature.
• analyze insurance claims for fraud and abuse.
• Perform medical business accoun-ng func-ons or track and trend billable hours and procedures
• Generate reminders for scheduled medical appointments or blood dona-on appointments
• Help pa-ents track, view, and pay medical claims and bills online.
• manage shiHs for providers manage or schedule hospital rooms or bed-spaces.
• provide wait -mes and electronic check-in for hospital emergency rooms and urgent care facili-es.
• allow healthcare providers and staff in healthcare sekngs process payments using HIPAA compliant apps.
• track or perform pa-ent sa-sfac-on surveys aHer an encounter or a clinical

visit.

• enable individuals to interact with PHR systems or EHR systems. Mobile apps that provide or facilitate supplemental clinical care, by coaching or promp-ng, to helps pa-ents manage their health in their daily environment Examples include apps that coach pa-ents with condi-ons such as cardiovascular disease, hypertension, diabetes, or obesity, and promote strategies for maintaining a healthy weight, gekng op-mal nutri-on, exercising and staying fit, managing salt intake, or adhering to pre-determined medica-on dosing schedules by simple promp-ng. Mobile apps that provide pa-ents with simple tools to organize and track their health informa-on Apps that provide simple tools for pa-ents with specific condi-ons or chronic diseases (e.g. Obesity, anorexia, arthri-s, diabetes, heart disease), to log, track, or trend their events or measurements (e.g. Blood pressure measurements, drug intake -mes, diet, daily rou-nes or emo-onal state) and share this informa-on with their health care provider as part of a disease-management plan. Mobile apps that provide easy access to informa-on related to pa-ents' health condi-ons or treatments (beyond providing an electronic "copy" of a medical reference)
• apps that use a pa-ent's diagnosis to provide a clinician with best prac-ce treatment guidelines for common illnesses or condi-ons such as influenza;
• apps that are drug-drug interac-on or drug-allergy look-up tools. Mobile apps that are specifically marketed to help pa-ents document, show, or communicate to providers, poten-al medical condi-ons
• apps that serve as videoconferencing portals specifically intended for medical use and to enhance communica-ons between pa-ents, healthcare providers,

and caregivers.

• apps specifically intended for medical uses that u-lize the mobile device's built-in camera or a connected camera for purposes of documen-ng or transmikng pictures (e.g. Photos of a pa-ent's skin lesion or wounds) to supplement or augment what would otherwise be a verbal descrip-on in a consulta-on between healthcare providers or between healthcare providers and pa-ents/caregivers. Mobile apps that perform simple calcula-ons rou-nely used in clinical prac-ce Examples of such general purpose tools include medical calculators for Body Mass Index (BMI), total body water/urea volume of distribu-on. Mobile apps that enable individuals to interact with PHR and EHR systems Ex include apps that provide pa-ents and providers with mobile access to health records systems or enables them to gain electronic access to health informa-on stored within a PHR or EHR. Mobile apps that meet the defini-on of Medical Devices Data Systems Ex include apps that are intended to transfer, store, convert format, and display medical device data, without controlling or altering the func-ons or parameters of any connected medical device. Clinical uses for telehealth technologies & sample clinical applica-ons

1. Transmikng images for assessment of diagnosis

• ex: transmikng of digital images such as images of wounds

2. Transmikng clinical data for assessment, diagnosis, or disease management.

• remote pt monitoring and transmikng pt's objec-ve and subjec-ve clinical data, such as monitoring VS or answers to disease management ques-ons.

3. Providing disease preven-on and promo-on of good health.

• case management provided via smartphone and pt educa-on provided through asthma and weight management programs conducted in schools

4. Using telephonic or video interac-ve technologies to provide health advice in emergent cases.

• performing teletriage in call centers or real--me stroke consulta-on btwn rural health centers and an academic medical center.

5. Using real--me video

• exchanging health services or educa-on live via videoconference. Point-of-care (POC) tes-ng Allows for tes-ng and diagnosis at the pt's side and can be conducted anywhere the pa-ent is, such as at the home, physician office, ambulance or hospital bedside.
• this technology allows for quick, on-the-spot tes-ng, with immediately available results that can be downloaded directly into the EHR through.
• decreases the risk of error in manually entered results Telehealth Refers to a wide range of health services that are delivered by telecommunica-ons-ready tools, such as the telephone, videophone, and computer. Telehealth encompasses three broad methods of digital care delivery that are "away" from the pa-ent: 1.Telemedicine (sta-onary scheduled remote diagnos-cs of health status) 2.Remote management/monitoring/coaching (sta-onary home or facility based, with scheduled and as-needed remote transmission of health status) 3.Mobile health (mhealth) "community" groups/social media (wearable mobile pa-ent-generated health data with scheduled and as-needed remote transmission of health status) Knowledge acquisi-on

Involves the telenurse receiving the informa-oni from the telehealth device via a variety of communica-on modes

• for ex, the telenurse receives the pa-ent's vital signs taken in the home and the pa-ent's response to customized ques-ons, which is transmiMed to a central server or website. Knowledge processing
• the result of the telenurse's knowledge acquisi-on
• understanding a set of informa-on and the ways it can be applied to a specific task.
• the telenurse assess the pa-ent's vital signs along with subjec-ve data received from the pa-ent as a result of of the customized ques-ons that were asked.
• the telenurse then combines this info with the overall pt history and diagnosis to get an up-to-date view of the pt's status and considers where this informa-on fits into the clinical picture being presented for the pa-ent. Knowledge genera-on
• by using skills and clinical knowledge of the disease process, the telenurse considers all of the data as they apply to the pt and decides the best course of ac-on to take and acts on the data.
• the telenurse may then ask a variety of ques-ons to ensure that a complete and accurate decision about next steps for the pa-ent is made. Ques-ons might include:
• Do i need to gather addi-onal data?
• do I need to call the pa-ent?
• do I need to call the physician and inquire about a change in the current plan of care? Knowledge dissemina-on

The telenurse determines how the knowledge will be used and distributed. Various ques-on that were posed in the knowledge genera-on stage are acted on, including the following possibili-es:

• calling the doctor
• obtaining a change in medica-on orders.
• calling the pt and instruc-ng her in a medica-on change
• reviewing ac-vi-es that could have led to changes (e.g. Ea-ng salty foods)
• educa-ng the pa-ent on the disease process, symptoms management, and self- management techniques. Founda-on of knowledge Model and Telehealth The nurse uses various technologies to acquire data; interpret the meaning of the data, thus genera-ng informa-on and knowledge; and then using that knowledge and wisdom to intervene appropriately. At Home Telemonitoring
• the ability to provide beMer healthcare is the number one benefit of using telehealth.
• info collected in the home becomes much more convenient for the pt, and the quality and -meliness of the info is improved drama-cally.
• this is an enhancement to care - it allows more direct, physical interven-on to occur only when it is actually needed.
• care is not directed by pre-scheduled appointment or subjec-ve percep-ons of condi-on, but instead can be determined by objec-ve measures of physical status.
• with telehealth, care can be delivered at the most appropriate site of care reducing reliance on emergency departments and inpa-ent facili-es. Driving Forces for telehealth

1. Demographics: more individuals with disability/unable to leave home
2. Nursing and healthcare worker shortage: telehealth can enhance job sa-sfac-on
3. Chronic Diseases and condi-ons: chronic disease limit independence.
4. New, educated consumers: people now more comfortable using technology, want to be more involved in their own care.
5. Excessive costs of healthcare services - telehealth decreases need for in- office visits, can help lower costs of chronic need for health services. Telemedicine The use of medical informa-on exchanged from one site to another via electronic communica-ons to improve pa-ents' health status. Telehealth A term used to encompass a broader defini-on of remote health care that does not always involve clinical services. Ex: videoconferencing, transmission of s-ll images, e-health including pa-ent portals, remote monitoring of vital signs, con-nuing medical educa-on and nursing call centers. The Health Resources Services Administra-on descrip-on of telehealth The use of technology to deliver health care, health informa-on, or health educa-on at a distance.

• common applica-ons include: teleradiology in which test results are forwarded to another facility for diagnosis; con-nuing professional educa-on, including presenta-ons by specialists to general prac--oners; and home monitoring, a supplement to home visits from nursing professionals. Telehealth Generally used as an umbrella term to describe all of the possible varia-ons of healthcare services that use telecommunica-ons. Can refer to clinical and nonclinical uses of health-related contacts.

Anas Code of Ethics for Nurses

1. Respect for human dignity
2. Respect for individual right to self-determinism
3. Primary commitment is to the pa-ent (individual, family, group or community)
4. Advocacy for the pa-ent
5. Par-cipa-on in the crea-on, maintenance, and improvement of healthcare environments
6. Advancing the Profession
7. Collabora-on with others to meet health needs
8. Shaping social policy. Issues having an ethical component includes the following:
9. Failure to adopt technology or use it adeptly.
10. Lack of regard for data integrity such as discrepancies. In record informa-on that are noted but no correc-ve ac-on is taken.
11. Failure to address threats to privacy and personal health informa-on.
12. Inappropriate access of PHI without a need to know.
13. Failure to keep informed of emerging developments and issues.
14. Failure to recognize and use technology to advance the profession.
15. Failure to engage in policy discussion that impact healthcare delivery.
16. Failure to recall that the pa-ent is their primary focus.
17. Failure to ac-vely par-cipate in the selec-on use, and/or evalua-on of technology that has the poten-al to improve healthcare.