Informatics Proctored

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Sample questions from Informatics Proctored

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.At change of shift in a pediatric emergency department, a 3-year-old with a history of asthma has an oxygen saturation of 89% on room air and intercostal retractions. The electronic health record displays an allergy alert for a medication the parent says the child has never received. Which action should the nurse take first?

   • A.Document that the parent disputes the allergy and continue with the planned medication
   • B.Call the health information management department to correct the allergy before intervening
   • C.Remove the allergy from the record so the provider can prescribe without delay
   • D.Assess the child and provide immediate respiratory support while asking the parent about the allergy history

   Rationale: The child's hypoxemia and retractions indicate an immediate threat, so the nurse should assess and support breathing while clarifying the allergy before a potentially related medication is given. Removing the allergy without verification could expose the child to harm. Waiting for a records department delays care, and simply documenting the disagreement does not resolve the safety concern. Informatics alerts support, but do not replace, clinical assessment and timely action.

2. 2.During a home visit, a 67-year-old client with heart failure reports taking an extra dose of digoxin after missing yesterday's dose. The electronic medication list still shows the former dose, and the client reports new nausea and yellow-green halos. Which action is the nurse's priority?

   • A.Ask the client to take the regular dose now to return to the prescribed schedule
   • B.Enter the symptoms in the home-care record and wait for the next routine medication review
   • C.Hold further digoxin, assess the client, and promptly notify the prescriber of possible toxicity
   • D.Update the medication list to reflect the extra dose and schedule follow-up next week

   Rationale: Nausea and visual color changes after an extra digoxin dose suggest toxicity and require immediate assessment and prescriber notification; the next dose should be withheld pending direction. Updating the list alone does not address a possible acute adverse drug effect. Taking another dose could worsen toxicity, and waiting for routine review is unsafe. The medication record should be reconciled after immediate clinical needs are addressed.

3. 3.In a long-term care facility, an 81-year-old resident has new confusion and a temperature of 38.2 C. The registered nurse is assessing the resident while a nursing assistant reports that another resident has fallen in the hallway. Which task is appropriate for the nurse to delegate to the nursing assistant?

   • A.Obtain and report a set of vital signs for the confused resident
   • B.Determine whether the confused resident's change in behavior is caused by infection
   • C.Assess the fallen resident for a possible head injury
   • D.Document the registered nurse's assessment in the electronic record

   Rationale: Obtaining and reporting vital signs is a predictable task that can be delegated to trained assistive personnel, while the registered nurse retains responsibility for assessment and interpretation. Determining the cause of confusion and assessing a possible head injury require nursing judgment. The assistant must not document an assessment performed by the registered nurse. Clear delegation and prompt reporting help the nurse prioritize both residents safely.

4. 4.At an outpatient clinic, a 16-year-old being seen for a sports physical tells the nurse, "I might hurt myself tonight," then asks that the statement not be entered in the electronic record. The client is calm, and the parent is in the waiting room. Which response is best?

   • A.Promise not to document the statement so the adolescent will continue talking
   • B.Explain that safety concerns must be shared with the care team, assess immediate risk, and document objectively
   • C.Enter the statement only in a personal note that is not visible to the care team
   • D.Ask the parent to access the portal and determine whether the adolescent has made similar statements

   Answer and rationale are in the full material.

5. 5.In a medical unit, a 54-year-old client with chronic kidney disease is prescribed a medication that is primarily cleared by the kidneys. The computerized order entry system displays a dose-range warning, but the latest creatinine result is not visible in the medication screen. What should the nurse do before administering the dose?

   • A.Ask another nurse to administer the dose so the order has a second check
   • B.Give half the prescribed dose and document the adjustment
   • C.Override the warning because the prescriber entered the order
   • D.Check the current renal function and clarify the dose with the prescriber or pharmacist if needed

   Answer and rationale are in the full material.