NR 599 MIDTERM EXAM 2026/2027 | 85 Questions & 100%
Correct Answers | Chamberlain College of Nursing | A+
Grade | Pass Guaranteed
Domain 1: Foundations of Nursing Informatics (Questions 1-18)
[1A: Historical Evolution & Legislative Drivers (HITECH, Meaningful Use) - Q1-8]
Question 1
The HITECH Act of 2009 (Title XIII & Title IV) allocated over $30 billion in incentive
payments for meaningful EHR use through which federal programs?
A. Medicare and Medicaid EHR Incentive Programs
B. TRICARE and Veterans Affairs Electronic Systems Initiative
C. Affordable Care Act Exchange Subsidies and CHIP
D. CMS Innovation Center Bundled Payment Pilots
Correct Answer: A. Medicare and Medicaid EHR Incentive Programs [CORRECT]
Rationale: The HITECH Act specifically authorized incentive payments through the
Medicare and Medicaid EHR Incentive Programs to accelerate provider adoption of
certified EHR technology. Options B, C, and D reference unrelated programs or
legislative vehicles.
Question 2
Under the HITECH Act's HIPAA Breach Notification Rule, a covered entity discovering a
breach affecting 600 individuals must complete which action within 60 days?
A. Report to the FBI Cyber Division only
B. Notify affected individuals, the Secretary of HHS, and prominent media outlets
C. Maintain an internal log and report annually at year-end
D. Encrypt all remaining data and suspend network access
Correct Answer: B. Notify affected individuals, the Secretary of HHS, and prominent
media outlets [CORRECT]
,Rationale: The Breach Notification Rule requires notification to HHS and media when
breaches affect more than 500 individuals; smaller breaches (<500) require logging and
annual reporting. Options A, C, and D misstate the statutory notification hierarchy.
Question 3
Which penalty structure did the HITECH Act establish for eligible hospitals and
professionals who failed to demonstrate meaningful use of certified EHR technology
beginning in 2015?
A. Increased malpractice insurance premiums
B. Payment reductions in Medicare fee schedules
C. Mandatory closure of paper-based record departments
D. Exclusion from state Medicaid expansion programs
Correct Answer: B. Payment reductions in Medicare fee schedules [CORRECT]
Rationale: The HITECH Act established downward payment adjustments (penalties) for
non-meaningful users starting in 2015 through Medicare reimbursement reductions.
Options A, C, and D describe consequences not authorized by the statute.
Question 4
A hospital's 2026 Promoting Interoperability program attestation requires reporting
syndromic surveillance data, immunization registry data, and which additional public
health measure?
A. Patient satisfaction scores from Press Ganey surveys
B. Electronic case reporting to the CDC and SDOH data collection with Z-code capture
C. Nursing hourly rounding documentation compliance
D. Joint Commission accreditation renewal status
Correct Answer: B. Electronic case reporting to the CDC and SDOH data collection with
Z-code capture [CORRECT]
Rationale: The 2026 Promoting Interoperability program requires electronic case
reporting to CDC, SDOH data collection with Z-code capture, e-prescribing, health
information exchange, patient electronic access within 48 hours, and Query Health
integration for prescription drug monitoring. Options A, C, and D are not meaningful
use/Promoting Interoperability measures.
,Question 5
A nurse informaticist is analyzing the relationship between the American Recovery and
Reinvestment Act (ARRA) and healthcare IT adoption. Which statement accurately
describes this legislative relationship?
A. ARRA exclusively funded hospital construction projects unrelated to technology
B. The HITECH Act was enacted as Title XIII of ARRA, establishing EHR incentive
payments and privacy breach notification requirements
C. ARRA prohibited federal funding for electronic health records entirely
D. ARRA and HITECH are competing statutes with contradictory payment structures
Correct Answer: B. The HITECH Act was enacted as Title XIII of ARRA, establishing EHR
incentive payments and privacy breach notification requirements [CORRECT]
Rationale: The HITECH Act was passed as part of ARRA in 2009, creating the Office of
the National Coordinator (ONC) authority, EHR incentive programs, and enhanced HIPAA
breach notification. Options A, C, and D misrepresent the legislative architecture.
Question 6
A patient requests an electronic copy of their diagnostic imaging results in DICOM
format. Under HITECH Act provisions, the covered entity must provide the record in
which manner?
A. Only in PDF format to ensure universal readability
B. In the requested electronic format if readily producible
C. Exclusively through a patient portal with two-factor authentication
D. Only after the patient completes a notarized release form
Correct Answer: B. In the requested electronic format if readily producible [CORRECT]
Rationale: The HITECH Act grants patients the right to receive electronic copies of their
records in the format requested if readily producible. Options A, C, and D impose
unlawful restrictions on patient access rights.
Question 7
Under the 2026 HTI-2 Final Rule, a Critical Access Hospital (CAH) found to be engaged
in information blocking faces which specific disincentive?
A. Automatic conversion to rural health clinic status
B. Loss of reasonable assurance determination for cost-based reimbursement
C. Mandatory sale of EHR assets to a qualified health network
D. Suspension of all Medicare Advantage contracts
, Correct Answer: B. Loss of reasonable assurance determination for cost-based
reimbursement [CORRECT]
Rationale: The HTI-2 Final Rule specifies that CAHs engaging in information blocking
lose their reasonable assurance status, while eligible clinicians face up to 5% Medicare
payment reductions and hospitals risk loss of meaningful use status. Options A, C, and
D are not HTI-2 disincentives.
Question 8
Which data elements were newly added to USCDI Version 4 under the 2026 HTI-2 Final
Rule to advance health equity and patient-centered care?
A. Surgical procedure codes and anesthesia records only
B. Sexual orientation, gender identity, SDOH assessments, exposure to violence, patient
goals/preferences, health insurance information, and advance directive status
C. Billing zip codes and insurance claim denial reasons
D. Physician NPI numbers and facility license identifiers
Correct Answer: B. Sexual orientation, gender identity, SDOH assessments, exposure to
violence, patient goals/preferences, health insurance information, and advance directive
status [CORRECT]
Rationale: USCDI v4 expands data exchange requirements to include sexual orientation,
gender identity, SDOH assessments, exposure to violence, patient goals/preferences,
health insurance information, and advance directive status. Options A, C, and D list
elements not included in the USCDI v4 expansion.
[1B: Definitions & Scope (ANA 2026, NI vs CNIO) - Q9-14]
Question 9
According to the ANA Nursing Informatics Scope and Standards of Practice (2026),
which activity represents the "Diagnosis of Informatics Problems" standard?
A. Installing hardware servers in the hospital data center
B. Analyzing workflow data to identify barriers to EHR documentation efficiency
C. Marketing new software to external vendors
D. Performing direct patient care procedures at the bedside
Correct Answers | Chamberlain College of Nursing | A+
Grade | Pass Guaranteed
Domain 1: Foundations of Nursing Informatics (Questions 1-18)
[1A: Historical Evolution & Legislative Drivers (HITECH, Meaningful Use) - Q1-8]
Question 1
The HITECH Act of 2009 (Title XIII & Title IV) allocated over $30 billion in incentive
payments for meaningful EHR use through which federal programs?
A. Medicare and Medicaid EHR Incentive Programs
B. TRICARE and Veterans Affairs Electronic Systems Initiative
C. Affordable Care Act Exchange Subsidies and CHIP
D. CMS Innovation Center Bundled Payment Pilots
Correct Answer: A. Medicare and Medicaid EHR Incentive Programs [CORRECT]
Rationale: The HITECH Act specifically authorized incentive payments through the
Medicare and Medicaid EHR Incentive Programs to accelerate provider adoption of
certified EHR technology. Options B, C, and D reference unrelated programs or
legislative vehicles.
Question 2
Under the HITECH Act's HIPAA Breach Notification Rule, a covered entity discovering a
breach affecting 600 individuals must complete which action within 60 days?
A. Report to the FBI Cyber Division only
B. Notify affected individuals, the Secretary of HHS, and prominent media outlets
C. Maintain an internal log and report annually at year-end
D. Encrypt all remaining data and suspend network access
Correct Answer: B. Notify affected individuals, the Secretary of HHS, and prominent
media outlets [CORRECT]
,Rationale: The Breach Notification Rule requires notification to HHS and media when
breaches affect more than 500 individuals; smaller breaches (<500) require logging and
annual reporting. Options A, C, and D misstate the statutory notification hierarchy.
Question 3
Which penalty structure did the HITECH Act establish for eligible hospitals and
professionals who failed to demonstrate meaningful use of certified EHR technology
beginning in 2015?
A. Increased malpractice insurance premiums
B. Payment reductions in Medicare fee schedules
C. Mandatory closure of paper-based record departments
D. Exclusion from state Medicaid expansion programs
Correct Answer: B. Payment reductions in Medicare fee schedules [CORRECT]
Rationale: The HITECH Act established downward payment adjustments (penalties) for
non-meaningful users starting in 2015 through Medicare reimbursement reductions.
Options A, C, and D describe consequences not authorized by the statute.
Question 4
A hospital's 2026 Promoting Interoperability program attestation requires reporting
syndromic surveillance data, immunization registry data, and which additional public
health measure?
A. Patient satisfaction scores from Press Ganey surveys
B. Electronic case reporting to the CDC and SDOH data collection with Z-code capture
C. Nursing hourly rounding documentation compliance
D. Joint Commission accreditation renewal status
Correct Answer: B. Electronic case reporting to the CDC and SDOH data collection with
Z-code capture [CORRECT]
Rationale: The 2026 Promoting Interoperability program requires electronic case
reporting to CDC, SDOH data collection with Z-code capture, e-prescribing, health
information exchange, patient electronic access within 48 hours, and Query Health
integration for prescription drug monitoring. Options A, C, and D are not meaningful
use/Promoting Interoperability measures.
,Question 5
A nurse informaticist is analyzing the relationship between the American Recovery and
Reinvestment Act (ARRA) and healthcare IT adoption. Which statement accurately
describes this legislative relationship?
A. ARRA exclusively funded hospital construction projects unrelated to technology
B. The HITECH Act was enacted as Title XIII of ARRA, establishing EHR incentive
payments and privacy breach notification requirements
C. ARRA prohibited federal funding for electronic health records entirely
D. ARRA and HITECH are competing statutes with contradictory payment structures
Correct Answer: B. The HITECH Act was enacted as Title XIII of ARRA, establishing EHR
incentive payments and privacy breach notification requirements [CORRECT]
Rationale: The HITECH Act was passed as part of ARRA in 2009, creating the Office of
the National Coordinator (ONC) authority, EHR incentive programs, and enhanced HIPAA
breach notification. Options A, C, and D misrepresent the legislative architecture.
Question 6
A patient requests an electronic copy of their diagnostic imaging results in DICOM
format. Under HITECH Act provisions, the covered entity must provide the record in
which manner?
A. Only in PDF format to ensure universal readability
B. In the requested electronic format if readily producible
C. Exclusively through a patient portal with two-factor authentication
D. Only after the patient completes a notarized release form
Correct Answer: B. In the requested electronic format if readily producible [CORRECT]
Rationale: The HITECH Act grants patients the right to receive electronic copies of their
records in the format requested if readily producible. Options A, C, and D impose
unlawful restrictions on patient access rights.
Question 7
Under the 2026 HTI-2 Final Rule, a Critical Access Hospital (CAH) found to be engaged
in information blocking faces which specific disincentive?
A. Automatic conversion to rural health clinic status
B. Loss of reasonable assurance determination for cost-based reimbursement
C. Mandatory sale of EHR assets to a qualified health network
D. Suspension of all Medicare Advantage contracts
, Correct Answer: B. Loss of reasonable assurance determination for cost-based
reimbursement [CORRECT]
Rationale: The HTI-2 Final Rule specifies that CAHs engaging in information blocking
lose their reasonable assurance status, while eligible clinicians face up to 5% Medicare
payment reductions and hospitals risk loss of meaningful use status. Options A, C, and
D are not HTI-2 disincentives.
Question 8
Which data elements were newly added to USCDI Version 4 under the 2026 HTI-2 Final
Rule to advance health equity and patient-centered care?
A. Surgical procedure codes and anesthesia records only
B. Sexual orientation, gender identity, SDOH assessments, exposure to violence, patient
goals/preferences, health insurance information, and advance directive status
C. Billing zip codes and insurance claim denial reasons
D. Physician NPI numbers and facility license identifiers
Correct Answer: B. Sexual orientation, gender identity, SDOH assessments, exposure to
violence, patient goals/preferences, health insurance information, and advance directive
status [CORRECT]
Rationale: USCDI v4 expands data exchange requirements to include sexual orientation,
gender identity, SDOH assessments, exposure to violence, patient goals/preferences,
health insurance information, and advance directive status. Options A, C, and D list
elements not included in the USCDI v4 expansion.
[1B: Definitions & Scope (ANA 2026, NI vs CNIO) - Q9-14]
Question 9
According to the ANA Nursing Informatics Scope and Standards of Practice (2026),
which activity represents the "Diagnosis of Informatics Problems" standard?
A. Installing hardware servers in the hospital data center
B. Analyzing workflow data to identify barriers to EHR documentation efficiency
C. Marketing new software to external vendors
D. Performing direct patient care procedures at the bedside
