CHAMBERLAIN COLLEGE OF NURSING NR 599
NURSING INFORMATICS FOR ADVANCED
PRACTICE Actual MIDTERM EXAMINATION 2026
– A+ Caliber Review
DOMAIN 1: ETHICAL-THEORETICAL SYNTHESIS (Questions 1-15)
Q1: A Family Nurse Practitioner in a federally qualified health center discovers the
clinic's new social determinants of health (SDOH) screening module in the EHR is
collecting data on immigration status without explicit patient consent or clear clinical
purpose. The data auto-populates a dashboard visible to all clinic staff. The clinic
director argues this helps "identify resource needs." Applying ANA Standards 7 (Ethics)
and 9 (Professional Practice Evaluation) with the DIKW model, what is the most ethically
defensible and professionally responsible initial action?
A. Immediately disable the SDOH module and purge all collected data to protect patient
privacy, then report the violation to the Office for Civil Rights.
B. Conduct an audit to determine which patients have been affected, document the
finding in each medical record, and continue using the module while seeking legal
counsel.
C. Collaborate with the informatics team to modify the module: require explicit opt-in
consent, limit access to need-to-know providers, and define clear clinical use cases for
each data element before reactivating.
D. Use the data proactively to connect undocumented patients with community
resources while working on long-term consent solutions, arguing beneficence
outweighs autonomy concerns in vulnerable populations.
,Correct Answer: C
STANDARD ALIGNMENT:
• Primary: ANA Standard 7 (Ethics) - "The nurse informaticist practices with compassion
and respect for the inherent dignity, worth, and unique attributes of every person."
Requires protecting autonomy through informed consent.
• Secondary: ANA Standard 9 (Professional Practice Evaluation) - "The nurse
informaticist evaluates her or his own practice..." Mandates assessing and improving
system implementations.
CONCEPT INTEGRATION:
1. DIKW Model - Recognizes that improperly collected data (immigration status)
cannot ethically become information or knowledge. Requires rebuilding from
ethical foundation.
2. Regulatory Synthesis - Balances HIPAA requirements, 21st Century Cures Act
interoperability goals, and ethical consent principles.
3. Systems Thinking - Addresses module design, access controls, and clinical
workflow simultaneously rather than isolated fixes.
CLINICAL JUDGMENT PATHWAY:
• Cues Recognized: Non-consensual data collection, sensitive immigration data, broad
access, unclear clinical utility.
• Analysis Performed: Weighed ethical principles (autonomy vs beneficence), regulatory
requirements, and practical implementation realities.
• Priority Established: Patient autonomy and consent as foundational; cannot build
ethical practice on unethical data collection.
• Action Rationale: Modifying the system addresses root cause while preserving
potential benefits; immediate disablement (A) loses beneficial SDOH function; passive
documentation (B) continues harm; paternalistic beneficence (D) violates core ethical
principles.
A+ DISTINCTION:
This answer demonstrates A+ level performance because it:
• Moves beyond binary "use/don't use" to system redesign
• Anticipates implementation challenges (access controls, use cases)
,• Balances competing ethical principles with practical solutions
• Exercises professional leadership through collaboration rather than unilateral action
Q2: A Psychiatric-Mental Health NP implementing a new AI suicide risk prediction tool
discovers its algorithm shows racial bias in validation studies, with 30% lower sensitivity
for Black patients. The tool goes live in 48 hours. The clinical director insists on
implementation due to grant funding requirements. Applying ANA Standards 7 (Ethics)
and 12 (Leadership) with algorithmic justice principles, what is the most professionally
responsible course of action?
A. Support immediate implementation while adding a clinical rule to manually increase
monitoring for Black patients to compensate for algorithmic bias.
B. Refuse to participate in implementation and file a whistleblower complaint with the
Office for Civil Rights regarding discriminatory technology.
C. Advocate for delayed implementation pending algorithmic revalidation with diverse
datasets, while simultaneously developing clinical protocols that ensure equitable
screening regardless of AI output.
D. Implement the tool only for non-Black patients to ensure safety for populations where
it is validated.
Correct Answer: C
STANDARD ALIGNMENT:
• Primary: ANA Standard 7 (Ethics) - Mandates addressing health disparities and
ensuring equitable care.
• Secondary: ANA Standard 12 (Leadership) - "The nurse informaticist leads within the
professional practice setting and the profession."
CONCEPT INTEGRATION:
1. Algorithmic Bias Detection - Recognition that AI tools can perpetuate structural
racism through training data bias.
2. Health Equity Framework - Understanding that disparate impact constitutes
ethical violation even if unintentional.
, 3. Implementation Science - Balancing funding requirements with patient safety
through phased approach.
CLINICAL JUDGMENT PATHWAY:
• Cues Recognized: Racial bias in validation, impending deadline, institutional pressure,
patient safety implications.
• Analysis Performed: Differentiated between individual patient harm (immediate) and
institutional repercussions (delayed), prioritized equity.
• Priority Established: Preventing discriminatory care while maintaining institutional
relationships for long-term change.
• Action Rationale: Delay with concurrent safety protocols addresses bias without
abandoning patients; manual compensation (A) institutionalizes bias; refusal (B)
abdicates leadership role; exclusionary implementation (D) creates illegal segregation.
A+ DISTINCTION:
• Navigates institutional pressure while maintaining ethical stance
• Proposes constructive alternative rather than obstruction
• Addresses both immediate safety (clinical protocols) and long-term equity
(revalidation)
• Demonstrates leadership through negotiation and protocol development
Q3: A Gerontological NP in a memory care facility is evaluating a new "wander
prevention" system using RFID tags and geofencing. The system alerts staff when
residents approach exits. Family councils express concerns about dignity and
"electronic restraint." The vendor demonstrates 40% reduction in elopement incidents at
pilot sites. Applying HTI usability principles and ANA Standard 1 (Assessment), which
evaluation approach represents best practice for ethical technology adoption?
A. Implement system-wide immediately due to demonstrated safety benefits, while
creating a consent process for future residents.
B. Conduct a phased pilot with consenting residents/families, comparing outcomes
while systematically assessing dignity impacts through resident interviews and family
feedback.
C. Reject the system as inherently dehumanizing, advocating instead for increased
staffing and environmental modifications despite higher costs.
NURSING INFORMATICS FOR ADVANCED
PRACTICE Actual MIDTERM EXAMINATION 2026
– A+ Caliber Review
DOMAIN 1: ETHICAL-THEORETICAL SYNTHESIS (Questions 1-15)
Q1: A Family Nurse Practitioner in a federally qualified health center discovers the
clinic's new social determinants of health (SDOH) screening module in the EHR is
collecting data on immigration status without explicit patient consent or clear clinical
purpose. The data auto-populates a dashboard visible to all clinic staff. The clinic
director argues this helps "identify resource needs." Applying ANA Standards 7 (Ethics)
and 9 (Professional Practice Evaluation) with the DIKW model, what is the most ethically
defensible and professionally responsible initial action?
A. Immediately disable the SDOH module and purge all collected data to protect patient
privacy, then report the violation to the Office for Civil Rights.
B. Conduct an audit to determine which patients have been affected, document the
finding in each medical record, and continue using the module while seeking legal
counsel.
C. Collaborate with the informatics team to modify the module: require explicit opt-in
consent, limit access to need-to-know providers, and define clear clinical use cases for
each data element before reactivating.
D. Use the data proactively to connect undocumented patients with community
resources while working on long-term consent solutions, arguing beneficence
outweighs autonomy concerns in vulnerable populations.
,Correct Answer: C
STANDARD ALIGNMENT:
• Primary: ANA Standard 7 (Ethics) - "The nurse informaticist practices with compassion
and respect for the inherent dignity, worth, and unique attributes of every person."
Requires protecting autonomy through informed consent.
• Secondary: ANA Standard 9 (Professional Practice Evaluation) - "The nurse
informaticist evaluates her or his own practice..." Mandates assessing and improving
system implementations.
CONCEPT INTEGRATION:
1. DIKW Model - Recognizes that improperly collected data (immigration status)
cannot ethically become information or knowledge. Requires rebuilding from
ethical foundation.
2. Regulatory Synthesis - Balances HIPAA requirements, 21st Century Cures Act
interoperability goals, and ethical consent principles.
3. Systems Thinking - Addresses module design, access controls, and clinical
workflow simultaneously rather than isolated fixes.
CLINICAL JUDGMENT PATHWAY:
• Cues Recognized: Non-consensual data collection, sensitive immigration data, broad
access, unclear clinical utility.
• Analysis Performed: Weighed ethical principles (autonomy vs beneficence), regulatory
requirements, and practical implementation realities.
• Priority Established: Patient autonomy and consent as foundational; cannot build
ethical practice on unethical data collection.
• Action Rationale: Modifying the system addresses root cause while preserving
potential benefits; immediate disablement (A) loses beneficial SDOH function; passive
documentation (B) continues harm; paternalistic beneficence (D) violates core ethical
principles.
A+ DISTINCTION:
This answer demonstrates A+ level performance because it:
• Moves beyond binary "use/don't use" to system redesign
• Anticipates implementation challenges (access controls, use cases)
,• Balances competing ethical principles with practical solutions
• Exercises professional leadership through collaboration rather than unilateral action
Q2: A Psychiatric-Mental Health NP implementing a new AI suicide risk prediction tool
discovers its algorithm shows racial bias in validation studies, with 30% lower sensitivity
for Black patients. The tool goes live in 48 hours. The clinical director insists on
implementation due to grant funding requirements. Applying ANA Standards 7 (Ethics)
and 12 (Leadership) with algorithmic justice principles, what is the most professionally
responsible course of action?
A. Support immediate implementation while adding a clinical rule to manually increase
monitoring for Black patients to compensate for algorithmic bias.
B. Refuse to participate in implementation and file a whistleblower complaint with the
Office for Civil Rights regarding discriminatory technology.
C. Advocate for delayed implementation pending algorithmic revalidation with diverse
datasets, while simultaneously developing clinical protocols that ensure equitable
screening regardless of AI output.
D. Implement the tool only for non-Black patients to ensure safety for populations where
it is validated.
Correct Answer: C
STANDARD ALIGNMENT:
• Primary: ANA Standard 7 (Ethics) - Mandates addressing health disparities and
ensuring equitable care.
• Secondary: ANA Standard 12 (Leadership) - "The nurse informaticist leads within the
professional practice setting and the profession."
CONCEPT INTEGRATION:
1. Algorithmic Bias Detection - Recognition that AI tools can perpetuate structural
racism through training data bias.
2. Health Equity Framework - Understanding that disparate impact constitutes
ethical violation even if unintentional.
, 3. Implementation Science - Balancing funding requirements with patient safety
through phased approach.
CLINICAL JUDGMENT PATHWAY:
• Cues Recognized: Racial bias in validation, impending deadline, institutional pressure,
patient safety implications.
• Analysis Performed: Differentiated between individual patient harm (immediate) and
institutional repercussions (delayed), prioritized equity.
• Priority Established: Preventing discriminatory care while maintaining institutional
relationships for long-term change.
• Action Rationale: Delay with concurrent safety protocols addresses bias without
abandoning patients; manual compensation (A) institutionalizes bias; refusal (B)
abdicates leadership role; exclusionary implementation (D) creates illegal segregation.
A+ DISTINCTION:
• Navigates institutional pressure while maintaining ethical stance
• Proposes constructive alternative rather than obstruction
• Addresses both immediate safety (clinical protocols) and long-term equity
(revalidation)
• Demonstrates leadership through negotiation and protocol development
Q3: A Gerontological NP in a memory care facility is evaluating a new "wander
prevention" system using RFID tags and geofencing. The system alerts staff when
residents approach exits. Family councils express concerns about dignity and
"electronic restraint." The vendor demonstrates 40% reduction in elopement incidents at
pilot sites. Applying HTI usability principles and ANA Standard 1 (Assessment), which
evaluation approach represents best practice for ethical technology adoption?
A. Implement system-wide immediately due to demonstrated safety benefits, while
creating a consent process for future residents.
B. Conduct a phased pilot with consenting residents/families, comparing outcomes
while systematically assessing dignity impacts through resident interviews and family
feedback.
C. Reject the system as inherently dehumanizing, advocating instead for increased
staffing and environmental modifications despite higher costs.
