Clinical Decision Support

1. What is the primary goal of Clinical Decision Support Systems (CDSS)?

A) Store patient billing info

B) Assist clinicians with evidence-based decisions

C) Manage hospital inventory

D) Schedule appointments

Answer: B
CDSS helps clinicians make informed decisions to improve care.

2. Which of the following is an example of a CDS tool?

A) Drug interaction alerts

B) Payroll software

C) Imaging viewer

D) Patient portal

Answer: A
Alerts about drug interactions are common CDS features.

3. What type of data do CDSS primarily use?

A) Financial data

B) Clinical patient data

C) Marketing data

D) Administrative data
Answer: B
CDSS analyze clinical data to guide decisions.

4. Which of these is a key component of CDS?

A) Knowledge base

B) Billing module

C) Email system

D) Firewall

Answer: A
The knowledge base contains rules and guidelines.

5. What is a ‘trigger’ in CDS?

A) The user login

B) An event that activates CDS recommendations

C) Data encryption method

D) Network error

Answer: B
Triggers prompt the system to provide alerts or advice.

6. Which CDS function helps prevent medication errors?

A) Drug allergy checking

B) Scheduling

C) Billing

D) Reporting

Answer: A
Checking allergies avoids harmful prescriptions.

7. What is a ‘hard stop’ alert in CDS?

A) Alert that can be overridden
B) Alert that must be addressed before continuing

C) Notification of system shutdown

D) Log out prompt

Answer: B
Hard stops require clinician action before proceeding.

8. Which of the following is a challenge in CDS implementation?

A) User resistance

B) Lack of data

C) Over-alerting leading to alert fatigue

D) Both A and C
Answer: D

Resistance and alert fatigue reduce effectiveness.

9. What is alert fatigue?

A) Users ignoring excessive alerts

B) System crash

C) Faster response time

D) High energy consumption

Answer: A
Too many alerts cause clinicians to ignore them.

10. How can CDS improve clinical workflow?

A) Automate routine tasks and provide timely recommendations

B) Slow down decision-making

C) Increase paperwork

D) Disconnect systems

Answer: A
CDS streamlines tasks and informs decisions.

11. Which standard supports CDS content sharing?

A) HL7 Arden Syntax

B) HTTP

C) FTP

D) SMTP

Answer: A

Arden Syntax is used to represent medical logic modules.

12. Which role is crucial in developing CDS content?

A) Clinicians and informaticists

B) Marketing team

C) Network engineers
D) Patients only

Answer: A
Clinicians and informatics experts ensure relevance.

13. What is the difference between passive and active CDS?

A) Passive requires user to seek info; active pushes alerts

B) Passive is faster

C) Active stores data only

D) No difference

Answer: A
Active CDS proactively alerts users; passive requires user action.

14. What type of CDS alert might warn about a dangerous drug dose?

A) Drug dose alert

B) Appointment reminder

C) Billing notification

D) System update

Answer: A
15. What is the function of ‘order sets’ in CDS?

A) Predefined groups of orders to standardize care

B) Random tests

C) Billing codes

D) Data backups

Answer: A
Order sets help standardize clinical pathways.

16. Which CDS feature supports diagnostic decision-making?

A) Differential diagnosis suggestions

B) Insurance claims processing

C) Appointment scheduling
D) Equipment inventory

Answer: A
CDS can suggest diagnoses based on data.

17. What is a key factor for CDS success?

A) High alert frequency

B) Integration into clinical workflow

C) Complex user interface

D) Limited access

Answer: B
Integration ensures CDS is used effectively.

18. What is the role of machine learning in CDS?

A) Automate billing

B) Analyze large datasets to improve predictions

C) Replace clinicians

D) Manage inventory

Answer: B
ML helps CDS learn and improve over time.

19. How does CDS contribute to patient safety?

A) Alerts on contraindications and allergies

B) Delays treatments

C) Ignores patient history

D) Reduces communication

Answer: A

20. What is ‘clinical pathway’ in the context of CDS?

A) A standardized care plan supported by CDS tools

B) Hospital hallway

C) Billing route

D) Data flowchart

Answer: A

21. Which of the following is a CDS knowledge representation method?

A) Arden Syntax

B) JPEG

C) PDF

D) CSV

Answer: A

22. What is the main challenge of maintaining CDS content?

A) Keeping clinical guidelines up to date

B) Running reports

C) Printing orders

D) Scheduling visits

Answer: A

23. How can CDS help reduce healthcare costs?

A) Prevent unnecessary tests and procedures

B) Increase hospital stays

C) Create billing errors

D) Slow down care

Answer: A

24. What does ‘alert override’ mean in CDS?

A) Ignoring or dismissing alerts

B) System crash

C) Alert sound

D) User login
Answer: A

25. What is the purpose of CDS evaluation?

A) Assess impact on clinical outcomes and usability

B) Delete data

C) Schedule appointments

D) Encrypt files

Answer: A

26. What is a “medical logic module” (MLM) in CDS?

A) A hardware component

B) A unit of medical knowledge encoded for CDS

C) Patient data record

D) Billing code

Answer: B
MLMs contain rules or logic for decision support.

27. Which of the following is an example of context-aware CDS?

A) Alerts based on patient age and condition

B) Generic system updates

C) Random alerts
D) Billing notifications

Answer: A
Context-aware CDS tailors alerts to specific patient data.

28. What is the role of natural language processing (NLP) in CDS?

A) Convert clinical notes into structured data

B) Encrypt data

C) Manage appointments

D) Backup data

Answer: A
NLP extracts usable data from free-text notes.
29. Which CDS alert type is considered most interruptive?

A) Soft-stop alert
B) Hard-stop alert
C) Informational alert

D) Silent alert

Answer: B
Hard-stop alerts require immediate user action.

30. What is the risk of poorly designed CDS alerts?

A) Improved care

B) Alert fatigue and ignored warnings

C) Faster documentation

D) Increased user satisfaction

Answer: B

31. Which factor enhances user acceptance of CDS?

A) Frequent irrelevant alerts

B) User involvement in CDS design

C) Complex interfaces

D) Lack of training

Answer: B

32. How does CDS help with clinical guidelines adherence?

A) Ignoring guidelines

B) Embedding guidelines into alerts and order sets

C) Increasing paperwork

D) Disabling alerts

Answer: B

33. What is a common source of knowledge for CDS?

A) Clinical practice guidelines

B) Patient financial data

C) Marketing surveys

D) Social media
Answer: A

34. Which CDS tool supports preventive care?

A) Reminders for screenings and immunizations

B) Billing reports

C) Equipment checklists

D) Staff schedules
Answer: A

35. How can CDS improve medication reconciliation?

A) Ignoring patient medications

B) Highlighting discrepancies between current and past meds

C) Deleting medication lists

D) Delaying prescriptions

Answer: B

36. What is the purpose of CDS “order sets”?

A) To standardize and speed up order entry

B) To randomize tests

C) To delay care

D) To encrypt data

Answer: A

37. What role does user feedback play in CDS?

A) None

B) Essential for improving CDS effectiveness and usability

C) Confuses developers

D) Decreases system security

Answer: B

38. What is the impact of CDS on diagnostic errors?

A) Increase errors
B) Help reduce errors by providing decision support

C) No impact

D) Delay diagnosis

Answer: B

39. What is the difference between knowledge-based and non-knowledge-based CDS?

A) Knowledge-based uses explicit rules; non-knowledge-based uses AI/machine learning

B) No difference

C) One stores billing data

D) One is hardware

Answer: A

40. How does CDS affect clinical documentation?

A) No effect

B) Can improve completeness and accuracy through prompts

C) Decreases data quality
D) Removes notes

Answer: B

41. What is the role of CDS in population health management?

A) No role

B) Identifying at-risk populations and suggesting interventions

C) Only billing

D) Scheduling

Answer: B

42. Which of these is a limitation of CDS?

A) Perfect accuracy

B) Dependence on quality data and system design

C) No user training needed

D) Unlimited budgets
Answer: B

43. How does CDS support evidence-based medicine?

A) By ignoring guidelines

B) By integrating current research and recommendations into clinical workflow

C) By increasing paperwork

D) By removing clinical decisions

Answer: B

44. What is “clinical context” in CDS?

A) Patient data and situation that influence decision support

B) Billing codes

C) Software version

D) Network status

Answer: A

45. How can CDS improve patient outcomes?

A) By providing timely, relevant clinical information and alerts

B) Slowing decisions

C) Ignoring patient history

D) Increasing errors

Answer: A

46. What is the main reason for CDS alert overrides?

A) Alert irrelevance or poor timing

B) System error

C) User error only

D) No overrides allowed

Answer: A
47. How can CDS help reduce healthcare costs?

A) By promoting unnecessary tests

B) By reducing errors, redundant tests, and adverse events

C) By increasing hospital stays

D) By ignoring insurance policies

Answer: B

48. What is a “clinical reminder” in CDS?

A) Notification for needed preventive or follow-up care

B) Billing deadline

C) Staff meeting alert

D) Equipment maintenance
Answer: A

49. What is a key component for successful CDS implementation?

A) Ignoring user feedback

B) Ongoing monitoring and evaluation

C) No training
D) Random alerts

Answer: B

50. How do CDS systems evolve over time?

A) Static, never updated

B) Updated with new guidelines, user feedback, and technology advances

C) Deleted after use

D) Replaced yearly

Answer: B

51. The primary purpose of CDSS is to:

A) Replace clinicians

B) Limit patient data access

C) Enhance decision-making with knowledge & info

D) Entertain patients
Answer: C

52. A false statement about CDSS:

A) Decreases quality of patient care

B) Manages clinical complexity

C) Supports clinical research

D) Monitors clinical details

Answer: A

53. A health maintenance alert in CDSS could be:

A) Annual Pap smear reminder

B) Seasonal flu alert

C) Sequential DTaP schedule

D) “Don’t be late for dinner”

Answer: D is not meaningful

54. CDSS relies on the principle that bad input → bad output, known as:

A) GIGO

B) PIIO

C) RERO

D) NANA

Answer: A. “Garbage In, Garbage Out”

55. Core components of CDSS include (choose three):

A) Knowledge base

B) Reasoning (inference) engine

C) User interface
D) Laboratory hardware

Answer: A, B & C

56. A Decision Support System (DSS) is:

A) A transactional system

B) A computer application supporting decisions

C) An executive reporting tool

D) None of the above

Answer: B. Decision‑making support app

57. Core components of a DSS include:

I. User interface

II. Knowledge engine

A) I only

B) II only

C) Neither

D) Both

Answer: D. Both UI & knowledge engine

58. “Garbage In, Garbage Out” in CDSS refers to:

A) Poor system design

B) Inaccurate data leads to inaccurate output

C) Clinicians enter garbage data

D) System filters out bad data

Answer: B. Inaccurate data → inaccurate output

1. Which of the following is NOT one of the “Five Rights” of CDS?

A) Right Patient
B) Right Time
C) Right Channel
D) Right Format
Answer: A) Right Patient
2. What is the main technical challenge of CDS implementation?
A) Nurse training
B) Alert fatigue
C) Complex rules needing IT expertise
D) Medical insurance
Answer: C) Complex rules needing IT expertise

3. Which organization developed the FHIR standard for CDS?

A) HIMSS
B) HL7
C) AHRQ
D) ONC
Answer: B) HL7

4. Which of the following is a benefit of CDS?

A) Increased hospital stay
B) Improved patient safety
C) Higher healthcare costs
D) Reduced alert fatigue
Answer: B) Improved patient safety

5. What are the requirements for developing a Clinical Decision Support System?
A. A robust EMR system
B. Support and commitment
C. Standardized workflows
D. Constant maintenance and updating
E. Understanding your institution’s scope
F. All of the above
Answer: F) All of the above

6. Which is a FALSE statement about CDSS?

A. Manages clinical complexity
B. Decreases the quality of patient care
C. Supports clinical research
D. Monitors clinical details
Answer: B) Decreases the quality of patient care

7. What kind of warnings appear with CDSS?

A. Drug-to-food interaction
B. Drug-to-drug interaction
C. Non‑formulary drugs
D. Labs due
E. Allergies
F. All of the above
Answer: F) All of the above

8. What are the problems with CDSS?

A. Alert fatigue caused by numerous pop-ups
B. Great patient satisfaction
C. A second set of eyes
D. Best practice advisories
Answer: A) Alert fatigue caused by numerous pop-ups

9. What is NOT a health maintenance alert that appears on CDSS?

A. Annual Pap smear
B. Seasonal flu
C. Sequential DTaP
D. “Don’t be late for dinner”
Answer: D) “Don’t be late for dinner”

10. Without CDSS, what could occur?

A. Duplicate orders
B. Medication errors
C. Wrong diagnosis
D. “I’m the doctor” mentality
E. All of the above
Answer: E) All of the above

11. Why do we need CDSS?

A. Healthcare is an ever‑changing body of knowledge
B. Dr. Barton Schmitt said so
C. I don’t know
Answer: A) Healthcare is an ever‑changing body of knowledge

12. How can nurse administrators positively influence staff about CDSS?
A. Involve nursing staff in design
B. Improve communication
C. Provide competency training
D. Fire laggards
E. 1, 2, & 3 are correct
Answer: E) 1, 2, & 3 are correct

13. What are the benefits of CDSS?

A. Cost savings
B. Increased patient safety
C. Less time analyzing data
D. Better quality care and outcomes
E. All of the above
Answer: E) All of the above
prep, each with clear answers and explanations:

14. What are the three essential components of a CDSS?

A) Interface, network, memory
B) Knowledge base, reasoning engine, user interface
C) Database, storage, CPU
D) Sensor, analytics, dashboard
Answer: B) Knowledge base, reasoning engine, user interface — these are the core
elements needed for CDSS to function effectively .

15. Which statement best describes the role of CDSS for nurses or clinicians?
A) Makes all decisions automatically
B) Provides expert options; clinician makes final call
C) Only monitors billing codes
D) Replaces clinical judgment entirely
Answer: B) Provides expert options; clinician makes final call — CDSS supports, not
supplants, clinician decisions .

16. Which of these tools is not typically part of CDSS?

A) Alerts and reminders
B) Diagnostic support
C) Travel booking system
D) Clinical guidelines
Answer: C) Travel booking system — it's unrelated to clinical workflows .

17. What is the primary purpose of modern Clinical Decision Support systems?
A) To reduce clinicians to paper-pushers
B) To automatically treat patients
C) To provide relevant patient-specific information to aid care
D) To generate billing invoices
Answer: C) To provide relevant patient-specific information to aid patient management .
18. The main benefit of CDSS is:
A) Increased paperwork
B) Reduced clinician knowledge
C) Improved safety and quality of care
D) Travel assistance
Answer: C) Improved safety and quality of care — CDSS offers alerts, evidence-based
guidance, and workflows to support better outcomes .
19. Which is a common CDSS pitfall?
A) Empowering clinician autonomy
B) Alert fatigue
C) Enhanced data integration
D) Improved patient outcomes
Answer: B) Alert fatigue — Repetitive alerts can overwhelm and lead to dismissal .

20. An effective CDSS maintains clinician autonomy by:

A) Forcing protocol adherence
B) Banning overrides
C) Allowing clinicians to adapt or dismiss suggestions
D) Ignoring clinician preferences
Answer: C) Allowing clinicians to adapt or dismiss suggestions — This ensures they remain
in control .

21. Core components of a CDSS include all EXCEPT:

A) Knowledge base
B) Reasoning engine
C) User interface
D) Billing automation
Answer: D) Billing automation — CDSS focuses on clinical, not billing, functionalities.