Chapter 15- Evaluating

Which activity is a possible solution for inadequate nursing staffing?

Identify the kind and amount of nursing services required.

Nurses have identified the following outcome in the care of a client who is recovering from a stroke: "Client will ambulate 100 feet without the use of mobility aids by 12/12/2011." Several nurses have evaluated the client's progression towards this outcome at various points during her care. Which of the following evaluative statements is most appropriate?

"12/12/2011 - Outcome partially met. Patient ambulated 75 feet without the use of mobility aids"

The correct sequence of steps for performance improvement is: 1. Discover a problem. 2. Plan a strategy using indicators. 3. Implement a change. 4. Assess the change.

1, 2, 3, 4

The nurse participates in a quality assurance program. Data from the previous year indicates a 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery. The nurse recognizes this is which type of evaluation?

Outcome evaluation

A nurse in a community health center has been having regular meetings with a woman who wants to stop smoking. Which of the following outcome decision options would the nurse document if the woman has not smoked for three months?

Outcome met

Nursing care and client outcomes may be evaluated by use of a retrospective evaluation process. Which of the following is an example of a retrospective evaluation process?

Postdischarge questionnaire.

The nurse is preparing to mail a client satisfaction questionnaire to a client who was discharged from the hospital four days ago. Which type of evaluation is the nurse conducting?

Retrospective evaluation

The nurse participates in a quality assurance program and reviews evaluation data for the previous month. Which of the following does the nurse recognize as an example of process evaluation?

A nursing care plan was developed within the eight hours of admission for 97% of all admissions.

The nurse is giving a shift report to the oncoming nurse who will be caring for a client with a portacath access device. The oncoming nurse states, I have never taken care of a client with a portacath. Would you give me the basics, so I know what to do? Which standard for establishing and sustaining healthy work environments is the oncoming nurse breaching?

Appropriate staffing

A nurse is educating a client on how to administer insulin, with the expected outcome that the client will be able to self-administer the insulin injection. How would this outcome be evaluated?

Asking the client to demonstrate self-injection of insulin

The nurse is caring for the client with pneumonia. An expected client outcome is, The client will maintain adequate oxygenation by discharge. Which outcome criterion indicates the goal is met?

Client no longer requires oxygen.

Which activity does the nurse perform during the evaluating stage? Select all that apply.

Collects data to determine the number of catheter-associated infections on the nursing unit. Increases the frequency of repositioning from every two hours to every one hour.

An older adult client has lost significant muscle mass during her recovery from a systemic infection. As a result, she has not yet met the outcomes for mobility and activities of daily living that are specified in her nursing plan of care. How should her nurses best respond to this situation?

Continue the plan of care with the aim of helping the client achieve the outcomes.

A nurse is interested in improving client care on the unit through performance improvement. What is the first step in this process?

Discover the problem.

A nurse is evaluating and revising a plan of care for a client with cardiac catheterization. Which of the following actions should the nurse perform before revising a plan of care?

Discuss any lack of progress with the client.

The nurse is caring for a client who is experiencing an asthma attack. Ten minutes after administering an inhaled bronchodilator to the client, the nurse returns to ask if the client's breathing is easier. The nurse is engaging in which phase of the nursing process?

Evaluating

An expected client outcome is, The client will remain free of infection by discharge. When evaluating the client's progress, the nurse notes the client's vital signs are within normal limits, the white blood cell count is 12,000, and the client's abdominal wound has a half-inch gap at the lower end with yellow-green discharge. Which statement would be an appropriate evaluation statement?

Goal not met; white blood cell count elevated, presence of yellow-green discharge from wound.

Upon evaluation of the client's plan of care, the nurse determines that the expected outcomes have been achieved. Based upon this response, the nurse will do what?

Terminate the plan of care.

Which client outcome is a physiologic outcome? Select all that apply.

The client's HA1c is 7.4%. The client's blood pressure is 118/74. The client rates his or her pain rating as 6.

A nurse forgets to raise the bed railings of a client who is confused after taking pain medications. The client attempts to get out of bed, and suffers a minor fall. The nurse asks a colleague who witnessed the fall not to mention it to anyone because the client only had minor bruises. What would be the appropriate action of the colleague?

The colleague should inform the nurse that a full report of the incident needs to be made.

The manager of a medical unit regularly reviews the incident reports that result from errors and near misses that occur on the unit. How should the manager best respond to these incident reports?

Use them to inform improvements and education on the unit.

When a charge nurse evaluates the need for additional staff nurses and additional monitoring equipment to meet the client's needs, the charge nurse is performing an evaluation termed ...

structure evaluation

The client reports participating in water aerobics for 60 minutes three times each week. This is an example of what type of outcome?

Affective outcome

A nurse working in a hospital setting discovers problems with the delivery of nursing care on the pediatric unit. Which of the following suggestions from the Institute of Medicine's Committee on Quality of Health Care in America (Kohn, Corrigan, & Donaldson, 2000) could help redesign and improve care? Select all that apply.

Base care on continuous healing relationships. Share knowledge and allow for free flow of information. Practice evidence-based decision making.

A nurse is evaluating the outcomes of a plan of care to teach an obese client about the calorie content of foods. What type of outcome is this?

Cognitive

Which activity does the nurse engage in during evaluation? Select all that apply.

Collect data to determine whether desired outcomes are met. Assess the effectiveness of planned strategies. Adjust the time frame to achieve the desired outcomes.

The client's expected outcome is The client will maintain skin integrity by discharge. Which of the following measures is best in evaluating the outcome?

Condition of the skin over bony prominences.

What cognitive processes must the nurse use to measure client achievement of outcomes during evaluation?

Critical thinking

A nurse is counseling a novice nurse who gives 150% effort at all times and is becoming frustrated with a health care system that provides substandard care to clients. Which of the following advice would be appropriate in this situation? Select all that apply.

Encourage the new nurse to leave her problems at work behind, instead of rehashing them at home. After establishing a reputation for delivering quality nursing care, have her seek creative solutions for nursing problems. Tell her to view nursing care concerns as challenges rather than overwhelming obstacles, and seek help for solutions.

The nurse assesses urine output following administration of a diuretic. Which step of the nursing process does this nursing action reflect?

Evaluation

The nurse has responded to a client's request to view her medical chart by arranging a meeting between the client, the clinical nurse leader, and her primary care physician. The nurse is exemplifying which of the following characteristics of quality health care?

Information

The client's pulse oximetry reading is 97% on room air 30 minutes after removal of a nasal cannula. This is an example of what type of outcome?

Physiologic outcome

When a nursing supervisor evaluates the staff nurse's performance with a group of clients to whom the staff nurse has provided nursing care, the supervisor is performing which type of evaluation?

Process evaluation

The nurse witnessed a more senior nurse make six unsuccessful attempts at starting an intravenous (IV) line on a client. The senior nurse persisted, stating, "I refuse to admit defeat." This resulted in unnecessary pain for the client. How should the first nurse best respond to this colleague's incompetent practice?

Report the nurse's practice and have the nurse manager address the matter.