Chapter 18: Evaluating

Which is a psychomotor client goal?

By 18AUG2015, the client will demonstrate improved motion in the left arm.

The nurse is reassessing a client with leukemia who has received several packed red blood cell transfusions over the past week. Which question should the nurse ask the client to evaluate the treatment?

Have you had any fevers?

One of the outcomes that has been identified in the care of a client with a new suprapubic catheter is that he will demonstrate the correct technique for cleaning his insertion site and changing his catheter prior to discharge. When should this outcome be evaluated?

throughout the client's hospital admission

A nurse manager tends to use the quality by inspection method of ensuring quality on the unit. Which actions, taken by this manager, are evidence of use of this technique? Select all that apply.

- The manager threatens to "write up" a nurse if the nurse is late to work again. - The nurse requests transfer off the unit for a nurse who has made three medication errors in three months.

Which characteristic is the most important indicator of high-quality nursing practice?

The nurse considers the individual needs of clients.

Priority setting is based on the information obtained during reassessment and is used to rank nursing diagnoses. Each factor contributes to priority setting except which?

Finances of the client

A group of nurses on the orthopedic floor of a hospital wish to improve their clinical performance. The nurse manager suggests a program in which the nurses will evaluate each other and provide feedback for improved performance. This program is termed:

Peer review

A mother brings an infant into the clinic for a well-baby visit. The mother reports being concerned at discharge from the hospital after giving birth about being able to get the infant to latch on for breastfeeding. Now, however, the mother reports success with breastfeeding. and the nurse finds that the baby is gaining weight appropriately. Which is an appropriate evaluative statement for this client?

"8FEB2016. Goal met. Mother reports that breastfeeding is going well with the infant eating every 2-3 hours and attaching to the nipple easily. Infant is gaining weight."

Which are components of an evaluative statement? Select all that apply.

-Description of how the client outcome was met -Client data that support how the outcome was met

Which are psychomotor outcomes? Select all that apply. -The client accurately draws up insulin. -The client safely ambulates using a walker. -The client identifies signs and symptoms of infection. -The client rates pain as a 2 on a 0 to 10 pain rating scale. -The client reports increased confidence in testing blood glucose level.

-The client accurately draws up insulin. -The client safely ambulates using a walker. Explanation: Examples of psychomotor outcomes include accurately drawing up insulin and ambulating safely using a walker. Identifying signs and symptoms of infection is an example of a cognitive outcome. Rating pain as a 2 on a 0 to 10 scale is a physiologic outcome. An example of an affective outcome is reporting increased confidence in testing blood glucose level.

A nurse manager tends to use the quality by inspection method of ensuring quality on the unit. Which actions, taken by this manager, are evidence of use of this technique? Select all that apply. -The manager threatens to "write up" a nurse if the nurse is late to work again. -The manager never participates in birthday or holiday celebrations with staff. -The manager holds an education session on use of a new piece of equipment when several nurses have difficulty with the skills. -The nurse requests transfer off the unit for a nurse who has made three medication errors in three months. -The nurse tries to make client rounds with the health care providers every morning.

-The manager threatens to "write up" a nurse if the nurse is late to work again. -The nurse requests transfer off the unit for a nurse who has made three medication errors in three months. Explanation: Quality by inspection focuses on finding deficient workers and removing them. Quality as opportunity focuses on finding opportunities for improvement and fosters an environment that thrives on teamwork. Holding education sessions regarding problem-prone procedures reflects this technique. Not participating in celebrations and making client rounds are not related to either quality style.

A nurse caring for an older adult client who has dementia observes another nurse putting restraints on the client without a physician's order. The client is agitated and not cooperating. What would be the best initial action of the first nurse in this situation?

Confront the nurse and explain how this could be dangerous for the client.

The nurse on a busy acute care floor identifies that several clients with heart failure are being readmitted within 2 weeks of discharge. Which step in performance improvement is the nurse demonstrating?

Discovering a problem

Before discharge the client will demonstrate aseptic dressing changes. This is an example of which type of evaluative statement?

Psychomotor

A client who was admitted to the acute care unit with angina pectoris is no longer having chest pain. Based on this assessment, what does the nurse decide to do with the plan of care for chest pain?

Terminate the plan of care related to the nursing diagnosis of chest pain.

The nurse is assessing the client's behavioral response to a nursing intervention. This type of evaluation is known as:

outcome evaluation.

A nurse manager is conducting peer reviews of the staff on the critical care unit. Which person would the nurse manager select to evaluate a registered nurse who is certified in critical care?

Another registered nurse with critical care certification

Which nursing action reflects evaluation? -The nurse identifies that the client does not tolerate activity. -The nurse sets a tolerable pain rating with the client. -The nurse auscultates the client's lungs and abdomen. -The nurse assesses urine output following administration of a diuretic.

The nurse assesses urine output following administration of a diuretic. Explanation: Assessing the client's response to a diuretic medication is an example of evaluation. Recognition of a client health problem that can be prevented or resolved by independent nursing intervention, such as activity intolerance, is the focus of diagnosing. Auscultating the client's lungs and abdomen is an example of assessment. Setting a tolerable pain rating with the client is an example of planning.

A new mother is having difficulty breastfeeding a newborn infant. A goal was established stating that the baby would be nursing every 2 to 3 hours by age 1 week. The mother presents to the follow-up center at 1 week and reports having discontinued breastfeeding. The nurse evaluates the original goal as:

completely unmet.

The nursing supervisor is evaluating how many clients each of the department nurses has been assigned for the shift. This type of evaluation would be considered:

structure.

Which action is appropriate when evaluating a client's responses to a plan of care? -Reinforce the plan of care when each expected outcome is achieved. -Terminate the plan if there are difficulties achieving the goals/outcomes. -Terminate the plan of care upon client discharge. -Continue the plan of care if more time is needed to achieve the goals/outcomes.

Continue the plan of care if more time is needed to achieve the goals/outcomes. Explanation: The client's goals/outcomes sometimes are not met or partially met only because more time is needed for the plan of care to be effective. It is not necessary to reinforce the plan of care when each expected outcome is achieved because as goals are met, the plan can simply continue to the next goal. Termination of the plan is not warranted due to difficulties in achieving goals/outcomes; modifications to the plan of care may only be required. The plan of care may continue past discharge if necessary.

A client comes into the clinic for a routine postoperative visit. While the nurse is assessing the level of pain, the client states that there is occasional discomfort but that pain levels have improved daily since returning home from the hospital. What should the nurse's response be regarding the client's plan of care? -Terminate the plan of care. -Continue the plan of care. -Promptly modify the plan of care. -Suggest increasing the pain medication.

Continue the plan of care. Explanation: The nurse should continue the plan of care, as the client is progressing toward the ultimate outcome—the healing of the surgical site. There is no need to modify the plan, as the client is responding. The client is still having some pain, so it would not be appropriate to discontinue the plan of care. With the improvement in the client's pain, there is no need to increase pain medication; the nurse should just remind the client to take it when pain is uncomfortable.

"The client will verbalize appropriate cast care on discharge" represents which type of outcome?

Cognitive

The nurse is caring for a postoperative client who reports ineffective pain management with pain rated a 7 on a 0-10 rating scale. Based on the information provided by the client, which step should the nurse take first to modify the care plan?

Evaluate the use of current pain relief measures.

A mother brings an infant into the clinic. The infant is 2 months old and has not been gaining weight appropriately. The outcome statement on the plan of care states, "The infant will double birth weight by 6 months of age." This is an example of which type of outcome statement?

Physical changes

Which are components of an evaluative statement? Select all that apply. -Description of how the client outcome was met -Client's health history -Name of the client's physician -Client data that support how the outcome was met -Client's health insurance information

-Description of how the client outcome was met -Client data that support how the outcome was met Explanation: An evaluative statement includes a description of how the client's outcome was met and the data that support that decision. The name of the physician, information on the client's health insurance, and the client's health history would only be included if they contributed to the client's outcome.

A nurse is evaluating the plan of care for a client in the clinic. Which actions should the nurse perform, as classic elements of evaluation? Select all that apply.

-Interpreting and summarizing findings -Collecting data to determine whether criteria and standards are being met -Terminating, continuing, or modifying the plan of care -Identifying evaluative criteria and standards

A large university hospital has commissioned a multidisciplinary group to review client records following discharge to evaluate client outcomes and the character and quality of nursing care that clients receive. Which type of evaluation process will take place?

A nursing audit

To improve quality care for clients, there are four steps that the nurse recognizes as being crucial for the process. Place them in the correct order. Use all options.

-Discover a problem. -Plan a strategy using indicators. -Implement a change. -Evaluate a change. Explanation: In order to improve quality performance the nurse should discover a problem, plan a strategy using appropriate indicators, implement a change, and evaluate the change.

A nurse is evaluating the plan of care for a client in the clinic. Which actions should the nurse perform, as classic elements of evaluation? Select all that apply. -identifying evaluative criteria and standards -Documenting only the facts related to the plan of care -Collecting data to determine whether criteria and standards are being met -Interpreting and summarizing findings -Terminating, continuing, or modifying the plan of care

-Interpreting and summarizing findings -Terminating, continuing, or modifying the plan of care -Identifying evaluative criteria and standards -Collecting data to determine whether criteria and standards are being met Explanation: The nurse must document findings as they relate to the plan of care but should also include the nurse's judgement as to whether the outcomes are being met. All of the other choices are criteria for evaluation.

Which nursing actions reflect the evaluation stage of the nursing process? Select all that apply.

-The nurse identifies that a client's pain is not being adequately treated. -The nurse documents the client's response to suctioning. -The nurse determines the client did not lose the expected 2 lb (0.90 kg).

A nurse manager is conducting peer reviews of the staff on the critical care unit. Which person would the nurse manager select to evaluate a registered nurse who is certified in critical care? -Another nurse manager -Another registered nurse with critical care certification -One of the staff critical care physicians -Another staff nurse from the medical-surgical unit

Another registered nurse with critical care certification. Explanation: Peer review is the evaluation of one staff member by another staff member on the same level in the hierarchy of the organization. Therefore, another registered nurse who is certified in critical care would be appropriate to evaluate a critical care nurse certified in critical care. A nurse manager and a critical care physician are at a higher level in the hierarchy than a staff nurse certified in critical care. A staff nurse without certification in critical care would also not be appropriate to evaluate a nurse with this certification.

The nurse should evaluate client outcomes at which time? -As early as possible -The day of discharge -Within 24 hours after identifying them -Several days after discharge

As early as possible Explanation: Nurses should evaluate client outcome achievement as early as possible. Celebrating outcome attainment with the client usually helps encourage the client and leads to further outcome achievement. When failure to meet designated outcomes is detected early, the care plan can be modified to remedy the failure. Waiting until the day of discharge may be too late. Evaluating outcomes after the client has been discharged would be difficult. Evaluating outcomes within 24 hours may be too soon or unnecessarily late, depending on the nature of the outcomes.

Which action is appropriate when evaluating a client's responses to a plan of care?

Continue the plan of care if more time is needed to achieve the goals/outcomes.

A nurse is evaluating nursing care and client outcomes by using a retrospective evaluation. Which action would the nurse perform in this approach? -The nurse directly observes the nursing care being provided. -The nurse reviews the client chart while the client is being cared for. -The nurse interviews the client while the client is receiving the care. -The nurse devises a postdischarge questionnaire to evaluate client satisfaction

The nurse devises a postdischarge questionnaire to evaluate client satisfaction. Explanation: Evaluations can be conducted concurrent with care (by using direct observation of nursing care, client interviews, and chart review to determine whether the specified evaluative criteria are met) or retrospectively (postdischarge questionnaires, client interviews by telephone or face to face, or chart review to collect data).

An older adult client who is recovering from a stroke is scheduled to be transferred to the rehabilitation unit in the morning. The client is tearful and reports feeling lonely and abandoned in the hospital unit. The family visits daily, and flowers and cards are in the room. Documentation in the chart indicates that the client's pastor has been by twice in the past week to visit. Which nursing diagnosis and outcome criteria need to be addressed immediately for this client?

Ineffective Coping; verbalizes support systems.

The focus of a hospital's current quality assurance program is a comparison of the health status of clients on admission and with that at the time of discharge. This form of quality assurance is characteristic of: -outcome evaluation. -structure evaluation. -process evaluation. -nursing audit.

outcome evaluation. Explanation: Outcome evaluation focuses on measurable changes in the health status of the client or the end results of nursing care. Whereas the proper environment for care and the right nursing actions are important aspects of quality care, the critical element in evaluating care is demonstrable changes in client health status. Process evaluation addresses performance expectations during the various stages of the nursing process. Structure evaluation addresses the environment of care. A nursing audit focuses on the review of records.

"The levels of performance accepted by and expected of nursing staff or other health team members" defines:

standards.

For a client with a self-care deficit, the long-term goal is that the client will be able to dress oneself by the end of the 6-week therapy. For best results, when should the nurse evaluate the client's progress toward this goal? -When the client is discharged -At the end of the 6-week therapy -Only when the client shows some progress -As soon as possible

As soon as possible Explanation: Evaluating the progress of a long-term goal prior to the end date encourages and motivates the client to continue working toward the goal. Waiting until the client is discharged or at the end of the 6 weeks does not provide the client the opportunity to feel a sense of accomplishment and motivation to continue working toward the goal. Only evaluating when the client shows progress may lead to the client becoming discouraged.

The nurse manager is holding a staff meeting and indicates that the unit is looking at a 3% budget cut for the coming year. The nurse manager asks the staff what they see as priorities for the unit, and solicits suggestions from the staff as to what budget areas might be reduced. Which standard for establishing and sustaining healthy work environments does this action represent? -Effective decision making -Micromanagement -Appropriate staffing -Meaningful recognition

Effective decision making. Explanation: Effective decision making ensures nurses are active, valued partners in making policy, directing and evaluating clinical care, and leading organizational operations. Appropriate staffing ensures that client needs are effectively matched with nurse competencies. Micromanagement would be demonstrated by the manager not asking for opinions and proceeding with decision making without input. Meaningful recognition highlights the value each nurse brings to the work for the organization, such as certification.

The nurse is caring for a client with congestive heart failure. The nurse manager informs the nurse that the client was enrolled in a clinical trial to assess whether a 10-minute walk, 3 times per day, leads to expedited discharge. Which type of evaluation best describes what the researchers are examining?

Outcome

Prior to the first visit following gastrectomy, the client will have a weight loss of 10 lb (4.5 kg). This is an example of which type of evaluative statement? -Cognitive -Psychomotor -Physical changes -Affective

Physical changes Explanation: Physical changes are related to actual body changes in the individual, represented here by the 10-lb (4.50-kg) weight loss. Psychomotor outcomes are related to new skill attainment. Cognitive outcomes are related to achieving greater knowledge. Affective outcomes are related to feelings and attitudes.

A nurse is evaluating the outcome of the plan of care after teaching a client how to prepare and administer an insulin pen. Which type of outcome is the nurse addressing? -Cognitive -Psychomotor -Affective -Physiologic

Psychomotor Explanation: Preparing and administering an insulin pen is a psychomotor outcome. Psychomotor outcomes describes the client's achievement of new skills. Cognitive outcomes describe increase in client knowledge or intellectual behaviors. Affective outcomes describe changes in client values, beliefs, and attitudes. Physiologic outcomes are concerned with how the human body works.

"The client will demonstrate cast care prior to discharge" is which type of evaluative statement? -Psychomotor -Cognitive -Affective -Physical changes

Psychomotor Explanation: This is an example of a psychomotor evaluative statement. Psychomotor outcomes are those that are related to new skill attainment. Cognitive outcomes are related to achieving greater knowledge. Affective outcomes are related to feelings and attitudes. Physical changes are related to actual body changes in the individual.

The nurse manager observes one of the unit nurses failing to wash hands on entering a client room. Hospital protocol is to wash hands before and after entering a client room. This scenario is an example of which approach to quality assurance?

Quality by inspection

Which action should the nurse perform in the evaluation phase? -Carry out treatment procedures. -Set priorities for care. -Record interventions. -Revise the plan of care.

Revise the plan of care. Explanation: The nurse should revise the plan of care during the evaluation phase. It provides the feedback mechanism that starts the entire chain of events again. Setting priorities is part of the planning phase. Carrying out treatment procedures and recording interventions are activities in the implementation phase of the nursing process.

The health care team has convened to discuss the care of an end-of-life client who is not able to achieve an acceptable level of comfort. The physician asks for the nurse's perspective of the situation. Which standard for establishing and sustaining healthy work environments does this action represent? -Skilled communication -Effective decision making -True collaboration -Appropriate staffing

True collaboration. Explanation: This scenario represents true collaboration, as nurses and other health care team members are demonstrating mutual respect, shared responsibility, and shared decision making. Although skilled communication and effective decision making are likely to be involved in true collaboration, these are not the focus of this scenario. There is no evidence of whether staffing is appropriate in this scenario.

The client identifies three strategies for minimizing leakage of an ileostomy bag. This is an example of: -an affective outcome. -a psychomotor outcome. -a physiologic outcome. -a cognitive outcome.

a cognitive outcome. Explanation: Cognitive outcomes demonstrate increases in client knowledge, such as strategies for minimizing leakage of an ileostomy bag. An affective outcome involves changes in the client's values, beliefs, and attitude. Physiologic outcomes are physical changes in the client. Psychomotor outcomes describe the client's achievement of new skills.