NURS (FUNDAMENTAL): Ch 15 NCLEX Evaluating

Question: In order 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. 1 Plan a strategy using indicators 2 Implement a change 3 Assess a change 4 Discover a problem

4, 1, 2, 3 Discover a problem Plan a strategy using indicators Implement a change Assess a change

A nurse uses the following classic elements of evaluation when caring for patients. Which item below places them in their correct sequence? (1) Interpreting and summarizing findings (2) Collecting data to determine whether evaluative criteria and standards are met (3) Documenting one's judgment (4) Terminating, continuing, or modifying the plan (5) Identifying evaluative criteria and standards (what one is looking for when evaluating, e.g., expected patient outcomes)

5, 2, 1,3, 4 The five classic elements of evaluation in order are (1) identifying evaluative criteria and standards (what you are looking for when you evaluate, e.g., expected patient outcomes), (2) collecting data to determine whether these criteria and standards are met, (3) interpreting and summarizing findings, (4) documenting your judgment, and (5) terminating, continuing, or modifying the plan.

A nurse on the unit fails to help a colleague ambulate a client even though she has time to do so. The nurse needing help should approach the nurse with which of the following? (Select all that apply) a) "This client is in need of our assistance and everyone who is free should come together for improved client outcomes" b) "Please come and help and work together as a team. You know that there is zero tolerance for selfish behavior" c) "Your behavior is unacceptable, we all have to work to ether as a team to provide quality care for our client" d) "Never mind, I will get someone else to help"

a) "This client is in need of our assistance and everyone who is free should come together for improved client outcomes" b) "Please come and help and work together as a team. You know that there is zero tolerance for selfish behavior" c) "Your behavior is unacceptable, we all have to work to ether as a team to provide quality care for our client"

A nurse is attempting to improve care on the pediatric ward of a hospital. Which nursing improvements might the nurse employ when following the recommendations of the Institute of Medicine's Committee on Quality of Health Care in America? Select all that apply. a) Basing patient care on continuous healing relationships b) Customizing care to reflect the competencies of the staff c) Using evidence-based decision making d) Having a charge nurse as the source of control e) Using safety as a system priority f) Recognizing the need for secrecy to protect patient privacy

a) Basing patient care on continuous healing relationships c) Using evidence-based decision making e) Using safety as a system priority

A nurse has been doing discharge teaching to a client with diabetes mellitus type 1. Which of the following outcomes indicates that the teaching has been effective? a) By a certain date, client will verbalize signs and symptoms of hypoglycemia. b) By a certain date, client will talk to a dietician regarding information for a diabetic diet. c) Before discharge, client will understand proper foot care and eye care. d) Before discharge, client will attempt to administer a subcutaneous injection.

a) By a certain date, client will verbalize signs and symptoms of hypoglycemia.

A nurse writes the following outcome for a patient who is trying to lose weight: "The patient can explain the relationship between weight loss, increased exercise, and decreased calorie intake." This is an example of what type of outcome? a) Cognitive b) Psychomotor c) Affective d) Physical changes

a) Cognitive Cognitive outcomes involve increases in patient knowledge;

Identifying the kind and amount of nursing services required is a possible solution for: a) Inadequate staffing. b) Nurses who are bored. c) Clients who fail to communicate their needs. d) Nurses frustrated with substandard care.

a) Inadequate staffing.

The nurse is caring for Mr. H., a 35-year-old man who is hospitalized following a motorcycle accident. He has a traumatic brain injury. The nurse is working with Mr. H. on self-care behaviors. The following would help the nurse to assess the success of the nursing interventions except which of the following? a) Model self-care behaviors for the client. b) Collect data on the number of self-care activities performed that day. c) Check with the client to ensure personal goals are met. d) Ask client to discuss his goals for the day at the start of the shift.

a) Model self-care behaviors for the client.

Which client outcome is a cognitive outcome? Select all that apply. a) The client describes how to perform progressive muscle relaxation. b) The client correctly ambulates with a walker. c) The client identifies signs and symptoms of hypoglycemia. d) The client lists the side effects of digoxin (Lanoxin). e) The client reports cycling 30 minutes three times each week.

a) The client describes how to perform progressive muscle relaxation. c) The client identifies signs and symptoms of hypoglycemia. d) The client lists the side effects of digoxin (Lanoxin).

Which client outcome is an example of a physiologic outcome? a) The client's pulse oximetry reading is 97% on room air 30 minutes after removal of a nasal cannula. b) The client explains how to administer a vaginal cream. c) The client reports walking for 30 minutes each day. d) The client demonstrates active range of motion exercises with left upper extremity.

a) The client's pulse oximetry reading is 97% on room air 30 minutes after removal of a nasal cannula.

Which of the following does a nurse recognize is among the rules suggested by the Institute of Medicine's (IOM) Committee on Quality of Health Care in America to improve health care? a) The patient as the source of control b) Cooperation among clinicians c) Providing client care based on a standardized plan of care d) Anticipation of clients' needs e) Safety as a system priority

a) The patient as the source of control b) Cooperation among clinicians d) Anticipation of clients' needs e) Safety as a system priority Each client should have his or her own customized plan of care.

A nurse is evaluating the plan of care for a client in the clinic. Which actions will she perform as a classic element of evaluation? Select all that apply. a) identifying evaluative criteria and standards b) interpreting and summarizing findings c) documenting only the facts related to the plan of care d) terminating, continuing, or modifying the plan of care e) collecting data to determine if criteria or standards are being met

a) identifying evaluative criteria and standards b) interpreting and summarizing findings d) terminating, continuing, or modifying the plan of care e) collecting data to determine if criteria or standards are being met

The focus of a hospital's current quality assurance program is a comparison between the health status of clients upon admission and at the time of discharge. This form of quality assurance is characteristic of: a) outcome evaluation. b) nursing audit. c) process evaluation. d) structure evaluation.

a) outcome evaluation.

Once a nurse has collected and interpreted the data on a client's outcome achievement, the nurse will then make a judgment and document a statement summarizing those findings. This is called which of the following? a) Evidence-based practice b) Evaluative statement c) Standard d) Criteria

b) Evaluative statement

A nurse manager notes an increase in the frequency of client falls during the last month. To promote a positive working environment, how would the nurse manager most effectively deal with this problem? a) Reprimand the nursing personnel responsible for the clients when the falls occurred. b) Investigate the circumstances that contributed to client falls. c) Institute a new policy on the prevention of client falls on the unit. d) Determine if client falls have increased on other nursing units in the hospital.

b) Investigate the circumstances that contributed to client falls.

Which nursing action reflects evaluation? a) The nurse performs a colostomy irrigation. b) The nurse assesses the client's response to pain medication. c) The nurse identifies that the client has wound drainage. d) The nurse sets an anxiety level of 3 or less with the client.

b) The nurse assesses the client's response to pain medication.

A nurse is evaluating nursing care and patient outcomes by using a retrospective evaluation. Which action would the nurse perform in this approach? a) The nurse reviews the patient chart while the patient is being cared for. b) The nurse devises a post-discharge questionnaire to evaluate patient satisfaction. c) The nurse directly observes the nursing care being provided. d) The nurse interviews the patient while he or she is receiving the care.

b) The nurse devises a post-discharge questionnaire to evaluate patient satisfaction.

The primary purpose for evaluating data about a client's care according to a functional health approach is to: a) determine implementation of medical orders. b) revise or modify the nursing care plan. c) meet accreditation standards. d) evaluate the need for health care consultations.

b) revise or modify the nursing care plan.

Which action should the nurse take when client data indicate that the stated goals have not been achieved? a) Implement a standardized plan of care. b) Collect more data for the database. c) Review each preceding step of the nursing process. d) Change the nursing orders.

c) Review each preceding step of the nursing process.

Which of the following is the most important indicator of quality nursing care? a) The nurse follows the policies and procedures of the institution. b) The nurse is organized and efficient in client care. c) The nurse considers the individual needs of clients. d) The nurse takes measures to ensure accurate medication administration.

c) The nurse considers the individual needs of clients.

The emergency room has a strict protocol regarding IM (intramuscular) injection technique. A nurse working in the emergency room has learned of a new technique to decrease pain with IM injections and would like to use it. What is the most appropriate way for the nurse to implement the technique? a) Ask the ER physician to order IM injections with the new technique. b) Research the protocols at other area emergency rooms. c) Begin using the technique to determine if it is effective. d) Petition to change the protocol based on the new evidence.

d) Petition to change the protocol based on the new evidence.

A male client has been recently diagnosed with diabetes after receiving emergency treatment for a hyperglycemic episode. Which of the client's actions indicates that he has achieved a cognitive outcome in the management of his new health problem? a) The client's blood sugars have been maintained within acceptable range in the days prior to discharge. b) The client expresses a desire to change the way that he eats and the amount of exercise he performs. c) The client can demonstrate the correct technique for using his new glucometer. d) The client is able to explain when and why he needs to check his blood sugar.

d) The client is able to explain when and why he needs to check his blood sugar.

A nurse is collecting evaluative data for a patient who is finished receiving chemotherapy for an osteosarcoma. Which nursing action represents this step of the nursing process? a) The nurse collects data to identify health problems. b) The nurse collects data to identify patient strengths. c) The nurse collects data to justify terminating the plan of care. d) The nurse collects data to measure outcome achievement.

d) The nurse collects data to measure outcome achievement.

A client has come into the clinic for a postoperative visit. The client states that the postoperative pain continues to be 6 on a 0 to 10 rating scale. The nurse evaluates the client and the current plan of care. Based on the information provided by the client, the nurse should: a) terminate the plan of care. b) call the pharmacy to determine if the client is taking pain medication. c) continue with the current plan of care. d) modify the plan of care.

d) modify the plan of care.

Which nurse is using criteria to determine expected standards of performance? a) The new graduate nurse consults the policies and procedures of the institution prior to skill implementation. b) The nurse manager provides the staff nurse feedback regarding job performance for the previous year. c) The nurse seeks information from the unlicensed assistive personnel (UAP) regarding the family's response to the nurse's education. d) The nurse preceptor provides feedback to the new graduate nurse after 6 weeks of orientation.

a) The new graduate nurse consults the policies and procedures of the institution prior to skill implementation. Standards are the levels of performance accepted and expected by the nursing staff and other health team members, such as institutional policies and procedures.

A nurse is evaluating the outcome of the plan of care after teaching a client how to prepare and administer an insulin pen. Which of the following types of outcome is the nurse addressing? a) Cognitive b) Psychomotor c) Physiological d) Affective

b) Psychomotor

Nurse Mayweather is auscultating lung sounds. She notes crackles in the LLL which were not present at the start of the shift. Nurse Mayweather is engaged in which type of nursing intervention? a) Maintenance intervention b) Surveillance intervention c) Educational intervention d) Psychomotor intervention

b) Surveillance intervention

Which client outcome is an example of a psychomotor outcome? a) The client reports testing blood sugar before meals. b) The client demonstrates stair climbing using a quad cane. c) The client identifies signs and symptoms of digoxin toxicity. d) The client reports grilling or baking meats rather than frying.

b) The client demonstrates stair climbing using a quad cane.

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

b) The nurse assesses urine output following administration of a diuretic.

A nurse writes the following outcome for a patient who is trying to stop smoking: "The patient appreciates or values a healthy body sufficiently to stop smoking." This is an example of what type of outcome? a) Cognitive b) Psychomotor c) Affective d) Physical changes

c) Affective Affective outcomes pertain to changes in patient values, beliefs, and attitudes.

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

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

The client identifies three strategies for minimizing leakage of an ileostomy bag. This is an example of what type of outcome? a) Physiologic outcome b) Affective outcome c) Psychomotor outcome d) Cognitive outcome

d) Cognitive outcome

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

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

For a client with self-care deficit, the long-term goal is that the client will be able to dress himself by the end of the 6-week therapy. For best results, when should the nurse evaluate the client's progress toward this goal? a) only when the client shows some progress b) when the client is discharged c) at the end of the 6-week therapy d) as soon as possible

d) as soon as possible

The terms "criteria" and "standards" are often used interchangeably, but they actually have distinct definitions. "Measurable qualities, attributes, or characteristics that identify knowledge or health status" are known as: a) evidence-based practice. b) evaluation. c) standards. d) criteria.

d) criteria.

Nurses formulate different types of goals for clients when planning client care. What is considered a psychomotor client goal? a) By 8/18/15, client will demonstrate improved motion in left arm. b) By 8/18/15, client will list three foods that are low in salt. c) By 8/18/15, client will learn three exercises designed to strengthen leg muscles. d) By 8/18/15, client will value his health sufficiently to quit smoking.

a) By 8/18/15, client will demonstrate improved motion in left arm.

Which of the following would a nurse know is a part of an evaluative statement? Select all that apply. a) Patient data that supports how the outcome was met b) Name of client's physician c) Client's health history d) Description of how the patient outcome was met

a) Patient data that supports how the outcome was met d) Description of how the patient outcome was met

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? a) Report the nurse applying the restraints to the supervisor. b) Confront the nurse and explain how this could be dangerous for the client. c) File an incident report and have the second nurse sign it. d) Contact the physician for an order for the restraints.

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

Priority setting is based on the information obtained during reassessment. Priority setting is used to rank nursing diagnoses. Each of the following contributes to priority setting except which of the following? a) The client's condition b) Feedback from the family c) Time and resources d) Finances of the client

d) Finances of the client

The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted? a) Magnet status b) Quality improvement c) Peer review d) Quality assurance

d) Quality assurance

The nurse participates in a quality assurance program and reviewing evaluation data from the previous year. Which of the following does the nurse recognize as an example of outcome evaluation? a) A 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery. b) A 4% increase in the number of baccalaureate prepared nurses are employed in the facility. c) A 97% bed occupancy rate in the critical care areas; 92% bed occupancy rate in the non-critical care areas. d) 98% of all hospital admissions had a nursing history completed within 24 hours of admission

a) A 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery. Quality assurance programs focus on three types of evaluation: structure, process, and outcome. Outcome evaluation focuses on measurable changes in the health status of clients, such as a 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery. Structure evaluation focuses on the environment in which care is provided, such as the number of baccalaureate-prepared nurses employed in the facility and bed occupancy rates. Process evaluation focuses on the nature and sequence of activities carried out by nursing implementing the nursing process, such as 98% of all hospital admissions had a nursing history completed within 24 hours of admission.

A nurse is evaluating the plan of care for a client and determines that the achievement of goals is difficult to evaluate. Which of the following might the nurse do in evaluating the plan to see that the outcomes are correctly written? Select all that apply. a) Be certain that the subject is the client or some part of the client. b) See if the client's expected behavior is written in observable, measurable terms, c) Rewrite the plan of care so that the client meets the expected outcomes. d) Be sure that the criteria for appropriate response are clearly specified. e) Specify time limits in the plan.

a) Be certain that the subject is the client or some part of the client. b) See if the client's expected behavior is written in observable, measurable terms, d) Be sure that the criteria for appropriate response are clearly specified. e) Specify time limits in the plan.

The nurse manager on an orthopedic unit has determined that the nurses are not keeping the nursing diagnoses up-to-date on client care plans and, in turn, are not using the plan of care. What is a feasible approach to correcting this problem? a) Develop a process for periodic review of care plans that focuses on deleting and updating the nursing diagnoses. b) Request that a staff development nurse instruct the nurses on concept mapping to use instead of care planning. c) Delegate the updating of nursing diagnoses for all clients on the unit to one nurse for each shift. d) Provide an in-service on interviewing and physical assessment skills; discuss the importance of these skills with the staff.

a) Develop a process for periodic review of care plans that focuses on deleting and updating the nursing diagnoses.

Which of the following actions should the nurse take during the evaluation phase of the nursing process? a) Document improved pain after pain medication administered b) Discontinue indwelling urinary catheter per provider's order c) Provide client with follow-up appointment after discharge d) Have client give input into plan of care upon admission

a) Document improved pain after pain medication administered

A new nurse who is being oriented to the subacute care unit is expected to follow existing standards when providing patient care. Which nursing actions are examples of these standards? Select all that apply. a) Monitoring patient status every hour b) Using intuition to troubleshoot patient problems c) Turning a patient on bed rest every 2 hours d) Becoming a nurse mentor to a student nurse e) Administering pain medication ordered by the physician f) Becoming involved in community nursing events

a) Monitoring patient status every hour c) Turning a patient on bed rest every 2 hours e) Administering pain medication ordered by the physician

Nurses are involved in many types of evaluation. All of the following are activities that are related to evaluation, but which of the following is the priority concern for nurses? a) Patients and their care b) Helping targeted groups of patients to achieve their specific outcomes c) Measuring the competence of individual nurses d) Measuring patient outcome achievement

a) Patients and their care

A group of nurses of 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. The nurses know that this program is termed which of the following? a) Peer review b) Quality and Safety Educatin for Nurses (QSEN) c) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) d) American Association of Critical-Care Nurses (AACN)

a) Peer review

A quality-assurance program reveals a higher incidence of falls and other safety violations on a particular unit. A nurse manager states, "We'd better find the folks responsible for these errors and see if we can replace them." This is an example of: a) Quality by inspection b) Quality by punishment c) Quality by surveillance d) Quality by opportunity

a) Quality by inspection Quality by inspection focuses on finding deficient workers and removing them. Quality as opportunity (d) focuses on finding opportunities for improvement and fosters an environment that thrives on teamwork, with people sharing the skills and lessons they have learned. Answers b and c are distractors.

Nurses formulate physiologic goals for patients when providing patient care. What are examples of physiologic goals? (Select all that apply.) a) By 4/6/15, the baby will demonstrate adequate sleep-wakefulness patterns. b) Before discharge, the baby will have reached a target weight gain of 8 lb (birth weight: 7 lb, 6 oz). c) By 4/6/15, the parents will list appropriate resources in case questions arise after discharge. d) By 4/6/15, the baby will show an adequate comfort level indicating satisfactory parenting. e) Before discharge, the parents of the baby will verbalize decreased anxiety about taking care of a newborn. f) Before discharge, the parents will demonstrate confidence in bathing and feeding their baby.

b) Before discharge, the baby will have reached a target weight gain of 8 lb (birth weight: 7 lb, 6 oz). d) By 4/6/15, the baby will show an adequate comfort level indicating satisfactory parenting. f) Before discharge, the parents will demonstrate confidence in bathing and feeding their baby. Physiologic goals meet the need of normal, healthy body functioning. An infant's sleep-wake patterns, comfort level, and weight are all examples of physiologic goals/outcomes.

A client is about to leave the hospital after having surgery for a fractured left femur. It is now in a plaster cast. The client asks how long before the cast will be dry. The nurse notes on his plan of care a learning outcome stating "Client will verbalize appropriate cast care upon discharge." This represents what type of outcome? a) Affective b) Cognitive c) Psychomotor d) Physical change

b) Cognitive

The nurse is caring for a client who is recovering from a cerebrovascular accident (CVA). When reviewing the client's orders, the nurse notes that one of the physicians wrote orders to ambulate the client while another physician ordered strict bed rest for the client. How would the nurse most appropriately remedy this conflict? a) Assess the client to determine if the client is capable of ambulation. b) Communicate with the physicians to coordinate their orders. c) Collaborate with the physical therapist to determine the client's ability. d) Instruct the client to ask the physicians for clarifications of instructions.

b) Communicate with the physicians to coordinate their orders.

A client has returned to the clinic for a postoperative visit. The nurse reviews the plan of care and could choose to take which action based on the client's previous responses to the current plan of care? Select all that apply. a) Explain the plan of care to significant others and advise them that there is an expectation that the client will achieve outcomes within a reasonable amount of time. b) Continue the plan of care if more time could result in achievement of outcomes. c) Terminate the plan of care if outcomes have been achieved. d) Modify the plan of care if difficulty has been encountered with achieving outcomes.

b) Continue the plan of care if more time could result in achievement of outcomes. c) Terminate the plan of care if outcomes have been achieved. d) Modify the plan of care if difficulty has been encountered with achieving outcomes.

After one nursing unit with an excellent safety record meets to review the findings of the audit, the nurse manager states, "We're doing well, but we can do better! Who's got an idea to foster increased patient well-being and satisfaction?" This is an example of leadership that values: a) Quality assurance b) Quality improvement c) Process evaluation d) Outcome evaluation

b) Quality improvement Unlike quality assurance, quality improvement is internally driven, focuses on patient care rather than organizational structure, focuses on processes rather than individuals, and has no end points. Its goal is improving quality rather than assuring quality. Answers c and d are types of quality-assurance programs.

Which expected client outcome is an example of a psychomotor outcome? Select all that apply. a) Reporting increased confidence in testing blood sugar. b) Safely ambulating using a walker. c) Identifying signs and symptoms of infection. d) Rating pain as a 2 on a 10-point scale. e) Accurately drawing up insulin.

b) Safely ambulating using a walker. e) Accurately drawing up insulin.

A client has just been admitted to the clinical unit. The nurse is providing her with the expectations she may have of the health care she will receive. She is told that she will not be harmed by any errors that might be made and she can expect to be safe in the facility. This assurance represents which expectation of the health care environment? a) Transparency b) Safety c) Control d) Individualization

b) Safety

The nurse is working with Ms. V. today. Ms. V. is having a difficult time accepting her new diagnosis of type 2 diabetes. Thenurse pulls up a chair next to Ms. V.'s bed and holds her hand while listening to her story. What type of nursing intervention is the nurse engaging in? a) Psychosocial intervention b) Supportive intervention c) Supervisory intervention d) Coordinating intervention

b) Supportive intervention

A client who was admitted to the acute care unit with angina pectoris is no longer having chest pain. Based on this assessment, which of the following does the nurse decide to do with the plan of care for chest pain? a) Establish a new plan of care b) Terminate the plan of care c) Modify the plan of care d) Continue the current plan of care

b) Terminate the plan of care Terminate the plan of care for chest pain as the expected outcome has been achieved. The plan of care for chest pain does not need to be continued or modified. A new plan of care is not indicated at this time.

At the beginning of prenatal care, the goal for the client was to gain 25 pounds by the end of the pregnancy. At 30 weeks of pregnancy, the client has only gained 1 pound. Which statement(s) would help the nurse most appropriately interpret this data? a) The client is progressing toward achieving the goal. The plan should be continued. b) The client is not achieving the goal. The nurse should determine the reasons the client has not been gaining weight. c) The client has partially achieved the determined goal. The nurse should revise the goal to reflect a more realistic outcome. d) It is too early to evaluate if the goal has been achieved. The client has 10 more weeks of pregnancy.

b) The client is not achieving the goal. The nurse should determine the reasons the client has not been gaining weight.

The nurse is conducting a peer review of a nursing colleague. Which action by the nurse is an example of peer review? a) The nurse seeks feedback from the nurse manager regarding job performance for the previous year. b) The nurse preceptor provides feedback to the new graduate nurse after 6 weeks of orientation. c) The new graduate nurse consults the policies and procedures of the institution prior to skill implementation. d) The nurse seeks information from the unlicensed assistive personnel (UAP) regarding the family's response to the nurse's education.

b) The nurse preceptor provides feedback to the new graduate nurse after 6 weeks of orientation.

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? a) Appropriate staffing b) True collaboration c) Effective decision making d) Skilled communication

b) True collaboration True collaboration involves skilled communication, mutual respect, shared responsibility, and decision making among nurses, and between nurses and other health team members. Skilled communication requires health team members to communicate in a non-intimidating manner with colleagues, allowing all voices to be heard regarding a matter. Effective decision making ensures nurses are valued and active partners in making policy, directing and evaluating clinical care, and leading organizational operations.

The nurse is caring for Mr. M., a 48-year-old man with congestive heart failure. The nurse manager informs the nurse that Mr. M. 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? a) Cost-effectiveness evaluation b) Process evaluation c) Outcome evaluation d) Structure evaluation

c) Outcome evaluation

Prior to the first postoperative visit post gastrectomy, the client will have a weight loss of 10 lbs. This is an example of which type of evaluative statement? a) Cognitive b) Psychomotor c) Physical changes d) Affective

c) Physical changes

The nurse has instructed the client in self-catheterization, but the client is unable to perform a return demonstration. What is the nurse's most appropriate plan of action? a) Teach the content again utilizing the same method. b) Revise the plan to include the inclusion of a support group. c) Reassess the appropriateness of the method of instruction. d) Report the client's inability to learn to the case manager.

c) Reassess the appropriateness of the method of instruction.

A nurse evaluates clients prior to discharge from a hospital setting. Which action is the most important act of evaluation performed by the nurse? a) The nurse evaluates the types of health care services available to the client. b) The nurse evaluates the competence of nurse practitioners. c) The nurse evaluates the client's goal/outcome achievement. d) The nurse evaluates the plan of care.

c) The nurse evaluates the client's goal/outcome achievement.

A nurse is writing an evaluative statement for a patient who is trying to lower her cholesterol through diet and exercise. Which evaluative statement is written correctly? a) "Outcome not met." b) "1/21/15—Patient reports no change in diet." c) "Outcome not met. Patient reports no change in diet or activity level." d) "1/21/15—Outcome not met. Patient reports no change in diet or activity level."

d) "1/21/15—Outcome not met. Patient reports no change in diet or activity level." The evaluative statement must contain a date; the words "outcome met," "outcome partially met," or "outcome not met"; and the patient data or behaviors that support this decision.

The mother of an infant comes to the clinic and asks the nurse if the infant can eat bananas now. The outcome statement on the infants plan of care states "The mother will explain proper nutrition for infants." this is an example of what type of outcome statement? a) Physical changes b) Affective c) Psychomotor d) Cognitive

d) Cognitive

Which statement related to the evaluation of outcome attainment for a client is correct? a) The nurse should initially evaluate the plan of care at the time of the client's discharge. b) Evaluation of the client's attainment of outcome goals is determined by the nurse and physician. c) Celebrating outcome achievement with a client often interferes with attainment of future goals. d) Collecting data related to outcome attainment requires the nurse to know when to collect the data, based upon established time criteria.

d) Collecting data related to outcome attainment requires the nurse to know when to collect the data, based upon established time criteria.

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? a) Suggest increasing the pain medication. b) Terminate the plan of care. c) Promptly modify the plan of care. d) Continue the plan of care.

d) Continue the plan of care.

A student health nurse is counseling a female college student who wants to lose 20 pounds. The nurse develops a plan to increase the student's activity level and decrease the consumption of the wrong types of foods and excess calories. The nurse plans to evaluate the student's weight loss monthly. When the student arrives for her first "weigh-in," the nurse discovers that instead of the projected weight loss of 5 pounds, the student has lost only 1 pound. Which is the best nursing response? a) Congratulate the student and continue the plan of care. b) Terminate the plan of care since it is not working. c) Try giving the student more time to reach the targeted outcome. d) Modify the plan of care after discussing possible reasons for the student's partial success.

d) Modify the plan of care after discussing possible reasons for the student's partial success.

A nurse just reported to the oncoming shift that she had failed to do an ordered dressing change. She reported to the nurse manager that this was the second time this week she had not had time to do the dressing change. The nurse manager recognized that the nurse normally was very punctual and was known to provide good care for her clients however the unit census had been very high on this particular week. The nurse manager knows that quality care must be provided and reports this occurrence as what type of quality approach? a) Quality by inspection b) Quality by design c) Quality by promotion d) Quality by opportunity

d) Quality by opportunity Quality by opportunity is focused on finding opportunity to improve quality through teamwork and sharing in a nonthreatening environment. Mistakes are seen as a breakdown in the system rather than a lack of motivation or competence of the nurse.

Which of the following is the most important indicator of quality nursing care? a) The nurse follows the policies and procedures of the institution. b) The nurse takes measures to ensure accurate medication administration. c) The nurse is organized and efficient in client care. d) The nurse considers the individual needs of clients.

d) The nurse considers the individual needs of clients. The personal side of nurse is the most important indicator of quality nursing care. Considering the individual needs of the clients demonstrates the nurse's belief in the importance of the client. Being organized and efficient, following policies and procedures, and ensuring accurate medication administration are important parts of nursing care but are mainly task oriented.

A large university hospital has commissioned a multidisciplinary group to review client records following discharge in order to evaluate client outcomes and the character and quality of nursing care that clients receive. This evaluative program is: a) an accreditation inspection. b) a structure evaluation. c) a process evaluation. d) a nursing audit.

d) a nursing audit. A nursing audit is a method of evaluating nursing care that involves reviewing client records to assess the outcomes of nursing care, or the process by which these outcomes were achieved. Structure evaluation addresses the environment in which care is provided. A process evaluation addresses performance expectations during the various stages of the nursing process. A nursing audit may be performed during an accreditation inspection, but this is not the only time that it takes place.