Chapter 18 Diagnosis NURS 3303

"The levels of performance accepted by and expected of nursing staff or other health team members" defines: criteria. evaluation. standards. evidence-based practice.

standards. Explanation: Standards are the "levels of performance accepted by and expected of nursing staff or other health team members." Criteria are "measurable qualities, attributes, or characteristics that identify skill, knowledge, or health status." Evidence-based practice incorporates delivering nursing care that evidence supports as likely to result in meeting the expected client outcomes. Evaluation involves measuring how well the client has achieved the outcomes that were set forth in the plan of care.

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 Explanation: Peer review is a process by which one nurse evaluates the performance of another to improve professional performance. QSEN has as its goal the preparation of nurses with the knowledge, skills, and attitudes necessary to improve the quality and safety of health care systems. AACN strives to provide safe work environments. HCAHPS measures client satisfaction with health care

A client with a new diagnosis of diabetes will be discharged on insulin therapy. Which client psychomotor outcome does the nurse expect after client education?

The client demonstrates administration of insulin. Explanation: Psychomotor outcomes describe the client's achievement of new skills, such as demonstration of administration of insulin. An affective outcome involves changes in the client's values, beliefs, and attitudes, such as testing blood sugar before meals. Cognitive outcomes demonstrate increases in client knowledge, such as signs and symptoms of hypoglycemia and correct injection sites.

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 health care provider 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 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 health care provider, 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.

For the second time this week, a nurse reports to the nurse manager failing to perform an ordered dressing change due to a lack of time. The nurse manager recognizes that the nurse normally is very punctual and known to provide good care for clients and that the unit census has been very high this week. However, the nurse manager knows that quality care must be provided and reports this occurrence. Which approach to quality assurance does this scenario represent? Quality by inspection Quality as opportunity Quality by design Quality as promotion

Quality as opportunity Explanation: Quality as 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 sign of incompetence in the nurse. Quality by inspection focuses on finding deficient workers and removing them. Quality by design and quality as promotion are not specific approaches to quality assurance.

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

Quality assurance Explanation: Accreditation by the Joint Commission evaluates quality assurance. Quality assurance is an externally driven process, demonstrating nursing excellence by meeting professional standards of care. Quality improvement is an internally driven, continuous process focusing on the processes of client care. Peer review is a process whereby individual nurses improve their professional performance through the evaluation of one staff member by another staff member on the same level of the hierarchy. Magnet status is awarded by the American Nurses Credentialing Center, recognizing health care organizations for their excellence in nursing.

A facility has participated in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and received the results. A nurse is part of the team reviewing the information. For which areas should the nurse expect the survey to provide information? Select all that apply. Facility cleanliness Courteous treatment Pain control Costs of services

Facility cleanliness Courteous treatment Pain control The program provides consumers with information about a hospital's performance in key areas of communication, pain control, timeliness of care, discharge instructions, hospital cleanliness, and treatment with courtesy and respect. The cost of services is not included in this survey.

The nurse and client have written the following outcome measure: "The client will eat at least 80% of each meal offered by 3/2." When should the nurse collect information to evaluate this outcome?

At the completion of each meal Explanation: The nurse should collect data at the completion of each meal to ensure the accuracy of the data and to monitor the client's progress toward meeting the goal so that the nurse can make changes to the plan when the client fails to make sufficient progress or celebrate with the client when the client demonstrates success. Although the final evaluation of goal attainment must occur on or shortly after 3/2, data collection must begin far earlier than that. It would not be appropriate for the client to direct when data collection should occur.

A mother brings an infant into the clinic for a well-infant 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 infant 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." Explanation: The evaluative statement should include the time frame/date, a judgment as to whether the goal was met, and data to support the decision

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

A 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery Explanation: 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 a rate of 98% of clients admitted to the hospital who had a nursing history completed within 24 hours after admission.

Which statement related to the evaluation of outcome attainment for a client is correct?

Collecting data related to outcome attainment requires the nurse to know when to collect the data, based upon established time criteria. Explanation: In addition to knowing what type of data to collect to determine outcome achievement, it is important to know when to collect the data based upon established time criteria. It is important for the nurse to evaluate client outcome achievement as early as possible and not wait until discharge, when the plan of care cannot be modified. Evaluation of the client's attainment of outcome goals is determined by the nurse, client, and the client's family. Celebrating outcome attainment with the client usually helps encourage the client and leads to further outcome achievement.

A nurse caring for an older adult client who has dementia observes another nurse putting restraints on the client without a health care provider'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. Explanation: Confronting the nurse and explaining the danger for the client is a form of peer evaluation. Peer evaluation involves evaluation of one staff member by another staff member on the same level in the hierarchy of the organization. This is an important mechanism nurses can use to improve their professional performance; it can be done formally or informally. Reporting the nurse does not enhance a good working relationship and does not follow the chain of command. An incident report is not warranted at this point in time. The health care provider should not be contacted for an order unless it is decided that the restraint is going to be left on the client

A nurse is reviewing a client's plan of care. What would the nurse determine is a problem related to the assessment phase of the nursing process?

Database does not reflect changes in the client condition. Explanation: Database input is done during the assessment phase of the plan of care. Nursing diagnoses are formed during the diagnosis phase of the nursing process. The plan of care is established during the planning phase of the nursing process. Inefficient use of nursing resources is part of the implementation phase.

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 Explanation: Discovering the problem by detecting that there are several readmissions with heart failure is the first step in the process of performance improvement. The next step would be to plan a strategy using indicators, which includes calling an interdisciplinary meeting. The team would then implement a change and, lastly, assess whether the change was effective.

Which action should the nurse take during the evaluation phase of the nursing process?

Document reassessment of pain after medication administration. Explanation: The evaluation phase includes documenting a reassessment of pain following an intervention such as the administration of pain medication. Providing a client with an appointment and discontinuing an indwelling urinary catheter are interventions. Having a client give input into a plan of care is part of the planning process

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. Explanation: Prior to proceeding with any changes in the plan of care, the nurse must first perform evaluation of the client's current pain relief measures. Once this has been performed, it might be appropriate to request a stronger analgesic or reinforce education for nonpharmacologic pain relief measures. Creating a new nursing diagnosis and goals would come after evaluating the current pain relief

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? Explanation: The administration of red blood cells is intended to correct an anemic condition in a client with leukemia. Leukemia destroys the bone marrow's ability to produce healthy white blood cells, red blood cells, and platelets. Headaches occur in clients with anemia as a result of decreased oxygenation, which causes arterial swelling. Joint or bone pain occurs as a result of the expansion of bone marrow from the accumulation of white blood cells. Bruising is a symptom of thrombocytopenia which occurs as a result of a decreased platelet production.

The nursing staff on a hospital unit uses peer review to improve professional performance. Who performs the review?

Nurses Explanation: Peer review is the evaluation of one staff member by another staff member on the same level of the hierarchy of the organization. Peer review is not done by the unit manager, clients, or visitors.

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 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 Explanation: Physical changes are related to actual body changes in the infant. 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.

A nurse is participating as a team member involved in the facility's evaluation process. The facility is conducting a retrospective evaluation. Which methods should the nurse expect to use to collect data? Select all that apply. Direct observation of client care Post-discharge client questionnaires Client interviews during the client's stay Chart review Telephone interviews of discharged clients

Post-discharge client questionnaires Chart review Telephone interviews of discharged clients Nursing care and client outcomes may be evaluated while the client is receiving care (i.e., a concurrent evaluation) or after the client has been discharged (i.e., a retrospective evaluation). Retrospective evaluation may use post-discharge questionnaires, client interviews (by telephone or face to face), or chart review (nursing audit) to collect data. Concurrent evaluation is conducted by using direct observation of nursing care, client interviews, and chart review to determine whether the specified evaluative criteria are met.

Which statement regarding quality improvement or quality assurance is correct? Quality improvement focuses on organization, structure, and individuals. Quality assurance promotes empowerment and collaboration. Quality improvement focuses on processes, data, and statistical thinking. Quality assurance is concerned with client satisfaction.

Quality improvement focuses on processes, data, and statistical thinking. Explanation: Quality improvement focuses on processes, data, statistical thinking, and client satisfaction and promotes empowerment and collaboration. Quality assurance focuses on organization structure and individuals and is externally driven.

A nurse is working as part of a quality assurance team that uses the American Nurses Association model. The team is evaluating the resources of the facility as well as the physical facilities and equipment. Which type of evaluation is the team engaged in?

Structure evaluation Explanation: A structure evaluation or audit focuses on the environment in which care is provided. Standards describe physical facilities and equipment; organizational characteristics, policies, and procedures; fiscal resources; and personnel resources. A process evaluation focuses on the nature and sequence of activities carried out by nurses implementing the nursing process. Criteria make explicit acceptable levels of performance for nursing actions related to client assessment, diagnosis, planning, implementation, and evaluation. Outcome evaluation focuses on measurable changes in the health status of the client, or the end results of nursing care. Quality by inspection focuses on finding deficient workers and removing them.

A client has been recently diagnosed with diabetes after receiving emergency treatment for a hyperglycemic episode. Which of the client's actions indicates that the client has achieved a cognitive outcome in the management of this new health problem? The client is able to explain when and why the client needs to check the blood glucose level. The client can demonstrate the correct technique for using a new glucometer. The client has maintained blood glucose levels within acceptable range in the days prior to discharge. The client expresses a desire to change the way that the client eats and exercises.

The client is able to explain when and why the client needs to check the blood glucose level. Explanation: The ability to describe the rationale and technique for blood glucose monitoring indicates that the client has achieved a cognitive outcome. Demonstration of the technique constitutes a psychomotor outcome, whereas the expression of a desire for change is an affective outcome. The maintenance of healthy blood glucose levels is a physiologic outcome.

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

The new graduate nurse consults the policies and procedures of the institution prior to skill implementation. Explanation: Standards are the levels of performance accepted and expected by the nursing staff and other health team members, such as institutional policies and procedures. The nurse preceptor providing feedback to the new graduate nurse after 6 weeks of orientation is an example of peer review. The nurse manager providing the staff nurse feedback regarding job performance for the previous year is typical of an annual employee review. The nurse seeking input from the UAP on a family's response to education is inappropriate, as the nurse may not delegate evaluation to the UAP.

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.

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

The nurse considers the individual needs of clients. Explanation: The personal, compassionate, caring side of a 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 nurse is evaluating nursing care and client outcomes by using a retrospective evaluation. Which action would the nurse perform in this approach?

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).

A nurse is following the rules recommended by the Institute of Medicine's Committee on Quality of Health Care in America to help redesign and improve client care. Which nursing actions are based on these rules? Select all that apply. The nurse customizes care based on client needs and values. The nurse becomes the source of control for client care. The nurse bases care on evidence-based decision making. The nurse customizes care based on availability of resources. The nurse promotes shared knowledge and the free flow of information. The nurse acknowledges that continuous decrease in waste improves client care.

The nurse customizes care based on client needs and values.. The nurse bases care on evidence-based decision making. The nurse promotes shared knowledge and the free flow of information. The nurse acknowledges that continuous decrease in waste improves client care. Nurses sometimes discover problems with the delivery of nursing care in their practice setting. The Institute of Medicine's Committee on Quality of Health Care in America suggests 10 rules to redesign and improve care: 1. Care based on continuous healing relationships 2. Customization based on client needs and values 3. The client as the source of control 4. Shared knowledge and the free flow of information 5. Evidence-based decision making 6. Safety as a system priority 7. The need for transparency 8. Anticipation of client's needs 9. Continuous decrease in waste 10. Cooperation among clinicians

Which of the following best summarizes the evaluation step of the nursing process? The nurse completes a health assessment to establish a database. The client and family have met health care goals and no longer need care. The nurse and client identify nursing diagnoses and appropriate interventions. The nurse and client measure achievement of planned outcomes of care.

he nurse and client measure achievement of planned outcomes of care. Explanation: In evaluation, which is the fifth step of the nursing process, the nurse and client together measure how well the client has achieved the outcomes specified in the plan of care. Establishing a health assessment is the first stage of the nursing process. Identifying nursing diagnosis is the second stage and implementation of care is the fourth stage. When the client no longer needs care, the relationship is terminated. Reference:

While auscultating a client's lung sounds, the nurse notes crackles in the left lower lobe, which were not present at the start of the shift. The nurse is engaged in which type of nursing intervention?

survellaince Surveillance interventions include detecting changes from baseline data and recognizing abnormal response. Nurses rely on the senses to detect changes, such as observing the appearance and characteristics of clients and hearing by auscultation, pitch, and tone. Nurses use these surveillance activities to determine the current status of clients and changes from previous states. Educational interventions require instruction, demonstration, and return demonstration of knowledge or a skill set. Psychomotor interventions involve the nurse physically working with the client. Maintenance interventions involve the nurse assisting the client with performing routine activities of daily living.

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. 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.