Chapter 18 - Evaluating

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

Nurses formulate different types of goals for clients when planning client care. What is considered a psychomotor client goal?

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

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 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?

Continue the plan of care.

Prior to the first postoperative visit postgastrectomy, the client will have a weight loss of 10 lb (4.5 kg). This is an example of which type of evaluative statement?

Physical changes

The nurse participates in a quality assurance program and reviews evaluation data for the previous month. The data indicates a nursing plan was developed within 8 hours of admission for 97% of all admissions. The nurse recognizes this as which type of evaluation?

Process evaluation

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?

Psychomotor

The nurse is caring for a client who has a fractured left femur. The client will be discharged home this afternoon. The outcome on the plan of care states "Client will demonstrate cast care prior to discharge" What type of evaluative statement is this?

Psychomotor

Which action should the nurse take when client data indicate that the stated goals have not been achieved?

Review each preceding step of the nursing process.

A nurse is caring for a client who is recovering from stroke. Which action would the nurse perform in the evaluation phase?

Revise the plan of care.

Which expected client outcome is an example of a psychomotor outcome? Select all that apply.

Safely ambulating using a walker Accurately drawing up insulin

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?

Surveillance intervention

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

The client measures capillary blood sugar level. The client catheterizes himself using clean technique.

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.

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?

True collaboration

The client identifies three strategies for minimizing leakage of an ileostomy bag. This is an example of:

a cognitive outcome.

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:

criteria

process evaluation

evaluation focusing on the nature and sequence of activities carried out by nurses implementing the nursing process

structure evaluation

focuses on the environment in which care is provided; also known as an audit

Identifying the kind and amount of nursing services required is a possible solution for:

inadequate staffing.

nursing-sensitive quality indicators

indicators specific to nursing that identify structures of care and care processes that influence care outcome

Time criteria

know when to collect data

evaluating

measurement of the extent to which the patient has achieved the goals specified in the plan of care; factors that positively or negatively influence goal achievement are identified, and the plan of care is terminated or revised

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:

outcome evaluation.

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:

peer review

standards

rules or guidelines that allow nurses to carry out professional roles, serving as protection for the nurse, the patient, and the institution where health care is given

criteria

specified behavior; for example, the measurable criteria in a patient goal specifies how the patient must perform the desired behavior

The terms "criteria" and "standard" are often used interchangeably but actually have distinct, separate definitions. "The levels of performance accepted by, and expected of, nursing staff or other health team members" is known as:

standards

Quality Improvement (QI)

the commitment and approach used to continuously improve every process in every part of an organization, with the intent of meeting and exceeding customer expectations and outcomes—also known as continuous quality improvement (CQI) or total quality management (TQM)

concurrent evaluation

the evaluation of nursing care and patient outcomes while the patient is receiving care, conducted by using direct observation of nursing care, patient interviews, and chart review to determine whether the specified evaluative criteria are met

The nurse is evaluating a plan of care for a client that the health care team is preparing for discharge. What outcome does the nurse hope to achieve by evaluating this plan of care?

to direct future nurse-client interactions

National Database of Nursing Quality Indicators (NDNQI)

ANA-funded database of nursing-sensitive quality indicators aimed at promoting and facilitating the standardization of information submitted by hospitals across the United States on nursing quality and patient outcomes

A nurse has been providing discharge teaching to a client with type 1 diabetes. Which outcome indicates that the teaching has been effective?

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

Nurses are involved in many types of evaluation. All of the activities listed are related to evaluation, but which activity is the priority concern for nurses?

Clients and their care

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.

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

The client lists the side effects of digoxin. The client describes how to perform progressive muscle relaxation. The client identifies signs and symptoms of hypoglycemia.

Which client outcome is an example of a physiologic outcome?

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

A nurse manager attempts to achieve performance improvement in the emergency department of a busy inner-city hospital. Which nursing actions follow Haase and Miller's recommended steps in performance improvement? Select all that apply.

The nurse discovers that there is a problem with the triage system that is in place in the emergency department. The nurse calls a meeting of the emergency department interdisciplinary team to affect change in the triage process. The nurse organizes a task force to implement change in the triage process of a busy emergency department. The nurse meets with the emergency department staff to assess changes made to the triage

The nurse is conducting a peer review of a nursing colleague. Which action by the nurse is an example of peer review?

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

quality assurance program

ongoing evaluation program designed and implemented to secure the excellence of health care; may involve an assessment of structure, process, and outcome standards

Patient expectation

Care Visualization Respect Control Right to your records EBP transparency confidentiality help value coperation

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

A nurse overhears a coworker telling a somewhat offensive joke to a client. Which nursing action is indicated?

Discuss the occurrence with the coworker.

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

Document reassessment of pain after medication administration.

A nurse finds that her client is not achieving the set outcomes for care and reviews the plan. Which actions are appropriate changes for the nurse to make in the plan of care? Select all that apply.

Modify the nursing diagnosis. Make the outcome statement more realistic. Adjust the time limits on the outcome statement. Increase the complexity of the outcome statement.

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

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?

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

Which nursing action reflects evaluation?

The nurse assesses urine output following administration of a diuretic.

A new mother is having difficulty breastfeeding her newborn infant. A goal was established stating 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 the she discontinued breastfeeding. The nurse evaluates the original goal as:

completely unmet.

peer review

evaluation of scientific, academic, or professional work by others working in the same field.

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 does the nurse collect information to evaluate this outcome?

at the completion of each meal

When the nurse prepares to discharge a client, and subsequently evaluates the effectiveness of the patient care, the nurse should determine whether the:

client's goals have been achieved.

Which authoritative statements guide current professional nursing practice?

ANA Standards of Nursing Practice

The nurse is collecting data on a client presenting to the medical short-stay unit for a colonoscopy. A client reports to the nurse that he quit smoking 6 months ago after being diagnosed with lung cancer. The nurse recognizes this change in behavior is which type of outcome?

Affective outcome

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?

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

5 basics of evaulation

Identify Interprete Document Terminate or continue modify

Identify Evaluative Criteria

Meets acceptable level

A nurse is reviewing the plan of care for a client. What might the nurse identify are problems related to the planning phase of the nursing process? Select all that apply.

Plan of care only contains standard knowledge that most nurses would implement if there was a plan of care. Long-term goal is vague. Outcomes are incorrectly developed. Nursing orders are superficial.

The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted?

Quality assurance

Which nurse is using criteria to determine expected standards of performance?

The new graduate nurse consults the policies and procedures of the institution prior to skill implementation.

Why are quality-assurance programs important in nursing?

They enable nursing to be accountable for the quality of care.

evaluative statement

a judgment summarizing the nurse's findings after data have been collected and interpreted to determine patient outcome achievement

A nurse incorrectly administers digoxin to her client. The nurse admits her actions to the nurse manager and to her peers in an effort to prevent them from making the same mistake. This is an example of:

quality by opportunity.

The primary purpose for evaluating data about a client's care according to a functional health approach is to:

revise or modify the client care plan.

When recording or documenting outcome attainment in the chart, nurses are to be very clear with the descriptions used. Which term is appropriate?

"Demonstrated steps"

A nurse must call a health care provider to request a prescription for a client who is experiencing pain unrelieved by the previous medication prescribed. When the nurse makes the call, the provider screams at the nurse and states, "Just do what the prescription says! I am not giving you another prescription for pain medication!" What is the best response by the nurse?

"Speaking to me that way is unacceptable. We should work together for the benefit of the client."

A nurse is caring for a client in the immediate postoperative period and discovers there are factors that are affecting the attainment of client goals. Which statement is true of factors that influence client responses and outcome achievement? Select all that apply.

The nurse will draw on positive factors to deal with other variables in the future. A client's strong motivation to learn appropriate health behaviors is an example of a positive factor. The nurse should understand which factors are helpful to attaining outcomes and manipulate them to achieve goals.

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?

as soon as possible

A client is administered an anxiolytic. Which nursing action demonstrates the nurse evaluating the client?

asking if the client feels less anxious 30 minutes after administering the medicine

performance improvement

commitment to healthier patients, quality care, reduced costs, and making a difference; accomplished by discovering a problem, planning a strategy, implementing a change, and assessing the change to see if the goal is met

retrospective evaluation

evaluation of nursing care and patient outcomes after the patient has been discharged using postdischarge questionnaires, patient interviews, or chart review to collect data

outcome evaluation

evaluation that focuses on measurable changes in the health status of the patient or the end results of nursing care