Chapter 19: Evaluating
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 -Affective -Psychomotor -Physical changes
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 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." -"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." -"Goal met" -"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."
"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.
When recording or documenting outcome attainment in the chart, nurses are to be very clear with the descriptions used. Which term is appropriate? -"Extremely well-mannered" -"Demonstrated steps" -"Great response" -"Inadequate skills"
"Demonstrated steps" Explanation: Written documentation of the subjective and objective data gathered and the judgment made about goal attainment is required on the client's health record. Judgments about goal attainment are written clearly and concisely. Avoid ambiguous terminology, such as "inadequate," "good," or "extremely well," which can be interpreted differently by different people.
A client is administered an anxiolytic. Which nursing action demonstrates the nurse evaluating the client? -Devising a plan for the client to practice anti-anxiety exercises at home -Asking whether the client feels less anxious 30 minutes after administering the medicine -Assigning the client a new nursing diagnosis based on the client's controlled anxiety -Collecting data about the client's history with anxiety
Asking whether the client feels less anxious 30 minutes after administering the medicine Explanation: Evaluation allows the nurse to determine whether the client has met the goal. By analyzing the client's response to the anxiolytic, the nurse determines the effectiveness of the nursing care. The other actions demonstrate other parts of the nursing process: assessment (collecting data about the client's history with anxiety), diagnosis (assigning the client a new nursing diagnosis based on the client's controlled anxiety), and planning (devising a plan for the client to practice anti-anxiety exercises at home).
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? -On 3/2 -On 3/3 -At the client's direction -At the completion of each meal
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 nurse is evaluating the plan of care for a client and determines that the achievement of goals is difficult to evaluate. What should the nurse do when evaluating the plan to ensure that the outcomes are achievable? Select all that apply. -Be certain that the subject is the client or some part of the client. Specify time limits in the plan. -Make sure the client's expected behavior is written in observable, measurable terms. -Rewrite the plan of care so that the client meets the expected outcomes. -Be sure that the criteria for appropriate response are clearly specified.
Be sure that the criteria for appropriate response are clearly specified. Be certain that the subject is the client or some part of the client. Make sure the client's expected behavior is written in observable, measurable terms. Specify time limits in the plan. Explanation: The nurse should not rewrite the plan of care just so the client meets the outcomes. The other choices are appropriate actions for the nurse to take when evaluating the plan of care.
Which statement related to the evaluation of outcome attainment for a client is correct? -Evaluation of the client's attainment of outcome goals is determined by the nurse and health care provider. -Collecting data related to outcome attainment requires the nurse to know when to collect the data, based upon established time criteria. -The nurse should initially evaluate the plan of care at the time of the client's discharge. -Celebrating outcome achievement with a client often interferes with attainment of future goals.
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.
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? -Planning a strategy using indicators -Discovering a problem -Implementing a change -Assessing the change
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.
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? -Provide additional relief with non-pharmacologic measures. -Request a stronger analgesic from the provider. -Evaluate the use of current pain relief measures. -Create a new nursing diagnosis to reflect new goals.
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 measures.
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. -Altered Mobility; able to tie shoes. -Impaired Walking; unilateral neglect. -Dysfunctional Family Processes; family contact daily.
Ineffective Coping; verbalizes support systems. Explanation: When considering appropriate evaluation criteria, be certain they relate directly to the diagnosis and the diagnosis relates to the assessment data. There are no data to support unilateral neglect. Tying shoes evaluates a client's abilities, not mobility. The nurse assesses that the family visits daily, so the family process is functional. Ineffective coping is appropriately evaluated by identification of coping mechanisms, such as support systems.
The nursing staff on a hospital unit uses peer review to improve professional performance. Who performs the review? -Nurses -Unit manager -Visitors -Clients
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.
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: -American Association of Critical-Care Nurses (AACN) -Peer review -Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) -Quality and Safety Education for Nurses (QSEN)
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 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? -Psychomotor -Affective -Cognitive -Physical changes
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 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 -Outcome evaluation -Process evaluation -Quality by inspection
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.
Which are areas of focus in quality improvement? Select all that apply. -Nurses -Data use -Processes -Individuals -Systems
Systems Processes Data use Explanation: According to the U.S. Department of Health and Human Services, Health Resources and Services Administration, quality improvement focuses on four key principles: systems and processes; clients; being part of a team; and use of the data. Nurses and individuals are not areas of focus in quality improvement.
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 expresses a desire to change the way that the client eats and exercises. -The client has maintained blood glucose levels within acceptable range in the days prior to discharge. -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 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 new graduate nurse consults the policies and procedures of the institution prior to skill implementation. -The nurse manager provides the staff nurse feedback regarding job performance for the previous year. -The nurse preceptor provides feedback to the new graduate nurse after 6 weeks of orientation. -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. 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 characteristic is the most important indicator of high-quality nursing practice? -The nurse is organized and efficient in client care. -The nurse considers the individual needs of clients. -The nurse takes measures to ensure accurate medication administration. -The nurse follows the policies and procedures of the institution.
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.
Why are quality-assurance programs important in nursing? -They allow increased retention of qualified nurses. -They enable nursing to be accountable for the quality of care. -They specify how resources are used or not used. -They facilitate increased enrollment in educational programs.
They enable nursing to be accountable for the quality of care. Explanation: Quality-assurance (QA) programs enable nursing to be accountable to society for the quality of nursing care. They are a response to the public mandate for professional accountability. QA programs do not facilitate increased enrollment in education programs, specify how resources are to be used, or increase retention of nurses.
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? -once the primary care health care provider has written a discharge order -throughout the client's hospital admission -during the first home health care visit -when the client is discharged
throughout the client's hospital admission Explanation: It is important to evaluate client outcomes early and frequently. Reserving evaluation for the time of discharge or after discharge is inappropriate, even if the designated time criteria for the outcome specifies "by time of discharge."