Fundamentals Nursing Prep U Chapter 15 Evaluating
The nurse is orienting a new client to the facility. The client is told that her preferences and choices would be sought and honored. This represents which expectation of the health care environment?
Individualization
A mother is bringing her infant into the clinic for a well baby check. The infant's weight gain is on target for age. A correctly written evaluative statement is which of the following?
"8FEB2016. Goal met. The infant's weight gain is appropriate for age."
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?
Model self-care behaviors for the client.
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?
Peer review
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 of the following types of outcome is the nurse addressing?
Psychomotor
The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted?
Quality assurance
A nurse is caring for a client who is recovering from stroke. Which of the following would the nurse perform in the evaluation phase?
Revise the plan of care
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 patient condition.
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?
Evaluative statement
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?
Patients and their care
When the nurse prepares to discharge a client, and subsequently evaluate the effectiveness of the patient care, the nurse should determine whether the:
client's goals have been achieved.
Which client outcome is a cognitive outcome? Select all that apply
• The client lists the side effects of digoxin (Lanoxin). • The client describes how to perform progressive muscle relaxation. • The client identifies signs and symptoms of hypoglycemia.
Which nursing actions reflect the evaluation stage of the nursing process? Select all that apply.
• The nurse identifies that a client's pain is not being adequately treated. • The nurse documents the client's response to suctioning. • The nurse determines the client did not lose the expected 2 lb (0.90 kg).
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
A client who was admitted to the acute care unit with angina pectoris is no longer having chest pain. Based on this assessment, what does the nurse decide to do with the plan of care for chest pain?
Terminate the plan of care related to the nursing diagnosis of chest pain
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.
At the beginning of prenatal care, the goal for the client was to gain 25 lb (11.25 kg) by the end of the pregnancy. At 30 weeks of pregnancy, the client has only gained 1 lb (0.45 kg). Which statement(s) would help the nurse most appropriately interpret these data?
The client is not achieving the goal. The nurse should determine the reasons the client has not been gaining weight.
A nurse is evaluating nursing care and patient outcomes by using a retrospective evaluation. Which action would the nurse perform in this approach?
The nurse devises a post-discharge questionnaire to evaluate patient satisfaction.
Which scenario represents a nurse demonstrating the critical thinking process?
assessing whether physician help is needed
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
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.
The nursing supervisor is evaluating how many clients each of the department nurses has been assigned for the shift. This type of evaluation would be considered:
structure
The nurse is preparing to evaluate the goals set for an newborn and newly delivered client. What physiologic goals will the nurse evaluate for effectiveness? (Select all that apply.)
• By 4/6/15, the newborn will demonstrate 2 hours of sleep prior to breastfeeding at night. • By 4/6/15, the mother will demonstrate pain rating of 0 on a 0-10 scale • Before discharge, the baby will have reached a target weight gain of 8 lb (birth weight: 7 lb, 6 oz).
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 new graduate nurse is working in a hospital that is utilizing a program to continuously improve every process in every department of the facility. What processes will the graduate determine is being utilized? Select all that apply
• Quality improvement • Continuous quality improvement • Total quality improvement
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 patient care. Which nursing actions are based on these rules? (Select all that apply.)
• The nurse bases patient care on established nursing 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 patient care.
A nursing student asks the clinical instructor to explain the difference between quality improvement and quality assurance. Which response by the clinical instructor is appropriate?
"Quality improvement focuses on processes, data, and statistical thinking."
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?
Quality by opportunity
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 nurse identifies an area where client care has been compromised. What steps should the nurse take to improve performance? Select all that apply.
• Plan a strategy using indicators • Assess the change • Discover a problem • Implement a change
The nurse manager observes one of the unit nurses failing to wash her hands upon entering a client room. Hospital protocol is washing hands before and after entering a client room. The nurse manager knows that this is an example of:
Quality by inspection
A mother brings her child into the clinic for follow up after beginning treatment for Attention Deficit Hyperactivity Disorder (ADHD). One of the outcomes was for the child to complete homework within a one hour time interval. The mother reports that it still takes 1 1/2 hours but that is dramatically reduced from the 3 hours or more before beginning treatment. What is the best response for the nurse to make to the child?
"You have done a great job by focusing on your homework and doing it in much less time. Do you think by your next visit that you can get it down to an hour?"
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 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery.
The nurse is caring for a newborn who is scheduled to be discharged tomorrow. The mother of the newborn expresses concern about being able to properly breast feed her infant. The nurse reviews the plan of care and finds that there is an outcome that states "The mother will express confidence in being able to meet nutritional needs of her infant." This is an example of which type of outcome statement?
Affective
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.
Quality assurance programs are important for ensuring quality nursing care. Which of the following situations need to be reported to the nurse manager? Select all that apply.
• Nurse assesses client after sneezing into hand. • Nurse administers medications to wrong client. • Nurse delays answering call lights to an abusive client. • Nurse refuses to provide care to a client with HIV.
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 do if there was a plan of care. • Long-term goal is vague. • Outcomes are incorrectly developed. • Nursing orders are superficial.
Which client outcome is a psychomotor outcome? Select all that apply.
• The client measures capillary blood sugar level. • The client catheterizes self, using clean technique.
A nurse is evaluating the plan of care for a client in the clinic. Which actions will be performed as a classic element of evaluation? Select all that apply.
• identifying evaluative criteria and standards • collecting data to determine if criteria or standards are being met • interpreting and summarizing findings • terminating, continuing, or modifying the plan of care