(PrepU) Chapter 18: Evaluating

A client reports to the nurse quitting smoking 6 months ago after being diagnosed with lung cancer. The nurse recognizes this change in behavior is which type of outcome?

Affective Affective outcomes pertain to changes in client values, beliefs, and attitudes and are more complex to evaluate. Changes in behaviors, such as the cessation of smoking or nutritional changes that lead to weight loss, are examples of affective outcomes. Cognitive outcomes involve an increase in client knowledge and are evaluated by asking the client to repeat information. Psychomotor outcomes describe the client's achievement of a new skill and are evaluated by having the client perform the skill. Physiologic outcomes result in physical changes and are evaluated through physical assessment.

"The client will verbalize appropriate cast care on discharge" represents which type of outcome?

Cognitive This is an example of a cognitive outcome. Cognitive outcomes are related to achieving greater knowledge. Psychomotor outcomes are those that are related to new skill attainment. Affective outcomes are related to feelings and attitudes. Physical changes are related to actual body changes in the individual.

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

Document reassessment of pain after medication administration. 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.

A hospital is revising its quality improvement program. The goal of the program is to improve quality in the facility. Which of the following are major premises of the program? (Select all that apply)

Focus on the organizational mission Customer orientation Leadership commitment Empowerment Focus is not on unit nurses in a quality improvement program. It is focused on client care and the other choices noted above.

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 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 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. 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 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. 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.

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" 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.

Which is a psychomotor client goal?

By 18AUG2015, the client will demonstrate improved motion in the left arm. Psychomotor client goals refer to the client's achievement of new skills, such as demonstrating improved motion in the left arm. Valuing health by quitting smoking is an example of an affective goal. Listing three foods low in salt is a cognitive goal. Learning exercises to strengthen leg muscles is an affective goal.

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

a cognitive outcome. Cognitive outcomes demonstrate increases in client knowledge, such as strategies for minimizing leakage of an ileostomy bag. An affective outcome involves changes in the client's values, beliefs, and attitude. Physiologic outcomes are physical changes in the client. Psychomotor outcomes describe the client's achievement of new skills.

"The levels of performance accepted by and expected of nursing staff or other health team members" defines:

standards. 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.

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?

throughout the client's hospital admission 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."

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. 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, orienting a new client to the facility, explains that the staff will ask for and honor the client's preferences and choices while providing care. This represents which expectation of the health care environment?

Individualization Individualization is represented by allowing the client to express his or her choices and preferences and then honoring them. The other choices represent other expectations of the health care environment. Transparency is the expectation that the information on all aspects of a client's health and care will be disclosed to the client. Control is the expectation that the client will retain autonomy and the right to self-determination. Safety is the expectation that the client will remain free from harm.

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. Teaching has been effective when the client verbalizes signs and symptoms of hypoglycemia, indicating that the client knows the information. Attempting to administer an injection is not an outcome that is effective. If the client was actually able to demonstrate an injection by oneself, then this outcome would be effective. Talking to a dietitian and understanding care do not demonstrate to the nurse that the teaching has been effective, but rather represent passive learning without a measurable outcome.

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?

Physical changes 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.

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

Quality assurance 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 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 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 blood glucose levels is a physiologic outcome.

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

The nurse considers the individual needs of clients. 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 evaluates clients prior to discharge from a hospital setting. Which action is the most important act of evaluation performed by the nurse?

The nurse evaluates the client's goal/outcome achievement. The priority is to evaluate the client's goal/outcome achievement. This determines if the nursing diagnosis has been resolved. If the client's goal/outcome had not been met the nurse should then begin evaluating all aspects of the plan of care. It is not the responsibility of the nurse to evaluate the competence of nurse practitioners. The nurse can evaluate services available to the client but this is not the purpose of the evaluation phase of the nursing process.

The client demonstrates stair climbing using a quad cane. This is an example of:

a psychomotor outcome. Psychomotor outcomes describe the client's achievement of new skills, such as stair climbing using a quad cane. An affective outcome involves changes in the client's values, beliefs, and attitude. Cognitive outcomes demonstrate increases in client knowledge. Physiologic outcomes are physical changes in the client.