TLB-Chapter 18: Evaluating

The client identifies three strategies for minimizing leakage of an ileostomy bag. This is an example of: an affective outcome. a psychomotor outcome. a physiologic outcome. a cognitive outcome.

a cognitive outcome. Explanation: 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.

Priority setting is based on the information obtained during reassessment and is used to rank nursing diagnoses. Each factor contributes to priority setting except which? Finances of the client The client's condition Time and resources Feedback from the family

Finances of the client Explanation: The client's condition, time and resources, and feedback or input from the family are all of great value when the nurse is prioritizing the client's nursing diagnoses. The client's finances, however, should not influence the nurse's priority setting. The nursing code of ethics states that clients should receive the same treatment regardless of their ability to pay.

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 nurse manager Another registered nurse with critical care certification One of the staff critical care physicians Another staff nurse from the medical-surgical unit

Another registered nurse with critical care certification Explanation: Peer review is the evaluation of one staff member by another staff member on the same level in the hierarchy of the organization. Therefore, another registered nurse who is certified in critical care would be appropriate to evaluate a critical care nurse certified in critical care. A nurse manager and a critical care physician are at a higher level in the hierarchy than a staff nurse certified in critical care. A staff nurse without certification in critical care would also not be appropriate to evaluate a nurse with this certification.

The nurse performs discharge teaching for a client. How would the nurse best evaluate the effectiveness of the discharge teaching? Review it to see if all health care provider prescriptions were covered. Ask the client to repeat back to the nurse how care will be conducted at home. Determine if critical pathways were completed. Ask if the client understands the teaching.

Ask the client to repeat back to the nurse how care will be conducted at home. Explanation: Evaluation is defined as the judgment of the effectiveness of nursing care to meet client goals based on the client's behavioral responses. This phase involves a thorough, systematic review of the effectiveness of nursing interventions and a determination of client goal achievement. The best way to evaluate the effectiveness of discharge teaching is to have the client repeat back to the nurse how care will be conducted at home. The nurse does not evaluate whether health care provider prescriptions or critical pathways have been completed during discharge teaching. Asking if the client understands the teaching does not allow the nurse to fully evaluate if the teaching was indeed successful.

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 On 3/2 On 3/3 At the client's direction

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.

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 physician 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 Explanation: 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 physician, 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.

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 Implementing a change Discovering a problem 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.

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 Cognitive Affective 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 client has returned to the clinic for a postoperative visit. The nurse reviews the plan of care and may choose to take which actions based on the client's previous responses to the current plan of care? Select all that apply. Terminate the plan of care if the client has achieved outcomes. Modify the plan of care if the client has encountered difficulty with achieving outcomes. Explain the plan of care to significant others and advise them of the expectation that the client will achieve outcomes within a reasonable amount of time. Continue the plan of care if more time could result in achievement of outcomes.

Terminate the plan of care if the client has achieved outcomes. Modify the plan of care if the client has encountered difficulty with achieving outcomes. Continue the plan of care if more time could result in achievement of outcomes. Explanation: The nurse should discuss the plan of care should with the client and any significant others at the onset of care. The nurse should inform the client that nurses will help along the way as the client strives to reach outcomes; the nurse should not demand that the client achieve outcomes on a set time frame. The other choices are appropriate actions for the nurse to take when reevaluating the plan of care.

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 nurse evaluates the plan of care. The nurse evaluates the competence of nurse practitioners. The nurse evaluates the types of health care services available to the client.

The nurse evaluates the client's goal/outcome achievement. Explanation: 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.