Ch 18
The nurse should evaluate client outcomes at which time? Within 24 hours after identifying them Several days after discharge The day of discharge As early as possible
Meeting the care needs of clients The priority concern for nurses should always be related to meeting the care needs of clients. The other choices are all activities related to evaluation that serve this priority.
A client is administered an anxiolytic. Which nursing action demonstrates the nurse evaluating the client? Assigning the client a new nursing diagnosis based on the client's controlled anxiety Asking whether the client feels less anxious 30 minutes after administering the medicine Collecting data about the client's history with anxiety 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
All of the activities listed are related to evaluation, but which activity is the priority concern for nurses? Meeting the care needs of clients Helping targeted groups of clients to achieve their specific outcomes Measuring client outcome achievement Measuring the competence of individual nurses
Meeting the care needs of clients The priority concern for nurses should always be related to meeting the care needs of clients. The other choices are all activities related to evaluation that serve this priority.
The nurse is caring for a client with congestive heart failure. The nurse manager informs the nurse that the client was enrolled in a clinical trial to assess whether a 10-minute walk, 3 times per day, leads to expedited discharge. Which type of evaluation best describes what the researchers are examining? Process Cost-effectiveness Outcome Structure
Outcome evaluation focuses on measurable changes in the health status of the client or the end results of nursing care, such as an expedited discharge of the client based on the client recovering more quickly due to an intervention. The focus of a process evaluation is the nature and sequence of activities carried out by nurses implementing the nursing process. A structure evaluation or audit focuses on the environment in which care is provided. Cost-effectiveness is not a type of evaluation identified by the American Nurses Association.
Before discharge the client will demonstrate aseptic dressing changes. This is an example of which type of evaluative statement? Psychomotor Affective Cognitive Physical changes
Psychomotor Psychomotor outcomes are those that are related to new skill attainment, such as learning aseptic dressing changes. Cognitive outcomes are related to achieving greater knowledge. Affective outcomes are related to feelings and attitudes. Physical changes are related to actual body changes in the individual.
Why are quality-assurance programs important in nursing? They facilitate increased enrollment in educational programs. 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 enable nursing to be accountable for the quality of care. 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.
A mother is bringing an infant into the clinic for a well-baby checkup. The infant's weight gain is on target for age. A correctly written evaluative statement for this client is: "8FEB2016. Goal met. The infant's weight gain is appropriate for age." "Progressing well." "8FEB2016. Goal met." "Goal met"
"8FEB2016. Goal met. The infant's weight gain is appropriate for age." An appropriately written evaluative statement should be dated, clearly state the judgement as to whether the outcome was met, and provide data to support the judgment.
The nurse determines that a client has not met the goal of consuming at least 80% of each meal served by a designated date. Which response(s) by the nurse would be appropriate regarding this lack of goal attainment? Select all that apply. "What kinds of things have we been doing to increase your appetite?" "Maybe it would be better if we delete this goal and work on something else." "Do you think you could meet the goal if we check on it in one week or so?" "Are you trying as much as possible to eat 80% of each meal?" "Do you think it is possible that you will be able to eat 80% of the food served here?"
"Do you think it is possible that you will be able to eat 80% of the food served here?" "What kinds of things have we been doing to increase your appetite?" "Do you think you could meet the goal if we check on it in one week or so?" The nurse should review the goal to determine whether it is realistic, review the actions taken to move the client toward goal attainment, and consider changing the time line for evaluation. There is no indication that discarding the goal is necessary. By asking whether the client is trying as much as possible to eat 80% of each meal, the nurse infers that the failure to meet the goal is the client's fault. This blame-placing should be avoided.
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 One of the staff critical care physicians Another registered nurse with critical care certification Another staff nurse from the medical-surgical unit
Another registered nurse with critical care certification 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.
A new mother is having difficulty breastfeeding a newborn infant. A goal was established stating that 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 having discontinued breastfeeding. The nurse evaluates the original goal as: partially met. completely unmet. inappropriately chosen for this client. met.
completely unmet. After collecting data and evaluating the client's behavioral responses, the nurse makes a judgment about goal attainment by comparing the client's actual behavioral responses with the predicted responses or predetermined outcome criteria developed in the planning phase. In this case the mother abandoned breastfeeding, which represents a complete failure to meet the collaborative goal established. If the mother reported breastfeeding the baby every 4 to 5 hours, the nurse could consider the goal partially met. There is no evidence that the goal was inappropriately chosen for the client.
A mother brings an infant into the clinic for a well-baby 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 baby is gaining weight appropriately. Which is an appropriate evaluative statement for this client? "8FEB2016. 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." "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."
"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." The evaluative statement should include the time frame/date, a judgment as to whether the goal was met, and data to support the decision.
The nurse participates in a quality assurance program and reviewing evaluation data from the previous year. Which should the nurse recognize as an example of outcome evaluation? Bed occupancy rates of 97% in the critical care areas and 92% in the non-critical care areas A 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery A rate of 98% of clients admitted to the hospital who had a nursing history completed within 24 hours after admission A 4% increase in the number of baccalaureate-prepared nurses employed in the facility
A 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery Quality assurance programs focus on three types of evaluation: structure, process, and outcome. Outcome evaluation focuses on measurable changes in the health status of clients, such as a 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery. Structure evaluation focuses on the environment in which care is provided, such as the number of baccalaureate-prepared nurses employed in the facility and bed occupancy rates. Process evaluation focuses on the nature and sequence of activities carried out by nursing implementing the nursing process, such as a rate of 98% of clients admitted to the hospital who had a nursing history completed within 24 hours after admission.
Which statement related to the evaluation of outcome attainment for a client is correct? The nurse should initially evaluate the plan of care at the time of the client's discharge. Collecting data related to outcome attainment requires the nurse to know when to collect the data, based upon established time criteria. Celebrating outcome achievement with a client often interferes with attainment of future goals. Evaluation of the client's attainment of outcome goals is determined by the nurse and physician.
Collecting data related to outcome attainment requires the nurse to know when to collect the data, based upon established time criteria. 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. (less)
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? File an incident report and have the second nurse sign it. Contact the physician for an order for the restraints. Confront the nurse and explain how this could be dangerous for the client. Report the nurse applying the restraints to the supervisor.
Confront the nurse and explain how this could be dangerous for the client. Confronting the nurse and explaining the danger for the client is a form of peer evaluation. Peer evaluation involves evaluation of one staff member by another staff member on the same level in the hierarchy of the organization. This is an important mechanism nurses can use to improve their professional performance; it can be done formally or informally. Reporting the nurse does not enhance a good working relationship and does not follow the chain of command. An incident report is not warranted at this point in time. The physician should not be contacted for an order unless it is decided that the restraint is going to be left on the client.
Which action is appropriate when evaluating a client's responses to a plan of care? Terminate the plan if there are difficulties achieving the goals/outcomes. Reinforce the plan of care when each expected outcome is achieved. Terminate the plan of care upon client discharge. Continue the plan of care if more time is needed to achieve the goals/outcomes.
Continue the plan of care if more time is needed to achieve the goals/outcomes. The client's goals/outcomes sometimes are not met or partially met only because more time is needed for the plan of care to be effective. It is not necessary to reinforce the plan of care when each expected outcome is achieved because as goals are met, the plan can simply continue to the next goal. Termination of the plan is not warranted due to difficulties in achieving goals/outcomes; modifications to the plan of care may only be required. The plan of care may continue past discharge if necessary.
The nurse in a burn intensive care unit (BICU) is caring for a 3-year-old child who was burned with scalding hot water. The client has burns covering 75% of the body. The client's condition is critical but stable. At 1000, the nurse reassesses the client and finds that the client is agitated and pulling at the endotracheal tube. Which is the nurse's priority intervention for this client at this time? Repositioning to prevent pressure injuries Providing medication for agitation Ensuring that the endotracheal tube is secure Changing the dressing to prevent infection
Ensuring that the endotracheal tube is secure The ABCs (airway, breathing, and circulation) are always top priority in client care. In this example, ensuring that the client maintains a patent airway will always be top priority. Each of these nursing tasks is important and will need to be accomplished at some point during client care.
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? Create a new nursing diagnosis to reflect new goals. Request a stronger analgesic from the provider. Evaluate the use of current pain relief measures. Provide additional relief with non-pharmacologic measures.
Evaluate the use of current pain relief measures. 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. 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 client will verbalize appropriate cast care on discharge" represents which type of outcome? Psychomotor Affective Cognitive Physical change
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 client will demonstrate cast care prior to discharge" is which type of evaluative statement? Physical changes Psychomotor Cognitive Affective
Psychomotor This is an example of a psychomotor evaluative statement. 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. Physical changes are related to actual body changes in the individual.
All of the activities listed are related to evaluation, but which activity is the priority concern for nurses? Measuring client outcome achievement Meeting the care needs of clients Measuring the competence of individual nurses Helping targeted groups of clients to achieve their specific outcomes
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.
The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted? Quality improvement Quality assurance Peer review Magnet status
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.
The nurse manager observes one of the unit nurses failing to wash hands on entering a client room. Hospital protocol is to wash hands before and after entering a client room. This scenario is an example of which approach to quality assurance? Quality by perception Quality by inspection Quality as initiative Quality as opportunity
Quality by inspection Quality by inspection is an approach to quality assurance in which nurses watch for deficient workers and remove them in an effort to prevent harm to clients. Quality as opportunity, on the other hand, focuses on finding opportunities for improvement and fosters an environment that thrives on teamwork, with people sharing the skills and lessons they have learned. Quality by perception and quality as initiative are not specific approaches to quality assurance.
Which are psychomotor outcomes? Select all that apply. The client reports increased confidence in testing blood glucose level. The client rates pain as a 2 on a 0 to 10 pain rating scale. The client safely ambulates using a walker. The client identifies signs and symptoms of infection. The client accurately draws up insulin. SUBMIT ANSWER
The client accurately draws up insulin. The client safely ambulates using a walker. Examples of psychomotor outcomes include accurately drawing up insulin and ambulating safely using a walker. Identifying signs and symptoms of infection is an example of a cognitive outcome. Rating pain as a 2 on a 0 to 10 scale is a physiologic outcome. An example of an affective outcome is reporting increased confidence in testing blood glucose level.
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 can demonstrate the correct technique for using a new glucometer. 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 expresses a desire to change the way that the client eats and exercises.
The client is able to explain when and why he needs to check his blood sugar. 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.
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 can demonstrate the correct technique for using a new glucometer. The client expresses a desire to change the way that the client eats and exercises. The client is able to explain when and why the client needs to check the blood glucose level. 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 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 nursing action reflects evaluation? The nurse identifies that the client has wound drainage. The nurse performs colostomy irrigation. The nurse sets an anxiety level of 3 or less with the client. The nurse assesses the client's response to pain medication.
The nurse assesses the client's response to pain medication. Examples of evaluation include assessing the client's response to pain medication. The focus of diagnosing is recognition of a client health problem that can be prevented or resolved by independent nursing intervention, such as a wound infection. Setting an anxiety rating with the client is an example of planning. Performing colostomy irrigation is an example of implementation.
Which characteristic is the most important indicator of high-quality nursing practice? The nurse considers the individual needs of clients. The nurse takes measures to ensure accurate medication administration. The nurse is organized and efficient in client care. The nurse follows the policies and procedures of the institution.
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 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 post discharge questionnaire to evaluate client satisfaction. The nurse reviews the client chart while the client is being cared for. The nurse interviews the client while the client is receiving the care. The nurse directly observes the nursing care being provided.
The nurse devises a postdischarge questionnaire to evaluate client satisfaction. Evaluations can be conducted concurrent with care (by using direct observation of nursing care, client interviews, and chart review to determine whether the specified evaluative criteria are met) or retrospectively (postdischarge questionnaires, client interviews by telephone or face to face, or chart review to collect data).
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 plan of care. The nurse evaluates the competence of nurse practitioners. The nurse evaluates the client's goal/outcome achievement. The nurse evaluates the types of health care services available to the client.
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.
Which nursing actions reflect the evaluation stage of the nursing process? Select all that apply. The nurse performs tracheostomy care using sterile technique. The nurse documents the client's response to suctioning. The nurse sets an anxiety level of 3 or less with the client. The nurse determines the client did not lose the expected 2 lb (0.90 kg). The nurse identifies that a client's pain is not being adequately treated.
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). Examples of evaluation include documenting the client's response to suctioning and making a judgment that the client did not reach the expected outcome of a 2-lb (0.90-kg) loss or adequate pain control. Setting an anxiety rating with the client is an example of planning. Performing tracheostomy care is an example of implementation.
A new mother is having difficulty breastfeeding a newborn infant. A goal was established stating that 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 having discontinued breastfeeding. The nurse evaluates the original goal as: met. completely unmet. partially met. inappropriately chosen for this client.
completely unmet. After collecting data and evaluating the client's behavioral responses, the nurse makes a judgment about goal attainment by comparing the client's actual behavioral responses with the predicted responses or predetermined outcome criteria developed in the planning phase. In this case the mother abandoned breastfeeding, which represents a complete failure to meet the collaborative goal established. If the mother reported breastfeeding the baby every 4 to 5 hours, the nurse could consider the goal partially met. There is no evidence that the goal was inappropriately chosen for the client.
Identifying the kind and amount of nursing services required is a possible solution for: nurses frustrated with substandard care. clients who fail to communicate their needs. nurses who are bored. inadequate staffing.
inadequate staffing. A possible solution for inadequate staffing is to identify the kind and amount of nursing services required. Using a team conference to develop a consistent plan of care is a possible solution for the client who fails to communicate needs. Educating the client to become an assertive health care consumer is a possible solution for the client who quietly accepts whatever care is delivered or not delivered. A possible solution for the nurse who is a candidate for burnout is to learn to give quality care during the designated work period. An initiative to focus on quality improvement is a possible solution to nurses frustrated with substandard care. Reviewing task assignments and work schedules is a possible solution to bored nurses.
The primary purpose for evaluating data about a client's care according to a functional health approach is to: determine implementation of medical orders. revise or modify the client care plan. evaluate the need for health care consultations. meet accreditation standards.
revise or modify the client care plan. Evaluation using the functional health approach provides a framework for organizing and evaluating data allowing the nurse to modify the client care plan. Evaluation has no influence upon meeting accreditation standards, implementation of medical orders, or the need for health care consultations.
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 when the client is discharged during the first home health care visit once the primary care physician has written a discharge order
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."
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. The nurse should initially evaluate the plan of care at the time of the client's discharge. Evaluation of the client's attainment of outcome goals is determined by the nurse and physician. 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. 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.
A nurse is evaluating a client to determine outcome achievement. The nurse determines that the client's outcome was partially met. When documenting the evaluative statement, the nurse records which other information? Data that support the decision of the outcome being partially met The client's verbal agreement of the outcome not being met The revision to the initial outcome identified The reason the outcome was only partially met
Data that support the decision of the outcome being partially met The two-part evaluative statement includes a decision about how well the outcome was met, along with client data or behaviors that support this decision. Client statements, reasons for not meeting the outcome, and revisions to the outcome statement are not included.
Which of the following best summarizes the evaluation step of the nursing process? The client and family have met health care goals and no longer need care. The nurse and client identify nursing diagnoses and appropriate interventions. The nurse completes a health assessment to establish a database. The nurse and client measure achievement of planned outcomes of care.
The nurse and client measure achievement of planned outcomes of care. In evaluation, which is the fifth step of the nursing process, the nurse and client together measure how well the client has achieved the outcomes specified in the plan of care. Establishing a health assessment is the first stage of the nursing process. Identifying nursing diagnosis is the second stage and implementation of care is the fourth stage. When the client no longer needs care, the relationship is terminated.