Chapter 15: PREPU

Question 2

Identifying the kind and amount of nursing services required is a possible solution for: ANSWER: inadequate staffing.

Question 15

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? ANSWER: As soon as possible (Evaluating the progress of a long-term goal prior to the end date will encourage and motivate the client to continue working towards the goal. )

Question 14

The nurse determines that the client is not meeting some of the expected outcomes in the plan of care. What are the next steps in the process? Select all that apply ANSWER: >Reevaluate each step of the nursing process. >Identify contributing factors. >Collect additional data. >Add or alter nursing diagnoses.

Question 12

The nurse manager observes one of the unit nurses failing to was 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: ANSWER: quality by inspection. (Quality by inspection is met by nurses watching for deficient workers and removing them in an effort to prevent harm to clients.)

Question 8

The nursing supervisor is presenting the staff nurse with yearly performance evaluations. What type of evaluation is the supervisor presenting to the staff? ANSWER: Process evaluation (Process evaluation focuses on the nurse's performance and whether the nursing care provided was appropriate and competent. )

Question 26

A nurse incorrectly administers digoxin to her client. The nurse admits her actions to the nurse manager and to her peers in an effort to prevent them from making the same mistake. This is an example of: ANSWER: quality by opportunity. (the nurse is attempting to improve quality through the opportunity of sharing her experience to help other nurses.)

Question 20

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? ANSWER: Process evaluation (Quality assurance programs focus on three types of evaluation: structure, process, and outcome. Process evaluation focuses on the nature and sequence of activities carried out by nurses implementing the nursing process, such as the timing of nursing care plan creation. Outcome evaluation focuses on measurable changes in the health status of clients. Structure evaluation focuses on the environment in which care is provided. There is no "design evaluation.")

Question 30

A nurse identifies an area where client care has been compromised. What steps should the nurse take to improve performance? Select all that apply. ANSWER: >Plan a strategy using indicators. >Assess the change. >Discover a problem. >Implement a change. (Clients are not always aware of problems on a clinical unit. For example, if blankets are not being supplied to the unit per facility policy the client may not be aware because the nurse went and got one from another unit; however, there is a problem that should be addressed. The other choices are all part of the process to improve performance.)

Question 27

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? ANSWER: Quality improvement focuses on processes, data, and statistical thinking. (Quality assurance focuses on organization structure and individuals and is externally driven.)

Question 1

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? ANSWER: Confront the nurse and explain how this could be dangerous for the client.

Question 5

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 client care. Which nursing actions are based on these rules? Select all that apply. ANSWER: >The nurse bases client 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 client care. (The Institute of Medicine's Committee on Quality of Health Care in America suggests 10 rules to redesign and improve care: 1. Care based on continuous healing relationships 2. Customization based on client needs and values 3. The client as the source of control 4. Shared knowledge and the free flow of information 5. Evidence-based decision making 6. Safety as a system priority 7. The need for transparency 8. Anticipation of client's needs 9. Continuous decrease in waste 10. Cooperation among clinicians)

Question 24

A nurse just reported to the oncoming shift that she had failed to perform 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? ANSWER: Quality by opportunity (Quality by opportunity is focused on finding opportunity to improve quality through teamwork and sharing in a nonthreatening environment.)

Question 4

Nurses are involved in many types of evaluation. All of the activities listed are related to evaluation, but which activity is the priority concern for nurses? ANSWER: Clients and their care (The priority concern for nurses should always be related to care of clients.)

Question 16

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: ANSWER: Criteria

Question 6

Which action should the nurse take during the evaluation phase of the nursing process? ANSWER: 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.)

QUestion 17

A client comes into the clinic for a routine postoperative visit. While the nurse is assessing the level of pain, the client states that there is occasional discomfort but that pain levels have improved daily since returning home from the hospital. What should the nurse's response be regarding the client's plan of care? ANSWER: Continue the plan of care. (The nurse should continue the plan of care, as the client is progressing toward the ultimate outcome—the healing of the surgical site. There is no need to modify the plan, as the client is responding.)

Question 22

A client has returned to the clinic for a postoperative visit. The nurse reviews the plan of care and could choose to take which action based on the client's previous responses to the current plan of care? Select all that apply. ANSWER: >Terminate the plan of care if outcomes have been achieved. >Modify the plan of care if difficulty has been encountered with achieving outcomes. >Continue the plan of care if more time could result in achievement of outcomes.

Question 28

A nurse has been providing discharge teaching to a client with type 1 diabetes. Which outcome indicates that the teaching has been effective? ANSWER: 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 client knows the information. Attempting to administer an injection is not an outcome that is effective. If the client was able to demonstrate an injection by himself or herself 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.)

QUestion 25

A nurse is caring for a client in the immediate postoperative period and discovers there are factors that are affecting the attainment of client goals. Which statement is true of factors that influence client responses and outcome achievement? Select all that apply. ANSWER: >The nurse will draw on positive factors to deal with other variables in the future. >A client's strong motivation to learn appropriate health behaviors is an example of a positive factor. >The nurse should understand which factors are helpful to attaining outcomes and manipulate them to achieve goals.

Question 11

A nurse is caring for a client who is recovering from stroke. Which action would the nurse perform in the evaluation phase? ANSWER: Revise the plan of care. (The nurse should revise the plan of care during the evaluation phase. It provides the feedback mechanism that starts the entire chain of events again. )

Question 29

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. ANSWER: >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

Question 23

A nurse is evaluating the plan of care for the client under her care. Which problem might the nurse note that is associated with the implementation phase of the plan of care? ANSWER: Nurses are not aware of client priorities and the plan of care.

Question 7

Nurses formulate different types of goals for clients when planning client care. What is considered a psychomotor client goal? ANSWER: By 18AUG2015, client will demonstrate improved motion in 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 a quality of life goal/outcome. Listing three foods low in salt is a cognitive goal/outcome. Learning exercises to strengthen leg muscles is an affective goal/outcome.)

Question 10

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: ANSWER: outcome evaluation. (Outcome evaluation focuses on measurable changes in the health status of the client or the end results of nursing care. Process evaluation addresses performance expectations during the various stages of the nursing process. Structure evaluation addresses the environment of care. A nursing audit focuses on the review of records.)

Qustion 13

The nurse is assessing the client's self-care capabilities for after discharge from the hospital. Which barrier greatly contributes to the nursing goals being unmet? Select all that apply. ANSWER: >Poor communication skills >Inadequate emotional coping skills >Debilitating illness >Family's lack of interest in the plan of care

Question 18

The nurse is participating in a quality improvement program at the hospital. What are major premises of a quality-improvement program? Select all that apply. ANSWER: >It determines whether nursing standards are being upheld. >Some governmental agencies mandate quality improvement programs. >It focuses on processes rather than individuals. >Its focus is on ensuring excellence in care.

Question 21

The nurse manager is holding a staff meeting and indicates that the unit is looking at a 3% budget cut for the coming year. The nurse manager asks the staff what they see as priorities for the unit, and solicits suggestions from the staff as to what budget areas might be reduced. Which standard for establishing and sustaining healthy work environments does this action represent? ANSWER: Effective decision making (Effective decision making ensures nurses are active, valued partners in making policy, directing and evaluating clinical care, and leading organizational operations. Appropriate staffing ensures that client needs are effectively matched with nurse competencies. Micromanagement would be demonstrated by the manager not asking for opinions and proceeding with decision making without input. Meaningful recognition highlights the value each nurse brings to the work for the organization, such as certification.)

Question 31

When recording or documenting outcome attainment in the chart, nurses are to be very clear with the descriptions used. Which term is appropriate? ANSWER: "Demonstrated steps" ( Avoid ambiguous terminology, such as "inadequate," "good," or "extremely well," which can be interpreted differently by different people.)

Question 9

Which action is appropriate when evaluating a client's responses to a plan of care? ANSWER: 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. The plan of care may continue past discharge if necessary.)

Question 3

Which nurse is using criteria to determine expected standards of performance? ANSWER: 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.)

Question 19

Which nursing actions reflect the evaluation stage of the nursing process? Select all that apply ANSWER: >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). (Setting an anxiety rating with the client is an example of planning.)