Chapter 18: Evaluating PrepU

Which are cognitive client outcomes? Select all that apply. -The client correctly ambulates with a walker. -The client lists the side effects of digoxin. -The client identifies signs and symptoms of hypoglycemia. -The client describes how to perform progressive muscle relaxation. -The client reports cycling 30 minutes three times each week.

-The client lists the side effects of digoxin. -The client describes how to perform progressive muscle relaxation. -The client identifies signs and symptoms of hypoglycemia. Cognitive outcomes demonstrate increases in client knowledge, such as listing side effects of medications, identifying signs and symptoms of hypoglycemia, and describing progressive muscle relaxation. Psychomotor outcomes describe the client's achievement of new skills, such as correct ambulation with a walker. An affective outcome involves changes in the client's values, beliefs, and attitude, such as the client's report of cycling.

Which client outcome is an example of a physiologic outcome? -The client explains how to administer a vaginal cream. -The client reports walking for 30 minutes each day. -The client demonstrates active range-of-motion exercises with left upper extremity. -The client's pulse oximetry reading is 97% on room air 30 minutes after removal of a nasal cannula.

The client's pulse oximetry reading is 97% on room air 30 minutes after removal of a nasal cannula. Physiologic outcomes are physical changes in the client, such as pulse oximetry. An affective outcome involves changes in the client's values, beliefs, and attitude, such as engaging in exercise. Cognitive outcomes demonstrate increases in client knowledge, such as administration of a vaginal cream. Psychomotor outcomes describe the client's achievement of new skills, such as performing active range-of-motion exercises.

Which nursing action reflects evaluation? -The nurse identifies that the client has wound drainage. -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 performs colostomy irrigation.

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.

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 -once the primary care physician has written a discharge order -when the client is discharged -during the first home health care visit

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."

Before discharge the client will demonstrate aseptic dressing changes. This is an example of which type of evaluative statement? -Psychomotor -Cognitive -Affective -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.

Which characteristic is the most important indicator of high-quality nursing practice? -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 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 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. -inappropriately chosen for this client. -partially 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.

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 -Time and resources -The client's condition -Feedback from the family

Finances of the client 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.

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 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.

A group of nurses on 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. This program is termed: -Peer review -Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) -American Association of Critical-Care Nurses (AACN) -Quality and Safety Education for Nurses (QSEN)

Peer review Peer review is a process by which one nurse evaluates the performance of another to improve professional performance. QSEN has as its goal the preparation of nurses with the knowledge, skills, and attitudes necessary to improve the quality and safety of health care systems. AACN strives to provide safe work environments. HCAHPS measures client satisfaction with health care.

As part of a quality improvement initiative nurses are asked to complete a structure evaluation. Which information should the nurse include in this work? Select all that apply. -The procedure for insertion of intravenous catheters has not been reviewed for two years. -The unit's rate of catheter-associated urinary tract infections has risen sharply in the last year. -Newly purchased beds are difficult to move through client room doors. -There is a potential for errors when clients are transferred from the emergency department to the nursing unit during shift change. -Because there is no door on the unit's diet kitchen, client families feel free to walk in and serve themselves coffee.

-Because there is no door on the unit's diet kitchen, client families feel free to walk in and serve themselves coffee. -Newly purchased beds are difficult to move through client room doors. Structural evaluations have to do with the physical structure of the unit, so lack of a door on the unit's diet kitchen and difficulty moving beds through doors are structural issues. Process evaluations have to do with how things are done, so review of procedures and transfers would be included in this review. Outcome evaluation has to do with client outcomes. In this case, an increase in infection rates is the outcome.

Which client outcomes are psychomotor outcomes? Select all that apply. -The client identifies five low-sodium foods. -The client describes how to empty a Jackson-Pratt drain. -The client reports imagery is effective in controlling anxiety. -The client measures capillary blood glucose level. -The client self-catheterizes using clean technique.

-The client measures capillary blood glucose level. -The client self-catheterizes using clean technique. Psychomotor outcomes describe the client's achievement of new skills, such as measuring capillary blood glucose level and self-catheterization. Cognitive outcomes demonstrate increases in client knowledge, such as identifying low-sodium foods and describing how to empty a wound drain. An affective outcome involves changes in the client's values, beliefs, and attitude, such as using imagery to control anxiety.

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

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 client is administered an anxiolytic. Which nursing action demonstrates the nurse evaluating the client? -Asking whether the client feels less anxious 30 minutes after administering the medicine -Collecting data about the client's history with anxiety -Assigning the client a new nursing diagnosis based on the client's controlled 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 Evaluation allows the nurse to determine whether the client has met the goal. By analyzing the client's response to the anxiolytic, the nurse determines the effectiveness of the nursing care. The other actions demonstrate other parts of the nursing process: assessment (collecting data about the client's history with anxiety), diagnosis (assigning the client a new nursing diagnosis based on the client's controlled anxiety), and planning (devising a plan for the client to practice anti-anxiety exercises at home).

Which action should the nurse take during the evaluation phase of the nursing process? -Have the client give input into plan of care upon admission. -Document reassessment of pain after medication administration. -Provide the client with a follow-up appointment after discharge. -Discontinue the indwelling urinary catheter per the provider's order.

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.

The nurse works as a client advocate for an older adult client admitted with hyponatremia. Which action can the nurse take to help the client advocate for oneself? -Incorporate therapeutic use of self. -Help the client with skin care. -Coordinate client activities. -Encourage the client to ask questions.

Encourage the client to ask questions. By encouraging the client to ask questions about one's care, the nurse teaches the client about self-advocacy. Providing skin care is a maintenance intervention undertaken to allow the client to preserve function and reduce the incidence of complications but does not help to promote self-advocacy. Acting in the advocacy role, the nurse would coordinate client activities. Incorporating therapeutic use of self in the care enables the nurse to be supportive of the client.

The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted? -Magnet status -Quality improvement -Peer review -Quality assurance

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 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 types of health care services available to the client. -The nurse evaluates the client's goal/outcome achievement. -The nurse evaluates the competence of nurse practitioners.

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.

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.