Chapter 19 evaluation

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

Quality assurance

A nurse caring for an older adult client who has dementia observes another nurse putting restraints on the client without a health care provider's order. The client is agitated and not cooperating. What would be the best initial action of the first nurse in this situation? Report the nurse applying the restraints to the supervisor. File an incident report and have the second nurse sign it. Confront the nurse and explain how this could be dangerous for the client. Contact the health care provider for an order for the restraints.

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

Which situations observed by a nurse should the nurse report to the nurse manager for quality assurance? Select all that apply. A nurse cleans a stethoscope between clients. A nurse assesses a client after sneezing into the nurse's hands. A nurse administers medications to the wrong client. A nurse delays answering call lights to an abusive client. A nurse refuses to provide care to a client with HIV.

A nurse assesses a client after sneezing into the nurse's hands. A nurse administers medications to the wrong client. A nurse delays answering call lights to an abusive client. A nurse refuses to provide care to a client with HIV.

For a client with a self-care deficit, the long-term goal is that the client will be able to dress oneself by the end of the 6-week therapy. For best results, when should the nurse evaluate the client's progress toward this goal? When the client is discharged At the end of the 6-week therapy Only when the client shows some progress As soon as possible

As soon as possible

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. 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. Newly purchased beds are difficult to move through client room doors. The unit's rate of catheter-associated urinary tract infections has risen sharply in the last year.

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 is a psychomotor client goal? By 18AUG2015, the client will value health sufficiently to quit smoking. By 18AUG2015, the client will demonstrate improved motion in the left arm. By 18AUG15, the client will list three foods that are low in salt. By 18AUG2015, the client will learn three exercises designed to strengthen leg muscles.

By 18AUG2015, the client will demonstrate improved motion in the left arm.

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 reason the outcome was only partially met The revision to the initial outcome identified

Data that support the decision of the outcome being partially met

The nurse is performing the evaluation phase of the nursing process with a client. Which purpose(s) will the nurse achieve? Select all that apply. Determine the client's responses to nursing interventions. Appraise the extent to which client goals were attained. Determine if nursing diagnoses were accurate. Ensure that the plan of care was followed as it was originally prepared. Collect subjective and objective data to make judgments about nursing care delivered

Determine the client's responses to nursing interventions. Appraise the extent to which client goals were attained. Determine if nursing diagnoses were accurate. Collect subjective and objective data to make judgments about nursing care delivered.

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? Effective decision making Micromanagement Appropriate staffing Meaningful recognition

Effective decision making

Which parts of the nurse's decision about care occur after evaluating the client's responses to the plan of care? Select all that apply. Terminate the plan of care Modify the plan of care Continue the plan of care Begin the plan of care Communicate the plan of care

Terminate the plan of care Modify the plan of care Continue the plan of care

The focus of a hospital's current quality assurance program is a comparison of the health status of clients on admission and with that at the time of discharge. This form of quality assurance is characteristic of: outcome evaluation. structure evaluation. process evaluation. nursing audit.

outcome evaluation

The nurse has performed multiple evaluations on the hospital unit. What evaluation does the nurse identify as a structure evaluation? tracking nurse-client ratios on various shifts determining the accuracy of a client's nursing diagnoses evaluating the technical skill of a nursing student deciding whether a client has met their goals of care

tracking nurse-client ratios on various shifts

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? Providing medication for agitation Repositioning to prevent pressure injuries Ensuring that the endotracheal tube is secure Changing the dressing to prevent infection

Ensuring that the endotracheal tube is secure

After incorrectly administering digoxin to a client, a nurse admits the error to the nurse manager and peers to prevent them from making the same mistake. This is an example of which approach to quality assurance? Quality by inspection Quality as opportunity Quality by supervision Quality as repetition

Quality as opportunity

Which characteristic is the most important indicator of high-quality nursing practice? The nurse is organized and efficient in client care. The nurse follows the policies and procedures of the institution. The nurse takes measures to ensure accurate medication administration. The nurse considers the individual needs of clients.

The nurse considers the individual needs of clients.

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. The nurse customizes care based on client needs and values. The nurse becomes the source of control for client care. The nurse bases care on evidence-based decision making. The nurse customizes care based on availability of resources. The nurse promotes shared knowledge and the free flow of information. The nurse acknowledges that continuous decrease in waste improves client care.

The nurse customizes care based on client 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 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

"The client will demonstrate cast care prior to discharge" is which type of evaluative statement? Psychomotor Cognitive Affective Physical changes

psychomotor

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.

The nurse is performing the evaluation phase of the nursing process with a client. Which purpose(s) will the nurse achieve? Select all that apply. Determine the client's responses to nursing interventions. Appraise the extent to which client goals were attained. Determine if nursing diagnoses were accurate. Ensure that the plan of care was followed as it was originally prepared. Collect subjective and objective data to make judgments about nursing care delivered.

Determine the client's responses to nursing interventions. Appraise the extent to which client goals were attained. Determine if nursing diagnoses were accurate. Collect subjective and objective data to make judgments about nursing care delivered.

The nurse manager on an orthopedic unit has determined that the nurses are not keeping the nursing diagnoses up-to-date on client care plans and, in turn, are not using the plan of care. What is a feasible approach to correcting this problem? Develop a process for periodic review of care plans that focuses on deleting and updating the nursing diagnoses. Request that a staff development nurse instruct the nurses on concept mapping to use instead of care planning. Provide an in-service on interviewing and physical assessment skills; discuss the importance of these skills with the staff. Delegate the updating of nursing diagnoses for all clients on the unit to one nurse for each shift.

Develop a process for periodic review of care plans that focuses on deleting and updating the nursing diagnoses.

To improve quality care for clients, there are four steps that the nurse recognizes as being crucial for the process. Place them in the correct order. Use all options. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1Discover a problem. 2Plan a strategy using indicators. 3Implement a change. 4Evaluate a change.

Discover a problem. Plan a strategy using indicators. Implement a change. Evaluate a change.

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

A nurse overhears a coworker telling a somewhat offensive joke to a client. Which nursing action is indicated? Report what was overheard to the charge nurse. Discuss the occurrence with the coworker. Apologize to the client for the coworker's behavior. Investigate whether the coworker and client have a previous relationship.

Discuss the occurrence with the coworker.

Which nursing action would be most effective in helping a client learn self-care behaviors? Check with the client to ensure that personal self-care goals are being met. Model self-care behaviors for the client. Collect data on the number of self-care activities the client has performed that day. Ask client to discuss the client's goals for the day at the start of the shift.

Model self-care behaviors for the client.

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? Design evaluation Outcome evaluation Structure evaluation Process evaluation

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."

A nurse is reviewing the plan of care for a client. Which should the nurse identify as problems related to the planning phase of the nursing process? Select all that apply. The plan of care only contains standard knowledge that most nurses would implement if there was no plan of care. Long-term goals are vague. Outcomes are incorrectly developed. Nursing orders are superficial. Database input does not reflect changes in a client's condition.

The plan of care only contains standard knowledge that most nurses would implement if there was no plan of care. Long-term goals are vague. Outcomes are incorrectly developed. Nursing orders are superficial.

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 inspection Quality as opportunity Quality by perception Quality as initiative

Quality by inspection

Which statement regarding quality improvement or quality assurance is correct? Quality improvement focuses on organization, structure, and individuals. Quality assurance promotes empowerment and collaboration. Quality improvement focuses on processes, data, and statistical thinking. Quality assurance is concerned with client satisfaction.

Quality improvement focuses on processes, data, and statistical thinking.

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 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 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.

Which are cognitive client outcomes? Select all that apply. 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. The client correctly ambulates with a walker. 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's pulse oximetry reading is 97% on room air 30 minutes after removal of a nasal cannula. The client reports walking for 30 minutes each day. The client demonstrates active range-of-motion exercises with left upper extremity. The client explains how to administer a vaginal cream.

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.

A nurse manager attempts to achieve performance improvement in the emergency department of a busy inner-city hospital. Which nursing actions follow Haase and Miller's recommended steps in performance improvement? Select all that apply. The nurse discovers that there is a problem with the triage system that is in place in the emergency department. The nurse calls a meeting of the emergency department interdisciplinary team to effect change in the triage process. The nurse organizes a task force to implement change in the triage process of a busy emergency department. The nurse meets with the emergency department staff to assess changes made to the triage process. When the goal of making changes to the triage process in the emergency department is not met, the nurse discontinues efforts to force change. When met with resistance to change from the emergency department staff, the nurses involves management to force the

The nurse discovers that there is a problem with the triage system that is in place in the emergency department. The nurse calls a meeting of the emergency department interdisciplinary team to effect change in the triage process. The nurse organizes a task force to implement change in the triage process of a busy emergency department. The nurse meets with the emergency department staff to assess changes made to the triage process.

What outcome does the nurse hope to achieve by evaluating the plan of care of a client who is being discharged? To direct future nurse-client interactions To formulate a database of nursing diagnoses To allow the nurse to terminate the nurse-client relationship To transfer medical prescriptions to the plan of care

To direct future nurse-client interactions

The health care team has convened to discuss the care of an end-of-life client who is not able to achieve an acceptable level of comfort. The health care provider asks for the nurse's perspective of the situation. Which standard for establishing and sustaining healthy work environments does this action represent? Skilled communication Effective decision making True collaboration Appropriate staffing

True collaboration

The focus of a hospital's current quality assurance program is a comparison of the health status of clients on admission and with that at the time of discharge. This form of quality assurance is characteristic of: outcome evaluation. structure evaluation. process evaluation. nursing audit.

outcome evaluation.

"The client will verbalize appropriate cast care on discharge" represents which type of outcome? Psychomotor Cognitive Affective Physical change

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.