NURSING PROCESS "EVALUATING"

A client reports to the nurse quitting smoking 6 months ago after being diagnosed with lung cancer. The nurse recognizes this change in behavior is which type of outcome? A. Affective B. Cognitive C. Psychomotor D. Physiologic

A. Affective Affective outcomes pertain to changes in client values, beliefs, and attitudes and are more complex to evaluate. Changes in behaviors, such as the cessation of smoking or nutritional changes that lead to weight loss, are examples of affective outcomes. Cognitive outcomes involve an increase in client knowledge and are evaluated by asking the client to repeat information. Psychomotor outcomes describe the client's achievement of a new skill and are evaluated by having the client perform the skill. Physiologic outcomes result in physical changes and are evaluated through physical assessment.

A nurse is attempting to improve care on the pediatric unit of a hospital. Which improvements might the nurse employ when following the recommendations of the Institute of Medicine's Committee on Quality of Health Care in America? Select all that apply. A. Basing patient care on continuous healing relationships B. Customizing care to reflect the competencies of the staff C. Using evidence-based decision making D. Having a charge nurse as the source of control E. Using safety as a system priority F. Recognizing the need for secrecy to protect patient privacy

A. Basing patient care on continuous healing relationships C. Using evidence-based decision making E. Using safety as a system priority Care should be based on continuous healing relationships and evidence-based decision making. Customization should be based on patient needs and values with the patient as the source of control. Safety should be used as a system priority, and the need for confidentiality of care with transparency for the patient and designated individuals, rather than secrecy is used.

A nurse writes the outcome for a patient who is trying to lose weight: "The patient will explain the relationship between weight loss, increased exercise, and decreased calorie intake." This outcome reflects which domain of learning? A. Cognitive B. Psychomotor C. Affective D. Physical changes

A. Cognitive Cognitive outcomes involve increases in patient knowledge; psychomotor outcomes describe the patient's achievement of new skills; affective outcomes pertain to changes in patient values, beliefs, and attitudes; and physical changes are actual bodily changes in the patient (e.g., weight loss, increased muscle tone).

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

A. 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.

During orientation to the critical care unit, a nurse learns that staff follow existing clinical practice guidelines, also called standards, for patient care. Which activities does the nurse expect to be included in these guidelines? Select all that apply. A. Monitoring vital signs and pulse oximetry every hour B. Using intuition to troubleshoot patient problems C. Repositioning a patient on bed rest every 2 hours D. Becoming a nurse mentor to a student nurse E. Administering pain medication prescribed by the health care provider F. Becoming involved in community nursing events

A. Monitoring vital signs and pulse oximetry every hour C. Repositioning a patient on bed rest every 2 hours E. Administering pain medication prescribed by the health care provider Standards are the levels of performance accepted and expected by the nursing staff or other health care team members. They are established by authority, custom, or consent. Standards would include monitoring patient status every hour, repositioning a patient on bed rest every 2 hours, and administering pain medication prescribed by the health care provider. Using intuition to troubleshoot patient problems, becoming a nurse mentor to a student nurse, and becoming involved in community nursing events are not included in patient care standards.

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

A. 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.

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

A. 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.

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

A. The client lists the side effects of digoxin. B. The client describes how to perform progressive muscle relaxation. C. 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.

Why are quality-assurance programs important in nursing? A. They enable nursing to be accountable for the quality of care. B. They facilitate increased enrollment in educational programs. C. They specify how resources are used or not used. D. They allow increased retention of qualified nurses.

A. 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.

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

A. To direct future nurse-client interactions The purpose of evaluation is to allow the client's achievement of expected outcomes and, when necessary, to modify the plan of care to direct future nurse-client interactions. The plan of care encompasses more than the relationship between the nurse and the client. It is important to evaluate the achievements by the client. The nurse develops nursing diagnoses during the diagnosis phase of the nursing process, not the evaluation phase. Medical prescriptions are health care provider interventions, not nursing interventions, and thus would not be included in the nursing plan of care. The purpose or outcome of evaluating the plan of care is not to terminate the nurse-client relationship.

The nurse is performing evaluation as part of enacting a client's nursing care plan. Which purpose of this phase of the nursing process will the nurse prioritize? A. To examine the client's behavioral response to the care received B. To adhere to the terms of the nursing care plan C. To limit assessment to only the beginning phase of the nursing process D. To appraise the collaboration of the client and family

A. To examine the client's behavioral response to the care received During evaluation, nurses continually assess responses of clients to particular nursing interventions, establish different priorities for nursing diagnoses, and alter plans of care as necessary. During client care, the priority purpose of evaluation is to examine the client's behavioral response to the care received. After that, the nurse may need to establish different priorities for nursing diagnoses and alter the plan of care. Appraising the collaboration of the client and family is a type of evaluation but is not necessarily the priority in all situations. Limiting assessment to the first phase of the nursing process is not a purpose of the nursing process. Evaluation is not performed simply to adhere to process.

A visiting nurse is following up with a patient who was given a prescription for a diuretic and told to chart her weight daily. The patient's weight has increased 5 lb since the nurse's last visit. What actions will the nurse take first? A. Explain to the patient that it is clear she is not adhering to her prescription and the health care provider will be notified B. Document the 5-lb weight gain and ask the patient about sodium intake and medication side effects C. Terminate the plan of care while determining the cause for the weight gain D. Encourage the patient to continue the prescription and return in 1 week

B. Document the 5-lb weight gain and ask the patient about sodium intake and medication side effects The nurse documents the goal has not yet been achieved and also suspects the patient has not adhered to the prescription, perhaps due to frequent urination or other side effects. The nurse further assesses the patient's understanding of the medication's purpose and effects, understanding of the disease process and complications.

A nurse is evaluating the outcome of the plan of care after teaching a client how to prepare and administer an insulin pen. Which type of outcome is the nurse addressing? A. Cognitive B. Psychomotor C. Affective D. Physiologic

B. Psychomotor Preparing and administering an insulin pen is a psychomotor outcome. Psychomotor outcomes describes the client's achievement of new skills. Cognitive outcomes describe increase in client knowledge or intellectual behaviors. Affective outcomes describe changes in client values, beliefs, and attitudes. Physiologic outcomes are concerned with how the human body works.

The nurse manager of a unit with an excellent safety record meets with staff to present the findings of a recent audit. The manager states, "We're doing well, but I believe we can do better. Who's got an idea to foster increased patient well-being and satisfaction?" This leader has demonstrated they value which process? A. Quality assurance B. Quality improvement C. Process evaluation D. Outcome evaluation

B. Quality improvement Unlike quality assurance, quality improvement (QI) is internally driven. QI focuses on patient care rather than organizational structure and processes rather than people, and has no end points. Its goal is improving quality rather than assuring quality. Process evaluation and outcome evaluation are types of quality-assurance programs.

As part of a hospital-wide quality-assurance program, an electronic medical record review for the last 6 months reveals a higher incidence of falls on a specific unit. The nurse authoring the study refers to the review as what type of evaluation? A. Quality by inspection B. Retrospective evaluation C. Concurrent study d. Quality by indicator

B. Retrospective evaluation Quality by inspection focuses on finding deficient workers and removing them. Concurrent evaluation uses direct observation of nursing care, patient interviews, and chart review to determine whether the specified evaluative criteria are met. Retrospective evaluation may use post discharge questionnaires, patient interviews (by telephone or face to face), or chart review (nursing audit) to collect data. Quality as opportunity focuses on finding opportunities for improvement and fosters an environment thriving on teamwork, with people sharing the skills and lessons they have learned.

Which action should the nurse take when client data indicate that the stated goals have not been achieved? A. Collect more data for the database. B. Review each preceding step of the nursing process. C. Implement a standardized plan of care. D. Change the nursing orders.

B. Review each preceding step of the nursing process. If a client's goal has not been achieved the nurse should review each of the preceding steps of the nursing process in order to try to identify the contributing factors causing problems with the plan of care. By conducting the evaluation this way, the nurse may find that more data must be collected or the plan of care needs revision. An individualized plan of care rather than a standardized plan of care is often warranted.

Nurses note that allowing patients to choose the time of their breakfast to improve patient satisfaction has resulted in medication delays for patients who have prescriptions for medications taken on an empty stomach. Which action will direct the nurses to the best outcome? A. Asking the pharmacy to dispense the medication at bedtime B. Suggesting a quality improvement project piloting a 6:00 AM administration C. Requesting that the health care provider prescribe the medication for midnight D. Telling the nurse manager that patients are getting their medications late

B. Suggesting a quality improvement project piloting a 6:00 AM administration Quality improvement or continuous quality improvement involves systematic, continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups. Quality-assurance programs enable nursing to be accountable for the quality of nursing care. Making changes without gathering needed data may prove unsafe or a waste of time. Reporting to the nurse manager does not reflect professional commitment to improving processes.

A nurse is writing nursing outcomes in the affective domain for a patient who is trying to stop smoking. Which outcome statement will the nurse include in the care plan? A. "The patient will state the relationship between smoking and coronary artery disease." B. "After the teaching session, the patient will redemonstrate the proper application of a nicotine patch." C. "The patient will state they value a healthy body sufficiently to stop smoking prior to discharge." D. "The patient will state that any changes in cough should be reported to the health care provider"

C. "The patient will state they value a healthy body sufficiently to stop smoking prior to discharge." Affective outcomes pertain to changes in patient values, beliefs, and attitudes. Cognitive outcomes involve increases in patient knowledge; psychomotor outcomes describe the patient's achievement of new skills; physical changes are actual bodily changes in the patient (e.g., weight loss, increased muscle tone).

The client outcome, "The mother will express confidence in being able to meet nutritional needs of the infant," is an example of which type of outcome statement? A. Psychomotor B. Cognitive C. Affective D. Physical

C. Affective Affective outcomes are related to feelings and attitudes. This client's outcome statement addresses confidence, which is a subjective feeling of efficacy. Psychomotor outcomes are those that are related to new skill attainment and execution of those skills. Cognitive outcomes are those related to achieving greater knowledge and information, not different feelings or perceptions. Physical changes are related to actual body changes in the infant.

The care plan for a patient just diagnosed with diabetes contains the expected outcome: "the patient will correctly measure the insulin dose and self-administer the injection, using correct technique by 12/12/24." The nurse observes the client fumbled with the syringe and drew up less insulin than prescribed. What action will the nurse take first? A. Document that the plan of care was unsuccessful B. State continuation of the care plan is indicated C. Assess the patient's vision and dexterity and revise the plan D. Designate a family member to administer the insulin

C. Assess the patient's vision and dexterity and revise the plan When an outcome is not achieved, the nurse can (1) delete or modify a diagnosis; (2) revise the diagnosis, making it more realistic; (3) adjust the time criteria, or (4) modify the nursing interventions. This outcome was not successfully met; further assessment and revision is indicated. It is inappropriate for the nurse to designate a family member to take over insulin administration without additional assessment and patient permission.

The nurse on a medical-surgical unit attends a class on the seven crucial conversations in health care. After observing a colleague administer an incorrect dose of medication without reporting it, which action will the nurse take? A. Speak to the nurse privately and tell her if she does not complete an event report, you will report her to the unit manager B. Tell the nurse you overheard her discussing giving too much medication, and she must complete an event report or you will C. Explain that you are aware of the medication incident, and you can assist her in notifying the health care provider for patient safety D. Give the nurse a copy of the handout from the class and explain that this class in crucial conversations was very helpful

C. Explain that you are aware of the medication incident, and you can assist her in notifying the health care provider for patient safety Crucial Conversations for Healthcare, addresses "undiscussable" communication breakdowns and gaps that can result in patient harm, medical errors, and staff turnover. When nurses feel unsafe to report problems or are not heard, dangerous shortcuts, incompetence, and disrespect may ensue. Threatening the nurse with reporting them is unprofessional and inconsistent with the crucial conversations. Providing a handout is passive aggressive and does not clearly relate the medication error to this concept.

"The levels of performance accepted by and expected of nursing staff or other health team members" defines: A. criteria. B. evaluation. C. standards. D. evidence-based practice.

C. standards. Standards are the "levels of performance accepted by and expected of nursing staff or other health team members." Criteria are "measurable qualities, attributes, or characteristics that identify skill, knowledge, or health status." Evidence-based practice incorporates delivering nursing care that evidence supports as likely to result in meeting the expected client outcomes. Evaluation involves measuring how well the client has achieved the outcomes that were set forth in the plan of care.

A nurse is writing an evaluative statement for a patient who is trying to lower cholesterol through diet and exercise. Which evaluative statement is most correctly written? A. "Outcome met." B. "1/21/25—Patient reports no change in diet." C. "Outcome not met. Patient reports no change in diet or activity level." D. "1/21/25—Outcome met. Cholesterol level has decreased 10 mg."

D. "1/21/25—Outcome met. Cholesterol level has decreased 10 mg." The evaluative statement should contain a date; the words "outcome met," "outcome partially met," or "outcome not met"; and the patient data or behaviors that support this decision. The other answer choices are incomplete statements.

After reviewing the admission SBAR and plan of care, the nurse begins to evaluate patient outcomes. Which statement reflects a clear evaluation of the patient's primary problem? Electronic health record (EHR) 8:00 AM Admission note S. Patient with profound wheezing, tachycardia, and anxiety B. Patient has history of asthma, for which she regularly uses inhalers and carries a rescue inhaler A. Pulse oximetry 89%, cyanosis of lips, dyspnea with increased work of breathing R. Admit to telemetry unit, add IV corticosteroids and mini-nebulizer treatments A. The patient states they were terrified when they were fighting to breathe and the wheezing would not stop. B. The nurse determines the patient's strengths include adherence to their medication regimen. C. The care plan includes the health problem of impaired gas exchange, etiology, bronchospasm. D. At 10:00 AM, no wheezing on auscultation, pulse oximetry is 94%, t

D. At 10:00 AM, no wheezing on auscultation, pulse oximetry is 94%, the patient reports no anxiety; the outcome has been met. The two-part evaluative statement includes a decision about how well the outcome was met, along with patient data or behaviors that support this decision. Outcomes may have been met, partially met, or not met. The nurse collects evaluative data to measure outcome achievement. While this may justify terminating the care plan, that is not necessarily so. Data to assess health problems and patient variables are collected during the first step of the nursing process.

Which action is appropriate when evaluating a client's responses to a plan of care? A. Reinforce the plan of care when each expected outcome is achieved. B. Terminate the plan if there are difficulties achieving the goals/outcomes. C. Terminate the plan of care upon client discharge. D. Continue the plan of care if more time is needed to achieve the goals/outcomes.

D. 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.

A university student works with the student health nurse to develop a weight loss plan that includes increasing activity and avoiding empty calories. At the next session, the student has lost 1 lb instead of the projected 5 lb. What action will the nurse take next? A. Congratulate the student and continue the care plan B. Terminate the care plan since it is not working C. Give the student more time to reach the targeted outcome D. Modify the plan after discussing possible reasons for partial success

D. Modify the plan after discussing possible reasons for partial success Since the student has only partially met her outcome, the nurse should first explore the factors making it difficult for her to reach her outcome and then modify the care plan. As the plan is not completely working as written, continuing without further assessment is contraindicated. It is premature to terminate the care plan before the outcome is met. The student may need additional support and time to reach the outcome.

Which action should the nurse perform in the evaluation phase? A. Carry out treatment procedures. B. Set priorities for care. C. Record interventions. D. Revise the plan of care.

D. 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. Setting priorities is part of the planning phase. Carrying out treatment procedures and recording interventions are activities in the implementation phase of the nursing process.

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

D. 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.

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

D. a cognitive outcome. 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.

A nurse is using the classic elements of evaluation when caring for patients. Place the steps of evaluation in the proper order they are carried out. A. Interpreting and summarizing findings B. Collecting data to determine whether evaluative criteria and standards are met C. Documenting your judgment D. Terminating, continuing, or modifying the plan E. Identifying evaluative criteria and standards (i.e., expected patient outcomes)

E. Identifying evaluative criteria and standards (i.e., expected patient outcomes) B. Collecting data to determine whether evaluative criteria and standards are met A. Interpreting and summarizing findings C. Documenting your judgment D. Terminating, continuing, or modifying the plan The five classic elements of evaluation in order are (1) identifying evaluative criteria and standards (what the nurse looks for during evaluation, that is, expected patient outcomes); (2) collecting data to determine whether these criteria and standards are met; (3) interpreting and summarizing findings; (4) documenting your judgment; and (5) terminating, continuing, or modifying the plan.