Chapter 18

16. A nurse working in a hospital setting discovers problems with the delivery of nursing care on the pediatric unit. Which of the following suggestions from the Institute of Medicines Committee on Quality of Health Care in America (Kohn, Corrigan, & Donaldson, 2000) could help redesign and improve care? Select all that apply. A) Base care on continuous healing relationships. B) Customize care based on available resources. C) Keep the nurse as the source of control. D) Share knowledge and allow for free flow of information E) Practice evidence-based decision making F) Emphasize safety as a system property.

A) Base care on continuous healing relationships. D) Share knowledge and allow for free flow of information E) Practice evidence-based decision making F) Emphasize safety as a system property.

15. A nurse is interested in improving patient care on the unit through performance improvement. What is the first step in this process? A) Discover the problem. B) Plan a strategy. C) Implement a change. D) Assess the change.

A) Discover the problem.

18. 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.

12. A nurse in a community health center has been having regular meetings with a woman who wants to stop smoking. Which of the following outcome decision options would the nurse document if the woman has not smoked for 3 months? A) outcome met B) outcome partially met C) outcome not met D) outcome inappropriate

A) outcome met

2. What is the purpose of evaluation in the nursing process? A) to direct future nursing interventions B) to formulate a database of nursing diagnoses C) to complete an initial plan of care D) to transfer medical orders to the plan of care

A) to direct future nursing interventions

14. A nurse has developed a plan of care for the nursing diagnosis Risk for Loneliness for a recently widowed man. When evaluating the plan, the man tells the nurse new information about his active social life. What would the nurse do next? A) Continue with the plan. B) Delete the nursing diagnosis. C) Tell the patient he is lonely. D) Adjust the time criteria.

B) Delete the nursing diagnosis.

10. A nurse is counseling a novice nurse who gives 150% effort at all times and is becoming frustrated with a healthcare system that provides substandard care to patients. Which of the following advice would be appropriate in this situation? Select all that apply. A) Tell the new nurse to help other nurses perform their jobs to ensure quality patient care is being delivered. B) Encourage the new nurse to leave her problems at work behind, instead of rehashing them at home. C) After establishing a reputation for delivering quality nursing care, have her seek creative solutions for nursing problems. D) Tell her to view nursing care concerns as challenges rather than overwhelming obstacles and seek help for solutions. E) State that if resources do not permit quality care, it is not the role of the new nurse to explore change strategies within the institution. F) Tell the nurse that if administration is not supportive, moving to another practice setting might be more appropriate.

B) Encourage the new nurse to leave her problems at work behind, instead of rehashing them at home. C) After establishing a reputation for delivering quality nursing care, have her seek creative solutions for nursing problems. D) Tell her to view nursing care concerns as challenges rather than overwhelming obstacles and seek help for solutions. F) Tell the nurse that if administration is not supportive, moving to another practice setting might be more appropriate.

23. A nurse forgets to raise the railings of the bed of a patient who is confused after taking pain medications. The patient attempts to get out of bed, and suffers a minor fall. The nurse asks a colleague who witnessed the fall not to mention it to anyone because the patient only had minor bruises. What would be the appropriate action of the colleague? A) No other steps need to be taken, since the patient was not seriously injured. B) The colleague should inform the nurse that a full report of the incident needs to be made. C) The colleague should monitor the patient closely for any adverse effects of the fall. D) The colleague should report the incident in a peer review of the nurse.

B) The colleague should inform the nurse that a full report of the incident needs to be made.

22. A nurse evaluates nursing care and outcomes for a current patient by using direct observation of nursing care, patient interviews, and chart review to determine whether the specified evaluative criteria are met. This practice is known as: A) a nursing audit B) a concurrent evaluation C) a retrospective evaluation D) an evaluation of patient satisfaction

B) a concurrent evaluation

9. A nurse is teaching a patient how to administer insulin, with the expected outcome that the patient will be able to self-administer the insulin injection. How would this outcome be evaluated? A) asking the patient to verbally repeat the steps of the injection B) asking the patient to demonstrate self-injection of insulin C) asking family members how much trouble the patient is having with injections D) asking the patient how comfortable he or she is with injections

B) asking the patient to demonstrate self-injection of insulin

5. What cognitive processes must the nurse use to measure patient achievement of outcomes during evaluation? A) intuitive thinking B) critical thinking C) traditional knowing D) rote memory

B) critical thinking

17. The nursing staff on a hospital unit are using peer review to improve professional performance. Who performs the review? A) unit manager B) nurses C) patients D) visitors

B) nurses

4. Nurses evaluate many aspects of the healthcare delivery system. Which of the following is always the primary concern when performing the evaluating step of the nursing process? A) the nurse B) the patient C) the healthcare system D) outcome achievement

B) the patient

6. A nurse is evaluating an established plan of care. After identifying the evaluative criteria and standards (expected patient outcomes), what must the nurse do next? A) Interpret and summarize findings. B) Document his or her judgment. C) Collect data about patient responses. D) Formulate a new plan of care.

C) Collect data about patient responses.

19. Which of the following are major premises of a quality-improvement program? Select all that apply. A) It focuses on organizational structure. B) It is driven by external factors. C) It focuses on processes rather than individuals. D) It has no end points. E) Its outcome is focused on assuring quality. F) It focuses on data and statistical thinking.

C) It focuses on processes rather than individuals. D) It has no end points. F) It focuses on data and statistical thinking.

7. Which of the following is a descriptor that helps to define the term criteria? A) immeasurable qualities B) established by authority C) acceptable level of performance D) evidence-based practice

C) acceptable level of performance

11. A plan of care for a patient with a low potassium level includes providing information about the effect of medications and dietary intake of foods high in potassium. How would a nurse measure achievement of an outcome for this plan? A) physical assessment B) health history C) laboratory data D) patient statements

C) laboratory data

21. What is evaluated when conducting a nursing audit? A) physical environment B) policies and procedures C) patient records D) patient satisfaction

C) patient records

1. Which of the following best summarizes the evaluating step of the nursing process? A) The nurse completes a health assessment to establish a database. B) The patient and family have met healthcare goals and no longer need care. C) The nurse and patient identify nursing diagnoses and appropriate interventions. D) The nurse and patient measure achievement of planned outcomes of care.

D) The nurse and patient measure achievement of planned outcomes of care.

13. Patient lost 2 of the 5 pound/month goal. How should the nurse alter the plan of care in response to this new data? A) The nurse should not alter the plan of care. B) The nurse should change the diet. C) The nurse should delete the nursing diagnosis. D) The nurse should modify the time criteria.

D) The nurse should modify the time criteria.

3. Which of the following would not be part of the nurses decision about care after evaluating the patients responses to the plan of care? A) terminate the plan of care B) modify the plan of care C) continue the plan of care D) begin the plan of care

D) begin the plan of care

8. A nurse is evaluating the outcomes of a plan of care to teach an obese patient about the calorie content of foods. What type of outcome is this? A) psychomotor B) affective C) physiologic D) cognitive

D) cognitive

20. A hospital is evaluating its policies and procedures. What type of evaluation is the hospital conducting? A) outcome B) process C) quality D) structure

D) structure