Chapter 18: Evaluating
Nurses on the unit were reviewing results of the national study conducted by the American Association of Critical-Care Nurses (AACN). Which of the following statements is true of the findings from the study?
Physicians and nurses who reported substandard care found that care was improved and reported more job satisfaction.
Before discharge the client will demonstrate aseptic dressing changes. This is an example of which type of evaluative statement?
Psychomotor
The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted?
Quality assurance
Which action should the nurse take when patient data indicate that the stated goals have not been achieved?
Review each preceding step of the nursing process.
A client has just been admitted to the clinical unit. The nurse is providing her with the expectations she may have of the health care she will receive. She is told that she will not be harmed by any errors that might be made and she can expect to be safe in the facility. This assurance represents which expectation of the health care environment?
Safety
The American Nurses Association defines components of quality care: structure evaluation, process evaluation, and outcome evaluation. Which of the following best defines structure evaluation?
Standards that describe physical facilities and equipment; organizational characteristics, policies, and procedures; fiscal resources; and personnel resources.
Which of the following organizations "Integrates use of outcomes and performance measures into accreditation process"?
The Joint Commission
Which client outcome is a cognitive outcome? Select all that apply.
The client identifies signs and symptoms of hypoglycemia. • The client lists the side effects of digoxin (Lanoxin). • The client describes how to perform progressive muscle relaxation.
Which client outcome is an example of a cognitive outcome?
The client identifies three strategies for minimizing leakage of an ileostomy bag.
At the beginning of prenatal care, the goal for the client was to gain 25 lb (11.25 kg) by the end of the pregnancy. At 30 weeks of pregnancy, the client has only gained 1 lb (0.45 kg). Which statement(s) would help the nurse most appropriately interpret these data?
The client is not achieving the goal. The nurse should determine the reasons the client has not been gaining weight.
At the beginning of prenatal care, the goal for the client was to gain 25 pounds by the end of the pregnancy. At 30 weeks of pregnancy, the client has only gained 1 pound. Which of the following would help the nurse most appropriately interpret this data?
The client is not achieving the goal. The nurse should determine the reasons the client has not been gaining weight.
Which client outcome is a cognitive outcome?
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.
Which client outcome is a psychomotor outcome?
The client measures capillary blood sugar level. The client catheterizes himself using clean technique.
Which nurse is using criteria to determine expected standards of performance?
The new graduate nurse consults the policies and procedures of the institution prior to skill implementation.
Which nursing action reflects evaluation?
The nurse assesses the client's response to pain medication.
Which of the following nursing actions reflects evaluation?
The nurse assesses urine output following administration of a diuretic.
Which characteristic is the most important indicator of high-quality nursing practice?
The nurse considers the individual needs of clients
Which of the following is the most important indicator of quality nursing care?
The nurse considers the individual needs of clients.
A nurse is evaluating nursing care and patient outcomes by using a retrospective evaluation. Which action would the nurse perform in this approach?
The nurse devises a post-discharge questionnaire to evaluate patient satisfaction.
Why are quality-assurance programs important in nursing?
They enable nursing to be accountable for the quality of care.
The client demonstrates stair climbing using a quad cane. This is an example of:
a psychomotor outcome.
A mother is bringing her infant into the the clinic for a well baby check. The infant's weight gain is on target for age. A correctly written evaluative statement is which of the following?
"8/2/2014. Goal met. The infant's weight gain is appropriate for age."
The nurse participates in a quality assurance program and reviewing evaluation data from the previous year. Which of the following does the nurse recognize as an example of outcome evaluation?
A 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery.
Which authoritative statements guide current professional nursing practice?
ANA Standards of Nursing Practice
For a patient with self-care deficit, the long-term goal is that the patient will be able to dress himself by the end of the six-week therapy. For best results, when should the nurse evaluate the patient's progress toward this goal?
As soon as possible
A nurse observes another nurse not washing her hands between clients. The nurse knows that this is a situation that needs to be addressed and falls under the category of
Broken rules
Nurses formulate different types of goals for patients when planning patient care. What is considered a psychomotor patient goal?
By 8/18/15, patient will demonstrate improved motion in left arm.
A client is about to leave the hospital after having surgery for a fractured left femur. It is now in a plaster cast. The client asks how long before the cast will be dry. The nurse notes on the client's plan of care a learning outcome stating "Client will verbalize appropriate cast care upon discharge." This represents what type of outcome?
Cognitive
The client identifies three strategies for minimizing leakage of an ileostomy bag. This is an example of what type of outcome?
Cognitive outcome
Which statement related to the evaluation of outcome attainment for a client is correct?
Collecting data related to outcome attainment requires the nurse to know when to collect the data based upon established time criteria.
A nurse caring for an elderly patient who has dementia observes another nurse putting restraints on the patient without a physician's order. The patient is agitated and not cooperating. What would be the best initial action of the first nurse in this situation?
Confront the nurse and explain how this could be dangerous for the patient.
Which action is appropriate when evaluating a client's responses to a plan of care?
Continue the plan of care if more time is needed to achieve the goals/outcomes.
Which action is appropriate when evaluating a patient's responses to a plan of care?
Continue the plan of care if more time is needed to achieve the goals/outcomes.
Identifying the kind and amount of nursing services required is a possible solution for:
Inadequate staffing.
Nurses are involved in many types of evaluation. All of the following are activities that are related to evaluation, but which of the following is the priority concern for nurses?
Patients and their care
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?
Affective
Which of the following organizations actively promote healthy work environments that create and foster excellence in nursing care?
American Association of Critical-Care Nurses (AACN)
Nurses formulate different types of goals for clients when planning client care. What is considered a psychomotor client goal?
By 18AUG2015, client will demonstrate improved motion in left arm.
A client is about to leave the hospital after having surgery for a fractured left femur. It is now in a plaster cast. The client asks how long before the cast will be dry. The nurse notes on his plan of care a learning outcome stating "Client will verbalize appropriate cast care upon discharge." This represents what type of outcome?
Cognitive
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 which of the following?
Criteria
n order 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.
Discover a problem Plan a strategy using indicators Implement a change Assess a change
The quality assurance model of the ANA identifies three essential components of quality care. Which one of these components does the nurse use when determining whether a patient has met the goals stated on the care plan?
Outcome
The American Nurses Association (ANA) designed a model of evaluation incorporating essentials of quality care. Which of the following evaluations is focused on measurable changes in health care or client outcomes?
Outcome evaluation
A nurse is evaluating the outcome of the plan of care after teaching a client how to prepare and administer an insulin pen. Which of the following types of outcome is the nurse addressing
Psychomotor
The nurse is caring for a newborn who is scheduled to be discharged tomorrow. The mother of the newborn expresses concern about being able to properly breast feed her infant. The nurse reviews the plan of care and finds that there is an outcome that states "The mother will express confidence in being able to meet nutritional needs of her infant." This is an example of which type of outcome statement?
Psychomotor
The client demonstrates stair climbing using a quad cane. What type of outcome is this an example of?
Psychomotor outcome
The primary purpose for evaluating data about a client's care according to a functional health approach is to
Revise or modify the nursing care plan
The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted?
The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted?
Which of the following "is an accrediting body for managed care targeting "effectiveness of care, access and availability of care, patient satisfaction, health plan stability, use of services, costs, and health plan descriptive information"?
The National Committee for Quality Assurance
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.
Which of the following actions on the part of the nurse would best promote client satisfaction?
The nurse sets care outcomes with the client.
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
A client is administered an anxiolytic. Which nursing action demonstrates the nurse evaluating the client?
asking if the client feels less anxious 30 minutes after administering the medicine
Which scenario represents a nurse demonstrating the critical thinking process?
assessing whether physician help is needed
When the nurse prepares to discharge a client, and subsequently evaluate the effectiveness of the patient care, the nurse should determine whether the:
client's goals have been achieved.
After the nursing plan of care has been developed, the nurse knows that:
each encounter with the client is an opportunity to reassess and revise the plan of care if necessary.
Identifying the kind and amount of nursing services required is a possible solution for
inadequate staffing.
The primary purpose for evaluating data about a client's care according to a functional health approach is to:
revise or modify the client care plan.
The terms "criteria" and "standard" are often used interchangeably but actually have distinct, separate definitions. "The levels of performance accepted by, and expected of, nursing staff or other health team members" is known as:
standards.
A client has returned to the clinic for a postoperative visit. The nurse reviews the plan of care and could choose to do which of the following based on the client's previous responses to the current plan of care? Select all that apply.
• 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
A new graduate nurse has come to your floor to work. She asks the charge nurse what the difference is between collecting data in the nursing assessment and in the evaluation phase of the nursing process. The charge nurse bases her response on her knowledge of which of the following statements?
"Data collected in the nursing assessment identifies patient health problems, whereas data collected in the evaluation phase is to determine if patient outcomes are being achieved."
Which of the following "is the only national nursing quality measurement program that provides hospitals with unit-level performance reports with comparisons to national averages, percentile rankings, and other important data"
American Nurses Association
Once a nurse has collected and interpreted the data on a client's outcome achievement, the nurse will then make a judgment and document a statement summarizing those findings. This is called which of the following?
Evaluative statement
A group of nurses of 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. The nurses know that this program is termed:
Peer review
A nurse is caring for a client who is recovering from stroke. Which of the following would the nurse perform in the evaluation phase?
Revise the plan of care
A client presents to the clinic for a routine postoperative visit. The nurse assesses the site of the incision and determines that the edges of the incision are approximated, sutures have been removed, and there is no redness or edema at the site. The incision appears to be well healed. The nurse reviews the plan of care and notes that one nursing diagnosis is related to potential infection related to impaired skin integrity. The nurse determines that this is no longer an issue for the client. Which change should the nurse make to the plan of care?
Terminate the plan of care as it relates to infection.
Which characteristic is the most important indicator of high-quality nursing practice?
The nurse considers the individual needs of clients.
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 client's goal/outcome achievement.
The primary purpose for evaluating data about a client's care according to a functional health approach is to:
revise or modify the patient care plan.
A nurse is talking with a new graduate nurse regarding the Institute of Medicine's (IOM) Committee on Quality of Health Care in America. Which of the following are among the rules suggested by the Institute of Medicine's Committee on Quality of Health Care in America to improve health care? Select all that apply.
• Care based on continuous healing relationships • Customization aseed on patient needs and values • Shared knowledge and the free flow of information • Evidence-based decision making
A nurse identifies an area where client care has been compromised. Which of the following steps should the nurse take to improve performance? Select all that apply.
• Implement a change • Plan a strategy using indicators • Assess the change • Discover a problem
A nurse is reviewing the plan of care for a client. Which of the following might the nurse determine are problems related to the planning phase of the nursing process? Select all that apply.
• Plan of care only contains standard knowledge that most nurses would do if there was a plan of care. • Long-term goal is vague. • Outcomes are incorrectly developed. • Nursing orders are superficial.
Which of the following does a nurse recognize is among the rules suggested by the Institute of Medicine's (IOM) Committee on Quality of Health Care in America to improve health care?
• The patient as the source of control • Safety as a system priority • Anticipation of clients' needs • Cooperation among clinicians
The mother of an infant comes to the clinic and asks the nurse if the infant can eat bananas now. The outcome statement on the infants plan of care states "The mother will explain proper nutrition for infants." this is an example of what type of outcome statement?
Cognitive
Once a nurse has collected and interpreted the data on a client's outcome achievement, the nurse will then make a judgment and document a statement summarizing those findings. This is called:
Evaluative statement
The nurse is orienting a new client to the facility. The client is told that her preferences and choices would be sought and honored. This represents which expectation of the health care environment
Individualization
The nurse is orienting a new client to the facility. The client is told that her preferences and choices would be sought and honored. This represents which expectation of the health care environment?
Individualization
The nurse is participating in a retrospective evaluation. Which activity would the nurse engage in with this type of evaluation?
Mailing a questionnaire
A group of nurses of 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. The nurses know that this program is termed which of the following?
Peer review
The mother brings her infant into the clinic. The infant is two months old and has not been gaining weight appropriately. The outcome statement on the plan of care states "The infant will double birth weight by 6 months of age." This is an example of what type of outcome statement?
Physical changes
The nurse is caring for a client who has a fractured left femur. He will be discharged home this afternoon. The outcome on the plan of care state "Client will demonstrate appropriate cast care prior to discharge" This is an example of what type of evaluative statement?
Psychomotor
A nurse finds that her client is not achieving the set outcomes for care and reviews the plan. Which of the following are appropriate changes for the nurse to make in the plan of care? Select all that apply.
• Delete or modify the nursing diagnosis • Make the outcome statement more sensible • Adjust the time limits on the outcome statement • Increase the complexity of the outcome statement
Client satisfaction is an important part of the evaluation process for hospitals. Nurses should be aware that clients may be asked questions that can provide data that can lead to quality improvement. Which of the following are questions that clients may be asked? (Select all that apply)
"After pressing the call button, did you did the care that you needed?" • "How often did nurses explain things to you in a way that you could understand?" • "How often did nurses treat you with respect?" • "How often did nurses listen to your concerns?"
The terms "criteria" and "standard" are often used interchangeably but actually have distinct separate definitions. "The levels of performance accepted by and expected of nursing staff or other health team members" is known as which of the following?
Standards
A male client has been recently diagnosed with diabetes after receiving emergency treatment for a hyperglycemic episode. Which of the client's actions indicates that he has achieved a cognitive outcome in the management of his new health problem?
The client is able to explain when and why he needs to check his blood sugar.
A nurse refuses to answer the questions of a student nurse. She tells her to go ask her instructor as it is not her job to answer those questions. This is an example of what category of communication that should be addressed?
Disrespect
Which of the following actions should the nurse take during the evaluation phase of the nursing process?
Document improved pain after pain medication administered
Which action should the nurse take during the evaluation phase of the nursing process?
Document reassessment of pain after medication administration.
A nurse manager notes an increase in the frequency of client falls during the last month. To promote a positive working environment, how would the nurse manager most effectively deal with this problem?
Investigate the circumstances that contributed to client falls
A nurse manager notes an increase in the frequency of client falls during the last month. To promote a positive working environment, how would the nurse manager most effectively deal with this problem?
Investigate the circumstances that contributed to client falls.
A nurse has committed to quality improvement in her nursing care. She knows that quality improvement will require her to do which of the following? (Select all that apply)
Leadership commitment • Continuous improvement • Focus on data collection • Focus on the mission of the organization
The nurse manager is dedicated to creating a healthy work environment for the nursing unit. She secures funding to display a plaque on the unit identifying all unit nurses who have earned certification. Which standard for establishing and sustaining healthy work environments does this action represent?
Meaningful recognition
Prior to the first postoperative visit post gastrectomy, the client will have a weight loss of 10 lbs. This is an example of which type of evaluative statement?
Physical changes
Which of the following agencies has as its primary goal to "prepare nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of their healthcare systems"?
Quality and Safety Education for Nurses (QSEN)
The nursing supervisor is evaluating how many clients each of the department nurses has been assigned for the shift. This type of evaluation would be considered:
structure
