Chapter 18: Evaluating PrepU

Which are components of an evaluative statement? Select all that apply. a. Description of how the client outcome was met b. Client's health history c. Name of the client's physician d. Client data that support how the outcome was met e. Client's health insurance information

a. Description of how the client outcome was met d. Client data that support how the outcome was met An evaluative statement includes a description of how the client's outcome was met and the data that support that decision. The name of the physician, information on the client's health insurance, and the client's health history would only be included if they contributed to the client's outcome.

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

b. 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.

Prior to the first visit following gastrectomy, the client will have a weight loss of 10 lb (4.5 kg). This is an example of which type of evaluative statement? a. Cognitive b. Psychomotor c. Physical changes d. Affective

c. Physical changes Physical changes are related to actual body changes in the individual, represented here by the 10-lb (4.50-kg) weight loss. Psychomotor outcomes are related to new skill attainment. Cognitive outcomes are related to achieving greater knowledge. Affective outcomes are related to feelings and attitudes.

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.

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? a. Planning a strategy using indicators b. Implementing a change c. Discovering a problem d. Assessing the change

c. Discovering a problem Discovering the problem by detecting that there are several readmissions with heart failure is the first step in the process of performance improvement. The next step would be to plan a strategy using indicators, which includes calling an interdisciplinary meeting. The team would then implement a change and, lastly, assess whether the change was effective.

"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.

Which nurse is using criteria to determine expected standards of performance? a. The nurse manager provides the staff nurse feedback regarding job performance for the previous year. b. The nurse seeks information from the unlicensed assistive personnel (UAP) regarding the family's response to the nurse's education. c. The new graduate nurse consults the policies and procedures of the institution prior to skill implementation. d. The nurse preceptor provides feedback to the new graduate nurse after 6 weeks of orientation.

c. The new graduate nurse consults the policies and procedures of the institution prior to skill implementation. Standards are the levels of performance accepted and expected by the nursing staff and other health team members, such as institutional policies and procedures. The nurse preceptor providing feedback to the new graduate nurse after 6 weeks of orientation is an example of peer review. The nurse manager providing the staff nurse feedback regarding job performance for the previous year is typical of an annual employee review. The nurse seeking input from the UAP on a family's response to education is inappropriate, as the nurse may not delegate evaluation to the UAP.

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 physician asks for the nurse's perspective of the situation. Which standard for establishing and sustaining healthy work environments does this action represent? a. Skilled communication b. Effective decision making c. True collaboration d. Appropriate staffing

c. True collaboration This scenario represents true collaboration, as nurses and other health care team members are demonstrating mutual respect, shared responsibility, and shared decision making. Although skilled communication and effective decision making are likely to be involved in true collaboration, these are not the focus of this scenario. There is no evidence of whether staffing is appropriate in this scenario.

A nurse on the unit fails to help a colleague ambulate a client even though there is time to do so. Which are appropriate responses by the nurse who required assistance with the client? Select all that apply. a. "We all have to work together as a team to provide quality care for our clients." b. "Never mind, I will get someone else to help." c. "This client is in need of our assistance, and everyone who is free should come together for improved client outcomes." d. "Please come and help and work together with me as a team." e. "If you don't assist me with client care, you may as well go home."

a. "We all have to work together as a team to provide quality care for our clients." c. "This client is in need of our assistance, and everyone who is free should come together for improved client outcomes." d. "Please come and help and work together with me as a team." The nurse who requested assistance with a client should address rather than ignore (as seen in the response, "Never mind, I will get someone else to help") the failure of the other nurse to work together with the first nurse as a team. The nurse is not in a position to tell the other nurse to go home, nor would this be an appropriate response, in any case. The other choices are all appropriate responses that address the concern of the nurse needing assistance.

Which action by the nurse is an example of peer review? a. The nurse seeks feedback from the nurse manager regarding job performance for the previous year. b. The nurse seeks information from the unlicensed assistive personnel (UAP) regarding the family's response to the nurse's education. c. The new graduate nurse consults the policies and procedures of the institution prior to skill implementation. d. The nurse preceptor provides feedback to the new graduate nurse after 6 weeks of orientation.

d. The nurse preceptor provides feedback to the new graduate nurse after 6 weeks of orientation. Peer review involves the evaluation of one staff member by another staff member on the same level in the hierarchy of the organization for the purpose of professional performance improvement. The nurse preceptor providing feedback to the new graduate nurse after 6 weeks of orientation is an example of peer review. The nurse manager and the UAP are not on the same level in the organization as the nurse. Consulting policies and procedures is not peer review.

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.

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: a. process. b. outcome. c. goal. d. subjective. e. structure.

e. structure. Availability of equipment, layout of physical facilities, nurse-client ratios, administrative support, and maintenance of nursing staff competence are some areas of concern for structure evaluation. Process, outcome, goal, and subjective evaluation address those respective categories.

The nurse and client have written the following outcome measure: "The client will eat at least 80% of each meal offered by 3/2." When should the nurse collect information to evaluate this outcome? a. At the completion of each meal b. On 3/2 c. On 3/3 d. At the client's direction

a. At the completion of each meal The nurse should collect data at the completion of each meal to ensure the accuracy of the data and to monitor the client's progress toward meeting the goal so that the nurse can make changes to the plan when the client fails to make sufficient progress or celebrate with the client when the client demonstrates success. Although the final evaluation of goal attainment must occur on or shortly after 3/2, data collection must begin far earlier than that. It would not be appropriate for the client to direct when data collection should occur.

Which statement related to the evaluation of outcome attainment for a client is correct? a. Collecting data related to outcome attainment requires the nurse to know when to collect the data, based upon established time criteria. b. The nurse should initially evaluate the plan of care at the time of the client's discharge. c. Celebrating outcome achievement with a client often interferes with attainment of future goals. d. Evaluation of the client's attainment of outcome goals is determined by the nurse and physician.

a. Collecting data related to outcome attainment requires the nurse to know when to collect the data, based upon established time criteria. In addition to knowing what type of data to collect to determine outcome achievement, it is important to know when to collect the data based upon established time criteria. It is important for the nurse to evaluate client outcome achievement as early as possible and not wait until discharge, when the plan of care cannot be modified. Evaluation of the client's attainment of outcome goals is determined by the nurse, client, and the client's family. Celebrating outcome attainment with the client usually helps encourage the client and leads to further outcome achievement.

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? a. Develop a process for periodic review of care plans that focuses on deleting and updating the nursing diagnoses. b. Request that a staff development nurse instruct the nurses on concept mapping to use instead of care planning. c. Provide an in-service on interviewing and physical assessment skills; discuss the importance of these skills with the staff. d. Delegate the updating of nursing diagnoses for all clients on the unit to one nurse for each shift.

a. Develop a process for periodic review of care plans that focuses on deleting and updating the nursing diagnoses. Upon recognizing that the nursing diagnoses are not up-to-date, an effective approach by the nurse manager is to establish a process for periodic review of the plan of care. This review process will require deletion of nursing diagnoses that have been resolved and, conversely, adding new diagnoses as needed. Implementing concept mapping will not correct the problem of poorly updated nursing diagnoses, as concept mapping requires the identification of nursing diagnoses. Developing interviewing and assessment skills is an important component of the assessment phase of the nursing process. Also, one nurse should not be responsible for updating nursing diagnoses for all client care plans on the unit.

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.

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? a. Effective decision making b. Micromanagement c. Appropriate staffing d. Meaningful recognition

a. Effective decision making Effective decision making ensures nurses are active, valued partners in making policy, directing and evaluating clinical care, and leading organizational operations. Appropriate staffing ensures that client needs are effectively matched with nurse competencies. Micromanagement would be demonstrated by the manager not asking for opinions and proceeding with decision making without input. Meaningful recognition highlights the value each nurse brings to the work for the organization, such as certification.

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? a. Encourage the client to ask questions. b. Help the client with skin care. c. Coordinate client activities. d. Incorporate therapeutic use of self.

a. 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.

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? a. Finances of the client b. The client's condition c. Time and resources d. Feedback from the family

a. 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 reassessing a client with leukemia who has received several packed red blood cell transfusions over the past week. Which question should the nurse ask the client to evaluate the treatment? a. Have you had any fevers? b. Have you experienced any tenderness in your joints? c. Have you noticed any bruising? d. Have you experienced any headaches?

a. Have you had any fevers? The administration of red blood cells is intended to correct an anemic condition in a client with leukemia. Leukemia destroys the bone marrow's ability to produce healthy white blood cells, red blood cells, and platelets. Headaches occur in patients with anemia as a result of decreased oxygenation, which causes arterial swelling. Joint or bone pain occurs as a result of the expansion of bone marrow from the accumulation of white blood cells. Bruising is a symptom of thrombocytopenia which occurs as a result of a decreased platelet production.

A nurse is evaluating the plan of care for a client in the clinic. Which actions should the nurse perform, as classic elements of evaluation? Select all that apply. a. Identifying evaluative criteria and standards b. Documenting only the facts related to the plan of care c. Collecting data to determine whether criteria and standards are being met d. Interpreting and summarizing findings e. Terminating, continuing, or modifying the plan of care

a. Identifying evaluative criteria and standards c. Collecting data to determine whether criteria and standards are being met d. Interpreting and summarizing findings e. Terminating, continuing, or modifying the plan of care The nurse must document findings as they relate to the plan of care but should also include the nurse's judgement as to whether the outcomes are being met. All of the other choices are criteria for evaluation.

Quality improvement in care delivery requires which components? Select all that apply. a. Leadership commitment b. Continuous improvement c. Total client care by the nursing unit d. Focus on data collection e. Focus on the mission of the organization

a. Leadership commitment b. Continuous improvement d. Focus on data collection e. Focus on the mission of the organization When performing quality improvement the nurse should be collaborating with other departments rather than maintaining total client care by the nurses. All of the other choices are part of the quality improvement process.

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: a. Peer review b. Quality and Safety Education for Nurses (QSEN) c. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) d. American Association of Critical-Care Nurses (AACN)

a. 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.

Before discharge the client will demonstrate aseptic dressing changes. This is an example of which type of evaluative statement? a. Psychomotor b. Cognitive c. Affective d. Physical changes

a. 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 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.

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? a. Quality by inspection b. Quality as opportunity c. Quality by perception d. Quality as initiative

a. Quality by inspection Quality by inspection is an approach to quality assurance in which nurses watch for deficient workers and remove them in an effort to prevent harm to clients. Quality as opportunity, on the other hand, focuses on finding opportunities for improvement and fosters an environment that thrives on teamwork, with people sharing the skills and lessons they have learned. Quality by perception and quality as initiative are not specific approaches to quality assurance.

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. a. Terminate the plan of care b. Modify the plan of care c. Continue the plan of care d. Begin the plan of care e. Communicate the plan of care

a. Terminate the plan of care b. Modify the plan of care c. Continue the plan of care Based on the client's responses to the plan of care, the nurse decides to terminate the plan if expected outcomes are achieved, modify the plan if there are difficulties in achieving the outcomes, or continue the plan if more time is needed to achieve the outcomes. Beginning the plan of care occurs in the implementation phase, and communicating the plan of care occurs in the outcome identification and planning phase.

Which are psychomotor outcomes? Select all that apply. a. The client accurately draws up insulin. b. The client safely ambulates using a walker. c. The client identifies signs and symptoms of infection. d. The client rates pain as a 2 on a 0 to 10 pain rating scale. e. The client reports increased confidence in testing blood glucose level.

a. The client accurately draws up insulin. b. The client safely ambulates using a walker. Examples of psychomotor outcomes include accurately drawing up insulin and ambulating safely using a walker. Identifying signs and symptoms of infection is an example of a cognitive outcome. Rating pain as a 2 on a 0 to 10 scale is a physiologic outcome. An example of an affective outcome is reporting increased confidence in testing blood glucose level.

A client with a new diagnosis of diabetes will be discharged on insulin therapy. Which client psychomotor outcome does the nurse expect after client education? a. The client demonstrates administration of insulin. b. The client reports testing blood sugar before meals. c. The client identifies signs and symptoms of hypoglycemia. d. The client identifies correct insulin injection sites.

a. The client demonstrates administration of insulin. Psychomotor outcomes describe the client's achievement of new skills, such as demonstration of administration of insulin. An affective outcome involves changes in the client's values, beliefs, and attitudes, such as testing blood sugar before meals. Cognitive outcomes demonstrate increases in client knowledge, such as signs and symptoms of hypoglycemia and correct injection sites.

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.

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

a. 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.

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.

After the nursing plan of care has been developed, the nurse knows that: a. each encounter with the client is an opportunity to reassess and revise the plan of care, if necessary. b. the plan will be followed by other health care providers and filed with the client's chart upon discharge. c. the responsibility for the assessment of the client has ended. d. the plan of care can only be changed by the nurse who developed it.

a. each encounter with the client is an opportunity to reassess and revise the plan of care, if necessary. During each encounter with clients, nurses assess function, ensuring prompt attention to emerging problems. Because a client's condition can change quickly and dramatically, astute nurses remain alert to subtle cues and inferences. As they initiate the plan of care, nurses must ensure that the planned interventions are still relevant. Each of the remaining responses is untrue.

Identifying the kind and amount of nursing services required is a possible solution for: a. inadequate staffing. b. clients who fail to communicate their needs. c. nurses who are bored. d. nurses frustrated with substandard care.

a. inadequate staffing. A possible solution for inadequate staffing is to identify the kind and amount of nursing services required. Using a team conference to develop a consistent plan of care is a possible solution for the client who fails to communicate needs. Educating the client to become an assertive health care consumer is a possible solution for the client who quietly accepts whatever care is delivered or not delivered. A possible solution for the nurse who is a candidate for burnout is to learn to give quality care during the designated work period. An initiative to focus on quality improvement is a possible solution to nurses frustrated with substandard care. Reviewing task assignments and work schedules is a possible solution to bored nurses.

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? a. throughout the client's hospital admission b. when the client is discharged c. during the first home health care visit d. once the primary care physician has written a discharge order

a. 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."

The nurse performs discharge teaching for a client. How would the nurse best evaluate the effectiveness of the discharge teaching? a. Review it to see if all health care provider prescriptions were covered. b. Ask the client to repeat back to the nurse how care will be conducted at home. c. Determine if critical pathways were completed. d. Ask if the client understands the teaching.

b. Ask the client to repeat back to the nurse how care will be conducted at home. Evaluation is defined as the judgment of the effectiveness of nursing care to meet client goals based on the client's behavioral responses. This phase involves a thorough, systematic review of the effectiveness of nursing interventions and a determination of client goal achievement. The best way to evaluate the effectiveness of discharge teaching is to have the client repeat back to the nurse how care will be conducted at home. The nurse does not evaluate whether health care provider prescriptions or critical pathways have been completed during discharge teaching. Asking if the client understands the teaching does not allow the nurse to fully evaluate if the teaching was indeed successful.

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

b. By 18AUG2015, the client will demonstrate improved motion in the left arm. Psychomotor client goals refer to the client's achievement of new skills, such as demonstrating improved motion in the left arm. Valuing health by quitting smoking is an example of an affective goal. Listing three foods low in salt is a cognitive goal. Learning exercises to strengthen leg muscles is an affective goal.

A client comes into the clinic for a routine postoperative visit. While the nurse is assessing the level of pain, the client states that there is occasional discomfort but that pain levels have improved daily since returning home from the hospital. What should the nurse's response be regarding the client's plan of care? a. Terminate the plan of care. b. Continue the plan of care. c. Promptly modify the plan of care. d. Suggest increasing the pain medication.

b. Continue the plan of care. The nurse should continue the plan of care, as the client is progressing toward the ultimate outcome—the healing of the surgical site. There is no need to modify the plan, as the client is responding. The client is still having some pain, so it would not be appropriate to discontinue the plan of care. With the improvement in the client's pain, there is no need to increase pain medication; the nurse should just remind the client to take it when pain is uncomfortable.

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. a. Implement a change. b. Discover a problem. c. Evaluate a change. d. Plan a strategy using indicators.

b. Discover a problem. d. Plan a strategy using indicators. a. Implement a change. c. Evaluate a change. In order to improve quality performance the nurse should discover a problem, plan a strategy using appropriate indicators, implement a change, and evaluate the change.

The nurse is caring for a postoperative client who reports ineffective pain management with pain rated a 7 on a 0-10 rating scale. Based on the information provided by the client, which step should the nurse take first to modify the care plan? a. Create a new nursing diagnosis to reflect new goals. b. Evaluate the use of current pain relief measures. c. Request a stronger analgesic from the provider. d. Provide additional relief with non-pharmacologic measures.

b. Evaluate the use of current pain relief measures. Prior to proceeding with any changes in the plan of care, the nurse must first perform evaluation of the client's current pain relief measures. Once this has been performed, it might be appropriate to request a stronger analgesic or reinforce education for nonpharmacologic pain relief measures. Creating a new nursing diagnosis and goals would come after evaluating the current pain relief measures.

The nursing staff on a hospital unit uses peer review to improve professional performance. Who performs the review? a. Unit manager b. Nurses c. Clients d. Visitors

b. Nurses Peer review is the evaluation of one staff member by another staff member on the same level of the hierarchy of the organization. Peer review is not done by the unit manager, clients, or visitors.

A nurse is participating as a team member involved in the facility's evaluation process. The facility is conducting a retrospective evaluation. Which methods should the nurse expect to use to collect data? Select all that apply. a. Direct observation of client care b. Post-discharge client questionnaires c. Client interviews during the client's stay d. Chart review e. Telephone interviews of discharged clients

b. Post-discharge client questionnaires d. Chart review e. Telephone interviews of discharged clients Nursing care and client outcomes may be evaluated while the client is receiving care (i.e., a concurrent evaluation) or after the client has been discharged (i.e., a retrospective evaluation). Retrospective evaluation may use post-discharge questionnaires, client interviews (by telephone or face to face), or chart review (nursing audit) to collect data. Concurrent evaluation is conducted by using direct observation of nursing care, client interviews, and chart review to determine whether the specified evaluative criteria are met.

A nurse must call a health care provider to request a prescription for a client who is experiencing pain unrelieved by the previous medication prescribed. When the nurse makes the call, the provider screams at the nurse and states, "Just do what the prescription says! I am not giving you another prescription for pain medication!" What is the best response by the nurse? a. "You shouldn't treat the client that way!" b. "OK. Don't give me a prescription, I will just call the chief of staff." c. "Speaking to me that way is unacceptable. We should work together for the benefit of the client." d. "I don't know why you won't give me a prescription for the pain medication. You are so rude!"

c. "Speaking to me that way is unacceptable. We should work together for the benefit of the client." The nurse should inform the health care provider that the response is inappropriate and that the nurse is entitled to respectful conversation. The behavior of the health care provider should also be reported. The major issue is client care and this should be a top priority for the health care team. The other responses do not deal with this situation to prevent the behavior occurring again.

The nurse participates in a quality assurance program and reviewing evaluation data from the previous year. Which should the nurse recognize as an example of outcome evaluation? a. A 4% increase in the number of baccalaureate-prepared nurses employed in the facility b. Bed occupancy rates of 97% in the critical care areas and 92% in the non-critical care areas c. A 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery d. A rate of 98% of clients admitted to the hospital who had a nursing history completed within 24 hours after admission

c. A 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery Quality assurance programs focus on three types of evaluation: structure, process, and outcome. Outcome evaluation focuses on measurable changes in the health status of clients, such as a 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery. Structure evaluation focuses on the environment in which care is provided, such as the number of baccalaureate-prepared nurses employed in the facility and bed occupancy rates. Process evaluation focuses on the nature and sequence of activities carried out by nursing implementing the nursing process, such as a rate of 98% of clients admitted to the hospital who had a nursing history completed within 24 hours after admission.

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

c. Confront the nurse and explain how this could be dangerous for the client. Confronting the nurse and explaining the danger for the client is a form of peer evaluation. Peer evaluation involves evaluation of one staff member by another staff member on the same level in the hierarchy of the organization. This is an important mechanism nurses can use to improve their professional performance; it can be done formally or informally. Reporting the nurse does not enhance a good working relationship and does not follow the chain of command. An incident report is not warranted at this point in time. The physician should not be contacted for an order unless it is decided that the restraint is going to be left on the client.

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

c. Ensuring that the endotracheal tube is secure The ABCs (airway, breathing, and circulation) are always top priority in client care. In this example, ensuring that the client maintains a patent airway will always be top priority. Each of these nursing tasks is important and will need to be accomplished at some point during client care.

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

c. The client measures capillary blood glucose level. d. 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.

The nurse is assessing the client's behavioral response to a nursing intervention. This type of evaluation is known as: a. structural evaluation. b. behavior modification. c. outcome evaluation. d. process evaluation.

c. outcome evaluation. Outcome evaluation, which focuses on the client and the client's function, is currently receiving a great deal of emphasis. Outcome evaluation determines the extent to which the client's behavioral response to nursing intervention reflects the desired client goal and outcome criteria. 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. Behavior modification is not a type of evaluation but a type of intervention that focuses on helping clients make lifestyle changes to achieve health goals.

"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 mother brings an infant into the clinic for a well-baby visit. The mother reports being concerned at discharge from the hospital after giving birth about being able to get the infant to latch on for breastfeeding. Now, however, the mother reports success with breastfeeding. and the nurse finds that the baby is gaining weight appropriately. Which is an appropriate evaluative statement for this client? a. "Goal met" b. "8FEB2016. Goal met." c. "Goal met. Mother reports that breastfeeding is going well with the infant eating every 2-3 hours and attaching to the nipple easily. Infant is gaining weight." d. "8FEB2016. Goal met. Mother reports that breastfeeding is going well with the infant eating every 2-3 hours and attaching to the nipple easily. Infant is gaining weight."

d. "8FEB2016. Goal met. Mother reports that breastfeeding is going well with the infant eating every 2-3 hours and attaching to the nipple easily. Infant is gaining weight." The evaluative statement should include the time frame/date, a judgment as to whether the goal was met, and data to support the decision.

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? a. When the client is discharged b. At the end of the 6-week therapy c. Only when the client shows some progress d. As soon as possible

d. As soon as possible Evaluating the progress of a long-term goal prior to the end date encourages and motivates the client to continue working toward the goal. Waiting until the client is discharged or at the end of the 6 weeks does not provide the client the opportunity to feel a sense of accomplishment and motivation to continue working toward the goal. Only evaluating when the client shows progress may lead to the client becoming discouraged.

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.

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? a. Design evaluation b. Outcome evaluation c. Structure evaluation d. Process evaluation

d. 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."

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.

While auscultating a client's lung sounds, the nurse notes crackles in the left lower lobe, which were not present at the start of the shift. The nurse is engaged in which type of nursing intervention? a. Educational b. Psychomotor c. Maintenance d. Surveillance

d. Surveillance Surveillance interventions include detecting changes from baseline data and recognizing abnormal response. Nurses rely on the senses to detect changes, such as observing the appearance and characteristics of clients and hearing by auscultation, pitch, and tone. Nurses use these surveillance activities to determine the current status of clients and changes from previous states. Educational interventions require instruction, demonstration, and return demonstration of knowledge or a skill set. Psychomotor interventions involve the nurse physically working with the client. Maintenance interventions involve the nurse assisting the client with performing routine activities of daily living.

Which of the following best summarizes the evaluation step of the nursing process? a. The nurse completes a health assessment to establish a database. b. The client and family have met health care goals and no longer need care. c. The nurse and client identify nursing diagnoses and appropriate interventions. d. The nurse and client measure achievement of planned outcomes of care.

d. The nurse and client measure achievement of planned outcomes of care. In evaluation, which is the fifth step of the nursing process, the nurse and client together measure how well the client has achieved the outcomes specified in the plan of care. Establishing a health assessment is the first stage of the nursing process. Identifying nursing diagnosis is the second stage and implementation of care is the fourth stage. When the client no longer needs care, the relationship is terminated.

Which nursing action reflects evaluation? a. The nurse identifies that the client does not tolerate activity. b. The nurse sets a tolerable pain rating with the client. c. The nurse auscultates the client's lungs and abdomen. d. The nurse assesses urine output following administration of a diuretic.

d. The nurse assesses urine output following administration of a diuretic. Assessing the client's response to a diuretic medication is an example of evaluation. Recognition of a client health problem that can be prevented or resolved by independent nursing intervention, such as activity intolerance, is the focus of diagnosing. Auscultating the client's lungs and abdomen is an example of assessment. Setting a tolerable pain rating with the client is an example of planning.