Chapter 19: Evaluating
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. Explanation: 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.
Which action should the nurse perform in the evaluation phase? Record interventions. Revise the plan of care. Set priorities for care. Carry out treatment procedures.
Revise the plan of care. Explanation: 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.
The nurse performs discharge teaching for a client. How would the nurse best evaluate the effectiveness of the discharge teaching? Review the content that was covered to see if all health care provider prescriptions were covered. Ask the client to describe how care will be conducted at home. Ask if the client understands the teaching and offer to answer any questions Determine whether each aspect of critical pathways were completed
Ask the client to describe how care will be conducted at home. Explanation: 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.
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? At the completion of each meal On 3/3 On 3/2 At the client's direction
At the completion of each meal Explanation: 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 is a psychomotor client goal? By 18AUG2015, the client will demonstrate improved motion in the left arm. By 18AUG2015, the client will learn three exercises designed to strengthen leg muscles. By 18AUG15, the client will list three foods that are low in salt. By 18AUG2015, the client will value health sufficiently to quit smoking.
By 18AUG2015, the client will demonstrate improved motion in the left arm. Explanation: 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.
Which statement related to the evaluation of outcome attainment for a client is correct? The nurse should initially evaluate the plan of care at the time of the client's discharge. Collecting data related to outcome attainment requires the nurse to know when to collect the data, based upon established time criteria. Celebrating outcome achievement with a client often interferes with attainment of future goals. Evaluation of the client's attainment of outcome goals is determined by the nurse and health care provider.
Collecting data related to outcome attainment requires the nurse to know when to collect the data, based upon established time criteria. Explanation: 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.
A nurse is reviewing a client's plan of care. What would the nurse determine is a problem related to the assessment phase of the nursing process? There is inefficient use of nursing resources. Database does not reflect changes in the client condition. Plan of care is vague and only contains information that nurses would utilize without a plan of care. Nursing diagnoses are too vague.
Database does not reflect changes in the client condition. Explanation: Database input is done during the assessment phase of the plan of care. Nursing diagnoses are formed during the diagnosis phase of the nursing process. The plan of care is established during the planning phase of the nursing process. Inefficient use of nursing resources is part of the implementation phase.
The nurse on a busy acute care floor identifies that several clients with heart failure are being readmitted within 2 weeks of discharge. Which step in performance improvement is the nurse demonstrating? Planning a strategy using indicators Implementing a change Discovering a problem Assessing the change
Discovering a problem Explanation: 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 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? Changing the dressing to prevent infection Ensuring that the endotracheal tube is secure Repositioning to prevent pressure injuries Providing medication for agitation
Ensuring that the endotracheal tube is secure Explanation: 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.
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? Create a new nursing diagnosis to reflect new goals. Provide additional relief with non-pharmacologic measures. Request a stronger analgesic from the provider. Evaluate the use of current pain relief measures.
Evaluate the use of current pain relief measures. Explanation: 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.
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? Time and resources Finances of the client Feedback from the family The client's condition
Finances of the client Explanation: 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.
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. Interpreting and summarizing findings Collecting data to determine whether criteria and standards are being met Identifying evaluative criteria and standards Terminating, continuing, or modifying the plan of care Documenting only the facts related to the plan of care
Identifying evaluative criteria and standards Collecting data to determine whether criteria and standards are being met Interpreting and summarizing findings 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.
An older adult client who is recovering from a stroke is scheduled to be transferred to the rehabilitation unit in the morning. The client is tearful and reports feeling lonely and abandoned in the hospital unit. The family visits daily, and flowers and cards are in the room. Documentation in the chart indicates that the client's pastor has been by twice in the past week to visit. Which nursing diagnosis and outcome criteria need to be addressed immediately for this client? Altered Mobility; able to tie shoes. Ineffective Coping; verbalizes support systems. Impaired Walking; unilateral neglect. Dysfunctional Family Processes; family contact daily.
Ineffective Coping; verbalizes support systems. Explanation: When considering appropriate evaluation criteria, be certain they relate directly to the diagnosis and the diagnosis relates to the assessment data. There are no data to support unilateral neglect. Tying shoes evaluates a client's abilities, not mobility. The nurse assesses that the family visits daily, so the family process is functional. Ineffective coping is appropriately evaluated by identification of coping mechanisms, such as support systems.
The nursing staff on a hospital unit uses peer review to improve professional performance. Who performs the review? Nurses Clients Unit manager Visitors
Nurses Explanation: 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 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: Peer review American Association of Critical-Care Nurses (AACN) Quality and Safety Education for Nurses (QSEN) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
Peer review Explanation: 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.
A nurse assures a client newly admitted to the clinical unit that the client will not be harmed by any errors and can expect to be safe in the facility. This assurance represents which expectation of the health care environment? Transparency Control Individualization Safety
Safety Explanation: Safety is represented by the expectation that the client won't be harmed by any errors and will be safe in the facility. The other choices represent other expectations of the health care environment. Transparency is the expectation that information on all aspects of a client's health and care will be provided and explained to the client and that nothing will be kept from the client. Individualization is the expectation that a client's care will be individualized or customized to meet that client's unique needs. Control is the expectation that the client will retain autonomy and the right to self-determination while receiving care.
Which are cognitive client outcomes? Select all that apply. The client correctly ambulates with a walker. The client identifies signs and symptoms of hypoglycemia. The client reports cycling 30 minutes three times each week. The client describes how to perform progressive muscle relaxation. The client lists the side effects of digoxin.
The client lists the side effects of digoxin. The client describes how to perform progressive muscle relaxation. The client identifies signs and symptoms of hypoglycemia. Cognitive outcomes demonstrate increases in client knowledge, such as listing side effects of medications, identifying signs and symptoms of hypoglycemia, and describing progressive muscle relaxation. Psychomotor outcomes describe the client's achievement of new skills, such as correct ambulation with a walker. An affective outcome involves changes in the client's values, beliefs, and attitude, such as the client's report of cycling.
Which nurse is using criteria to determine expected standards of performance? The nurse manager provides the staff nurse feedback regarding job performance for the previous year. The new graduate nurse consults the policies and procedures of the institution prior to skill implementation. The nurse preceptor provides feedback to the new graduate nurse after 6 weeks of orientation. The nurse seeks information from the unlicensed assistive personnel (UAP) regarding the family's response to the nurse's education.
The new graduate nurse consults the policies and procedures of the institution prior to skill implementation. Explanation: 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.
Which of the following best summarizes the evaluation step of the nursing process? The nurse completes a health assessment to establish a database. The client and family have met health care goals and no longer need care. The nurse and client identify nursing diagnoses and appropriate interventions. The nurse and client measure achievement of planned outcomes of care.
The nurse and client measure achievement of planned outcomes of care. Explanation: 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.
The nurse is implementing the nursing care plan with a client. Which of the nurse's actions best reflects evaluation? The nurse assesses the client's response to pain medication. The nurse identifies that the client has wound drainage. The nurse performs colostomy irrigation. The nurse sets an anxiety level of 3 or less with the client.
The nurse assesses the client's response to pain medication. Explanation: Examples of evaluation include assessing the client's response to pain medication. The focus of diagnosing is recognition of a client health problem that can be prevented or resolved by independent nursing intervention, such as a wound infection. Setting an anxiety rating with the client is an example of planning. Performing colostomy irrigation is an example of implementation.
Which characteristic is the most important indicator of high-quality nursing practice? The nurse takes measures to ensure accurate medication administration. The nurse considers the individual needs of clients. The nurse is organized and efficient in client care. The nurse follows the policies and procedures of the institution.
The nurse considers the individual needs of clients. Explanation: 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.
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 nurse evaluates the competence of nurse practitioners. The nurse evaluates the plan of care. The nurse evaluates the types of health care services available to the client.
The nurse evaluates the client's goal/outcome achievement. Explanation: The priority is to evaluate the client's goal/outcome achievement. This determines if the nursing diagnosis has been resolved. If the client's goal/outcome had not been met the nurse should then begin evaluating all aspects of the plan of care. It is not the responsibility of the nurse to evaluate the competence of nurse practitioners. The nurse can evaluate services available to the client but this is not the purpose of the evaluation phase of the nursing process.
Why are quality-assurance programs important in nursing? They allow increased retention of qualified nurses. They facilitate increased enrollment in educational programs. They specify how resources are used or not used. They enable nursing to be accountable for the quality of care.
They enable nursing to be accountable for the quality of care. Explanation: 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.
A new mother is having difficulty breastfeeding a newborn. A goal was established stating that the infant would be nursing every 2 to 3 hours by age 1 week. The mother presents to the follow-up center at 1 week and reports having discontinued breastfeeding 4 days ago. How will the nurse characterize the original goal? Unmet Partially met Inappropriately chosen for this client Abandoned
Unmet Explanation: After collecting data and evaluating the client's behavioral responses, the nurse makes a judgment about goal attainment by comparing the client's actual behavioral responses with the predicted responses or predetermined outcome criteria developed in the planning phase. In this case the mother ceased breastfeeding, which represents an unmet goal. If the mother reported breastfeeding the infant every 4 to 5 hours, the nurse could consider the goal partially met. There is no evidence that the goal was inappropriately chosen for the client despite it being unachieved. Goals are not typically described as being "abandone
The client identifies three strategies for minimizing leakage of an ileostomy bag. This is an example of: a cognitive outcome. an affective outcome. a physiologic outcome. a psychomotor outcome.
a cognitive outcome. Explanation: 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.