Ch. 15 Evaluating Taylor NCLEX

A hospital is evaluating its policies and procedures. What type of evaluation is the hospital conducting? a) Structure b) Outcome c) Quality d) Process

a) Structure Explanation: A structure evaluation or audit focuses on the environment in which care is provided. Standards describe physical facilities and equipment, organizational characteristics, policies and procedures, fiscal resources, and personnel resources.

The client identifies three strategies for minimizing leakage of an ileostomy bag. This is an example of what type of outcome? a) Psychomotor outcome b) Physiologic outcome c) Affective outcome d) Cognitive outcome

d) 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.

Which expected client outcome is an example of a psychomotor outcome? Select all that apply. a) Reporting increased confidence in testing blood sugar. b) Accurately drawing up insulin. c) Safely ambulating using a walker. d) Rating pain as a 2 on a 10-point scale. e) Identifying signs and symptoms of infection.

b) Accurately drawing up insulin., c) Safely ambulating using a walker. Explanation: 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 10-point scale is a physiologic outcome. An example of an affective outcome is reporting increased confidence in testing blood sugar.

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

d) 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.

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 allow increased retention of qualified nurses. d) They specify how resources are used or not used.

a) 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, specify how resources are to be used, or increase retention of nurses.

The administrators of a community hospital have determined that the number of client falls has increased over the last year. Nurse managers are invited from each hospital unit to evaluate falls-risk assessment tools for use on their units. What step does this represent in the performance improvement process? a) Implementing a change b) Planning a strategy using indicators c) Discovery of the problem d) Assessing the change

b) Planning a strategy using indicators Explanation: Evaluation of assessment tools is an example of planning a strategy using indicators. The discovery of the problem has already occurred, and the process has moved to the second step of planning. Upon acceptance of a falls-risk assessment tool, the process will move to the implementation phase, and after the tool has been used for a period of time, the process will be assessed.

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

b) 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 six 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.

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

b) The nurse and client measure achievement of planned outcomes of care. Explanation: In evaluating, 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.

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) True collaboration c) Appropriate staffing d) Effective decision making

b) True collaboration Explanation: True collaboration involves skilled communication, mutual respect, shared responsibility, and decision making among nurses, and between nurses and other health team members. Skilled communication requires health team members to communicate in a non-intimidating manner with colleagues, allowing all voices to be heard regarding a matter. Effective decision making ensures nurses are valued and active partners in making policy, directing and evaluating clinical care, and leading organizational operations.

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? a) The client's blood sugars have been maintained within acceptable range in the days prior to discharge. b) The client can demonstrate the correct technique for using his new glucometer. c) The client is able to explain when and why he needs to check his blood sugar. d) The client expresses a desire to change the way that he eats and the amount of exercise he performs.

c) The client is able to explain when and why he needs to check his blood sugar. Explanation: The ability to describe the rationale and technique for blood glucose monitoring indicates that the client has achieved a cognitive outcome. Demonstration of the technique constitutes a psychomotor outcome, while the expression of a desire for change is an affective outcome. The maintenance of healthy blood sugars is a physiologic outcome.

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) When the client is discharged b) Once the primary care physician has written a discharge order c) Throughout the client's hospital admission d) During the first home health care visit

c) Throughout the client's hospital admission Explanation: 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 is collecting data on a client presenting to the medical short-stay unit for a colonoscopy. A client reports to the nurse that he quit smoking six months ago after being diagnosed with lung cancer. The nurse recognizes this change in behavior is which type of outcome? a) Psychomotor outcome b) Cognitive outcome c) Physiologic outcome d) Affective outcome

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

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

d) Inadequate staffing. Explanation: 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 refused to cooperate with the therapeutic regimen, while educating the client to become an assertive healthcare 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.

The American Nurses Association defines components of quality care: structure evaluation, process evaluation, and outcome evaluation. Which of the following best defines structure evaluation? a) Demonstrable changes in a client's health status that consider the environment for care and the nursing actions provided. b) Measurable changes in the health status of the client or the end results of the nursing care provided. c) The nature and sequence of activities carried out by nurses implementing the nursing process. d) Standards that describe physical facilities and equipment; organizational characteristics, policies, and procedures; fiscal resources; and personnel resources.

d) Standards that describe physical facilities and equipment; organizational characteristics, policies, and procedures; fiscal resources; and personnel resources. Explanation: Structure evaluation focuses on the environment in which the care is provided and includes standards that describe physical facilities and equipment; organizational characteristics, policies, and procedures; fiscal resources; and personnel resources. Process evaluation is the nature and sequence of activities carried out by nurses implementing the nursing process. Outcome evaluation focuses on measurable changes in the health status of the client or the end results of the nursing care provided.

The nurse observes a nursing colleague enter an isolation room without appropriate personal protective equipment. According to the study Silence Kills: The Seven Crucial Conversations for Healthcare, of which type of crucial conversation category is this an example? a) Broken rules b) Incompetence c) Mistakes d) Poor teamwork

a) Broken rules Explanation: Failure to wear appropriate personal protective equipment when entering an isolation room is an example of breaking the rules. Incompetence involves lack of knowledge and skill to perform a particular task. Mistakes are unintended errors. Poor teamwork involves failure of a team member to assist other members as needed.

The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted? a) Peer review b) Magnet status c) Quality assurance d) Quality improvement

c) Quality assurance Explanation: Accreditation by the Joint Commission evaluates quality assurance. Quality assurance is an externally driven process, demonstrating nursing excellence by meeting professional standards of care. Quality improvement is an internally driven continuous process, focusing on the processes of client care. Peer review is a process whereby individual nurses improve their professional performance through the evaluation of one staff member by another staff member on the same level of the hierarchy. Magnet status is awarded by the American Nurses Credentialing Center, recognizing health care organizations for their excellence in nursing.

Which 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) Evaluation of the client's attainment of outcome goals is determined by the nurse and physician. c) The nurse should initially evaluate the plan of care at the time of the client's discharge. d) Celebrating outcome achievement with a client often interferes with attainment of future goals.

a) 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.

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) Meaningful recognition c) True collaboration d) Appropriate staffing

a) Effective decision making Explanation: Effective decision making ensures nurses are valued and active 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. True collaboration involves skilled communication, mutual respect, shared responsibility, and decision making among nurses, and between nurses and other health team members. Meaningful recognition highlights the value each nurse brings to the work for the organization, such as certification.

Which client outcome is a cognitive outcome? Select all that apply. a) The client identifies signs and symptoms of hypoglycemia. b) The client reports cycling 30 minutes three times each week. c) The client correctly ambulates with a walker. d) The client lists the side effects of digoxin (Lanoxin). e) The client describes how to perform progressive muscle relaxation.

a) The client identifies signs and symptoms of hypoglycemia. d) The client lists the side effects of digoxin (Lanoxin)., e) The client describes how to perform progressive muscle relaxation., Explanation: 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. A psychomotor outcome involves changes in the client's values, beliefs, and attitude. 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 cognitive outcome? a) The client identifies three strategies for minimizing leakage of an ileostomy bag. b) The client's pulse ranges from 60 to 100 beats per minute. c) The client demonstrates how to take a radial pulse. d) The client's finger stick blood sugar is greater than 70 and less than 110.

a) The client identifies three strategies for minimizing leakage of an ileostomy bag. 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, such as blood sugar values and pulse rate. Psychomotor outcomes describe the client's achievement of new skills, such as taking a radial pulse.

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

a) The nurse assesses urine output following administration of a diuretic. Explanation: 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.

Which nursing action reflects the evaluation stage? Select all that apply. a) The nurse determines the client did not lose the expected two pounds. b) The nurse performs tracheostomy care using sterile technique. c) The nurse identifies that the client has developed a pressure ulcer. d) The nurse sets an anxiety level of 3 or less with the client. e) The nurse documents the client's response to suctioning.

a) The nurse determines the client did not lose the expected two pounds. e) The nurse documents the client's response to suctioning., Explanation: Examples of evaluation include documenting the client's response to suctioning and making a judgment that the client did not reach the expected outcome of a two-pound loss. The focus of diagnosing is recognition of a client health problem that can be prevented or resolved by independent nursing intervention, such as a pressure ulcer. Setting an anxiety rating with the client is an example of planning. Performing tracheostomy care is an example of implementation.

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, the nurses are not using the plan of care. What is a feasible approach to correcting this problem? a) Provide an in-service on interviewing and physical assessment skills; discuss the importance of these skills with the staff. b) Develop a process for periodic review of care plans that focuses on deleting and updating the nursing diagnoses. c) Delegate the updating of nursing diagnoses for all clients on the unit to one nurse for each shift. d) Request that a staff development nurse instruct the nurses on concept mapping to use instead of care planning.

b) Develop a process for periodic review of care plans that focuses on deleting and updating the nursing diagnoses. Explanation: 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 patient care plans on the unit.

When the nurse prepares to discharge a client, and subsequently evaluate the effectiveness of the nursing care, the nurse should determine whether the ... a) physician orders have been completed b) client's goals have been achieved c) critical pathways are completed d) documentation is thorough

b) client's goals have been achieved 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 focus of a hospital's current quality assurance program is a comparison between the health status of clients upon admission and at the time of discharge. This form of quality assurance is characteristic of what? a) Process evaluation. b) Nursing audit. c) Structure evaluation. d) Outcome evaluation.

d) Outcome evaluation. Explanation: Outcome evaluation focuses on measurable changes in the health status of the client or the end results of nursing care. Whereas the proper environment for care and the right nursing actions are important aspects of quality care, the critical element in evaluating care is demonstrable changes in client health status. Process evaluation addresses performance expectations during the various stages of the nursing process. Structure evaluation addresses the environment of care. A nursing audit focuses on the review of records.