Ch. 18

Which are psychomotor outcomes? Select all that apply.

Accurately drawing up insulin The client will safely ambulate using a walker.

A nurse manager is conducting peer reviews of the staff on the critical care unit. Which person would the nurse manager select to evaluate a registered nurse who is certified in critical care?

Another registered nurse with critical care certification

The nurse should evaluate client outcomes at which time?

As early as possible

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

Which is a psychomotor client goal?

By 18AUG2015, the client will demonstrate improved motion in the left arm.

A nurse has been providing discharge teaching to a client with type 1 diabetes. Which outcome indicates that the teaching has been effective?

By a certain date, the client will verbalize signs and symptoms of hypoglycemia.

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?

Continue the plan of care.

Which nursing action would be most effective in helping a client learn self-care behaviors?

Model self-care behaviors for the client.

"The client will demonstrate cast care prior to discharge" is which type of evaluative statement?

Psychomotor

A nurse manager is preparing for a visit from The Joint Commission. The nurse manager determines that this visit reflects which type of evaluation?

Retrospective evaluation

Which action should the nurse perform in the evaluation phase?

Revise the plan of care.

Which action by the nurse is an example of peer review?

The nurse preceptor provides feedback to the new graduate nurse after 6 weeks of orientation.

Which purpose of the evaluation phase of the nursing process is a priority during client care?

To examine the client's behavioral response to the care received

When the nurse prepares to discharge a client, and subsequently evaluates the effectiveness of the patient care, the nurse should determine whether the:

client's goals have been achieved.

The primary purpose for evaluating data about a client's care according to a functional health approach is to:

revise or modify the client care plan.

When recording or documenting outcome attainment in the chart, nurses are to be very clear with the descriptions used. Which term is appropriate?

"Demonstrated steps"

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?

Confront the nurse and explain how this could be dangerous for the client.

Quality improvement in care delivery requires which components? Select all that apply.

Leadership commitment Continuous improvement Focus on data collection Focus on the mission of the organization

The nurse is caring for a client with congestive heart failure. The nurse manager informs the nurse that the client was enrolled in a clinical trial to assess whether a 10-minute walk, 3 times per day, leads to expedited discharge. Which type of evaluation best describes what the researchers are examining?

Outcome

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?

The client demonstrates administration of insulin.

A client has been recently diagnosed with diabetes after receiving emergency treatment for a hyperglycemic episode. Which of the client's actions indicates that the client has achieved a cognitive outcome in the management of this new health problem?

The client is able to explain when and why the client needs to check the blood glucose level.

Which client outcome is an example of a physiologic outcome?

The client's pulse oximetry reading is 97% on room air 30 minutes after removal of a nasal cannula.

Which nursing action reflects evaluation?

The nurse assesses urine output following administration of a diuretic.

A nurse is evaluating nursing care and client outcomes by using a retrospective evaluation. Which action would the nurse perform in this approach?

The nurse devises a postdischarge questionnaire to evaluate client satisfaction.

After incorrectly administering digoxin to a client, a nurse admits the error to the nurse manager and peers to prevent them from making the same mistake. This is an example of which approach to quality assurance?

Quality as opportunity

Which precepts are among the rules suggested by the Institute of Medicine's (IOM) Committee on Quality of Health Care in America to improve health care? Select all that apply.

The client as the source of control Safety as a system priority Anticipation of clients' needs Cooperation among clinicians

Which are cognitive client outcomes? Select all that apply.

The client lists the side effects of digoxin. The client describes how to perform progressive muscle relaxation. The client identifies signs and symptoms of hypoglycemia.

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?

Surveillance

The focus of a hospital's current quality assurance program is a comparison of the health status of clients on admission and with that at the time of discharge. This form of quality assurance is characteristic of:

outcome evaluation.

"The levels of performance accepted by and expected of nursing staff or other health team members" defines:

standards.

Which client outcomes are psychomotor outcomes? Select all that apply.

The client measures capillary blood glucose level. The client self-catheterizes using clean technique.

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.

Why are quality-assurance programs important in nursing?

They enable nursing to be accountable for the quality of care.

The client identifies three strategies for minimizing leakage of an ileostomy bag. This is an example of:

a cognitive outcome.

Which authoritative statements guide current professional nursing practice?

American Nurses Association Standards of Nursing Practice

A client is administered an anxiolytic. Which nursing action demonstrates the nurse evaluating the client?

Asking whether the client feels less anxious 30 minutes after administering the medicine

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?

True collaboration

The nurse is assessing the client's behavioral response to a nursing intervention. This type of evaluation is known as:

outcome evaluation.

A nurse manager attempts to achieve performance improvement in the emergency department of a busy inner-city hospital. Which nursing actions follow Haase and Miller's recommended steps in performance improvement? Select all that apply.

The nurse discovers that there is a problem with the triage system that is in place in the emergency department. The nurse calls a meeting of the emergency department interdisciplinary team to effect change in the triage process. The nurse organizes a task force to implement change in the triage process of a busy emergency department. The nurse meets with the emergency department staff to assess changes made to the triage process.

The nursing supervisor is evaluating how many clients each of the department nurses has been assigned for the shift. This type of evaluation would be considered:

structure.

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?

Ensuring that the endotracheal tube is secure

A hospital is evaluating its policies and procedures. What type of evaluation is the hospital conducting?

Structure

Which action should the nurse take during the evaluation phase of the nursing process?

Document reassessment of pain after medication administration.

A nurse is working as part of a quality assurance team that uses the American Nurses Association model. The team is evaluating the resources of the facility as well as the physical facilities and equipment. Which type of evaluation is the team engaged in?

Structure evaluation

A client who was admitted to the acute care unit with angina pectoris is no longer having chest pain. Based on this assessment, what does the nurse decide to do with the plan of care for chest pain?

Terminate the plan of care related to the nursing diagnosis of chest pain.

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?

Discovering a problem

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?

Effective decision making

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?

Finances of the client

A nurse overhears a coworker telling a somewhat offensive joke to a client. Which nursing action is indicated?

Discuss the occurrence with the coworker.

Which action should the nurse take when client data indicate that the stated goals have not been achieved?

Review each preceding step of the nursing process.

Which statements are true of factors that influence client responses and outcome achievement and of how the nurse should use them? Select all that apply.

The nurse should draw on positive factors to deal with other variables in the future. A client's strong motivation to learn appropriate health behaviors is an example of a positive factor. The nurse should identify which factors are helpful to attaining outcomes and manipulate them to achieve goals.

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?

"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."

Which are components of an evaluative statement? Select all that apply.

Description of how the client outcome was met Client data that support how the outcome was met

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 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery

A nurse is documenting evaluation of the care provided for an infant born with Down syndrome. Which nursing actions exemplify the appropriate documentation process? Select all that apply.

After the data have been collected to determine client outcome achievement, the nurse writes an evaluative statement to summarize the findings. The nurse writes a 2-part evaluative statement that includes a decision about how well the outcome was met, along with client data that support the decision. The nurse has three decision options for how goals have been met.

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?

As soon as possible

All of the activities listed are related to evaluation, but which activity is the priority concern for nurses?

Meeting the care needs of clients

"The client will verbalize appropriate cast care on discharge" represents which type of outcome?

Cognitive

A nurse is evaluating a client to determine outcome achievement. The nurse determines that the client's outcome was partially met. When documenting the evaluative statement, the nurse records which other information?

Data that support the decision of the outcome being partially met

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?

Develop a process for periodic review of care plans that focuses on deleting and updating the nursing diagnoses.

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?

Evaluate the use of current pain relief measures.

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?

Have you had any fevers?

The nursing staff on a hospital unit uses peer review to improve professional performance. Who performs the review?

Nurses

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

A mother brings an infant into the clinic. The infant is 2 months old and has not been gaining weight appropriately. The outcome statement on the plan of care states, "The infant will double birth weight by 6 months of age." This is an example of which type of outcome statement?

Physical changes

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?

Physical changes

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?

Process evaluation

Before discharge the client will demonstrate aseptic dressing changes. This is an example of which type of evaluative statement?

Psychomotor

Which are major premises of a quality-improvement (QI) program? Select all that apply.

QI determines whether nursing standards are being upheld. QI programs may be mandated by some governmental agencies. QI focuses on processes rather than individuals. QI's focus is on ensuring excellence in care.

The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted?

Quality assurance

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?

Quality by inspection

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?

Safety

A client has returned to the clinic for a postoperative visit. The nurse reviews the plan of care and may choose to take which actions based on the client's previous responses to the current plan of care? Select all that apply.

Terminate the plan of care if the client has achieved outcomes. Modify the plan of care if the client has encountered difficulty with achieving outcomes. Continue the plan of care if more time could result in achievement of outcomes.

Which nurse is using criteria to determine expected standards of performance?

The new graduate nurse consults the policies and procedures of the institution prior to skill implementation.

A new mother is having difficulty breastfeeding a newborn infant. A goal was established stating that the baby 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. The nurse evaluates the original goal as:

completely unmet.

Identifying the kind and amount of nursing services required is a possible solution for:

inadequate staffing.

"Measurable qualities, attributes, or characteristics that identify knowledge or health status" defines:

criteria.

A mother is bringing an infant into the the clinic for a well-baby checkup. The infant's weight gain is on target for age. A correctly written evaluative statement for this client is:

"8FEB2016. Goal met. The infant's weight gain is appropriate for age."

A client reports to the nurse quitting smoking 6 months ago after being diagnosed with lung cancer. The nurse recognizes this change in behavior is which type of outcome?

Affective

Which 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.