NUR FUND CH #15 + PREP U

A nurse manager notes an increase in the frequency of client falls during the last month. To promote a positive working environment, how would the nurse manager most effectively deal with this problem?

- Investigate the circumstances that contributed to client falls. p. 250-251 Rationale: The most effective method to address the increased frequency of client falls (and to promote a positive working environment) would be to determine the circumstances that contributed to the clients' falls. Attempting to identify and reprimand individual nurses does not lead to an atmosphere of openness and honesty in determining the causes. Instituting a new policy to prevent falls is premature before identifying why the falls are occurring. It may be relevant later to determine if other nursing units are having the same problem, but it is not necessary at this time.

Nurse Mayweather is auscultating lung sounds. She notes crackles in the LLL which were not present at the start of the shift. Nurse Mayweather is engaged in which type of nursing intervention?

- Surveillance intervention p. 246 Rationale: Surveillance interventions include detecting changes from baseline data and recognizing abnormal response. Nurses rely on the senses to detect changes: observing the appearance and characteristics of clients; hearing by auscultation, pitch, and tone. Nurses use these surveillance activities to determine the current status of clients and changes from previous states.

Which of the following would a nurse know is a part of an evaluative statement? Select all that apply. Description of how the patient outcome was met Patient data that supports how the outcome was met Name of client's physician Client's health history

-Description of how the patient outcome was met -Patient data that supports how the outcome was met An evaluative statement includes a description of how the patient's outcome was met and the data that supports that decision. The name of the physician and the health history would only be included if it contributed to the patient's outcome.

What guides professional practice?

ANA Standards of Nursing Practice

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

Client's goals have been achieved

Which action is appropriate when evaluating a client's responses to a plan of care?

Continue the plan of care if more time is needed to achieve the goals/outcomes.

Which of the following actions should the nurse take during the evaluation phase of the nursing process? Provide client with follow-up appointment after discharge Document improved pain after pain medication administered Have client give input into plan of care upon admission Discontinue indwelling urinary catheter per provider's order

Document improved pain after pain medication administered Documenting improved pain after pain medication is an evaluation of pain relief after an intervention. 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.

Priority setting is based on the information obtained during reassessment. Priority setting is used to rank nursing diagnoses. Each of the following contributes to priority setting except which of the following? Time and resources Feedback from the family Finances of the client The client's condition

Finances of the client

The nurse is orienting a new client to the facility. The client is told that her preferences and choices would be sought and honored. This represents which expectation of the health care environment?

Individualization Explanation: Individualization is represented by allowing the client to express their choices and preferences and then honoring them. The other choices represent expectations of the health care environment but do not define individualization.

Nurses are involved in many types of evaluation. All of the following are activities that are related to evaluation, but which of the following is the priority concern for nurses?

Patients and their care

A group of nurses of the orthopedic floor of a hospital wish to improve their clinical performance. The nurse manager suggests a program in which the nurses will evaluate each other and provide feedback for improved performance. The nurses know that this program is termed which of the following?

Peer review

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

Quality assurance

A new graduate nurse is working in a hospital that is utilizing a program to continuously improve every process in every department of the facility. What processes will the graduate determine is being utilized? Select all that apply Continuous quality improvement Quality improvement Risk management Total quality improvement Performance quality improvement

Quality improvement Continuous quality improvement Total quality improvement

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

Revise or modify the nursing care plan

The terms "criteria" and "standard" are often used interchangeably but actually have distinct, separate definitions. "The levels of performance accepted by, and expected of, nursing staff or other health team members" is known as:

Standards. 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 male client has been recently diagnosed with diabetes after receiving emergency treatment for a hyperglycemic episode. Which of the client's actions indicates that he has achieved a cognitive outcome in the management of his new health problem? The client expresses a desire to change the way that he eats and the amount of exercise he performs. The client can demonstrate the correct technique for using his new glucometer. The client's blood sugars have been maintained within acceptable range in the days prior to discharge. The client is able to explain when and why he needs to check his blood sugar.

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.

At the beginning of prenatal care, the goal for the client was to gain 25 lb (11.25 kg) by the end of the pregnancy. At 30 weeks of pregnancy, the client has only gained 1 lb (0.45 kg). Which statement(s) would help the nurse most appropriately interpret these data?

The client is not achieving the goal. The nurse should determine the reasons the client has not been gaining weight. Explanation: The client is not achieving the goal. The nurse should determine what the causes are in order to revise the plan of care. It is important to determine as early as possible if the plan of care is being successful. This will allow sufficient time to revise the plan of care. It is unrealistic to think the client will achieve the goal in the next 10 weeks. The client may not achieve the goal, but the priority at this time is to determine the reasons and revise the plan of care.

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. The client reports walking for 30 minutes each day. The client demonstrates active range of motion exercises with left upper extremity. The client explains how to administer a vaginal cream.

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.

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. 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.

Which nursing action reflects evaluation?

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 is an example of planning. Performing colostomy irrigation is an example of implementation.

One of the outcomes that has been identified in the care of a client with a new suprapubic catheter is that he will demonstrate the correct technique for cleaning his insertion site and changing his catheter prior to discharge. When should this outcome be evaluated?

Throughout the patient's hospital admission

A client with a recently fractured left femur has been reluctant to comply with his physical therapy for fear of the pain associated with movement. A goal for this client is to attend therapy treatments 3 times each day. The nurse is evaluating the goal for this client. The client states, "I don't like therapy; it hurts, but I have been going twice a day." The client chart has an entry from the last shift nurse stating the client went to therapy 2 times with encouragement. The nurse evaluates the goal as:

goal partially met.

A client is about to leave the hospital after having surgery for a fractured left femur. It is now in a plaster cast. The client asks how long before the cast will be dry. The nurse notes on his plan of care a learning outcome stating "Client will verbalize appropriate cast care upon discharge." This represents what type of outcome?

Cognitive

Which statement related to the evaluation of outcome attainment for a client is correct?

Collecting data related to outcome attainment requires the nurse to know when to collect the data based upon established time criteria.

A nurse finds that her client is not achieving the set outcomes for care and reviews the plan. Which actions are appropriate changes for the nurse to make in the plan of care? Select all that apply.

• Delete or modify the nursing diagnosis • Make the outcome statement more sensible • Adjust the time limits on the outcome statement • Increase the complexity of the outcome statement

The mother of an infant comes to the clinic and asks the nurse if the infant can eat bananas now. The outcome statement on the infants plan of care states "The mother will explain proper nutrition for infants." this is an example of what type of outcome statement?

Cognitive Explanation: 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 and physical changes are related to actual body changes in the infant.

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? File an incident report and have the second nurse sign it. Confront the nurse and explain how this could be dangerous for the client. Contact the physician for an order for the restraints. Report the nurse applying the restraints to the supervisor.

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.

When recording or documenting outcome attainment in the chart, nurses are to be very clear with the descriptions used. Which term is appropriate? "Great response" "Demonstrated steps" "Inadequate skills" "Extremely well-mannered"

Demonstrated Steps

A group of nurses of the orthopedic floor of a hospital wish to improve their clinical performance. The nurse manager suggests a program in which the nurses will evaluate each other and provide feedback for improved performance. The nurses know that this program is termed which of the following? Quality and Safety Education for Nurses (QSEN) Peer review Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) American Association of Critical-Care Nurses (AACN)

Peer review Explanation: Peer review is a process by which one nurse evaluates the performance of another in an effort to improve their professional performance. QSEN has as its goal the preparation of nurses with the knowledge, skills, and attitudes (KSAs) necessary to improve the quality and safety of healthcare systems. AACN strives to provide safe work environments and HCAHPS measures client satisfaction with health care.

A client has just been admitted to the clinical unit. The nurse is providing her with the expectations she may have of the health care she will receive. She is told that she will not be harmed by any errors that might be made and she can expect to be safe in the facility. This assurance represents which expectation of the health care environment?

Safety Explanation: Safety is represented by the expectation that the client won't be harmed by any errors and they will be safe in the facility. The other choices represent expectations of the health care environment but do not define safety.

Which of the following nursing actions reflects evaluation?

The nurse assesses urine output following administration of a diuretic.

A nurse is evaluating nursing care and patient outcomes by using a retrospective evaluation. Which action would the nurse perform in this approach? The nurse devises a post-discharge questionnaire to evaluate patient satisfaction. The nurse interviews the patient while he or she is receiving the care. The nurse reviews the patient chart while the patient is being cared for. The nurse directly observes the nursing care being provided.

The nurse devises a post-discharge questionnaire to evaluate patient satisfaction. Explanation: Evaluations can be conducted concurrent with care (conducted by using direct observation of nursing care, patient interviews, and chart review to determine whether the specified evaluative criteria are met), or retrospective (post discharge questionnaires, patient interviews by telephone or face to face, or chart review to collect data

A nurse on the unit fails to help a colleague ambulate a client even though there is time to do so. What is the best response by the nurse requiring assistance? Select all that apply

a) "This client is in need of our assistance and everyone who is free should come together for improved client outcomes" b) "Please come and help and work together as a team. You know that there is zero tolerance for selfish behavior" c) "Your behavior is unacceptable, we all have to work to ether as a team to provide quality care for our client"

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

a) The client describes how to perform progressive muscle relaxation. c) The client identifies signs and symptoms of hypoglycemia. d) The client lists the side effects of digoxin (Lanoxin).