Prep U: Ch 18: Evaluating

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" explanation: Written documentation of the subjective and objective data gathered and the judgment made about goal attainment is required on the client's health record. Judgments about goal attainment are written clearly and concisely. Avoid ambiguous terminology, such as "inadequate," "good," or "extremely well," which can be interpreted differently by different people.

Which are psychomotor outcomes? Select all that apply.

Accurately drawing up insulin The client will safely ambulate 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 0 to 10 scale is a physiologic outcome. An example of an affective outcome is reporting increased confidence in testing blood glucose level.

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 explanation: Peer review is the evaluation of one staff member by another staff member on the same level in the hierarchy of the organization. Therefore, another registered nurse who is certified in critical care would be appropriate to evaluate a critical care nurse certified in critical care. A nurse manager and a critical care physician are at a higher level in the hierarchy than a staff nurse certified in critical care. A staff nurse without certification in critical care would also not be appropriate to evaluate a nurse with this certification.

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 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.

A nurse is evaluating the plan of care for a client and determines that the achievement of goals is difficult to evaluate. What should the nurse do when evaluating the plan to ensure that the outcomes are achievable? Select all that apply.

Be sure that the criteria for appropriate response are clearly specified. Be certain that the subject is the client or some part of the client. Make sure the client's expected behavior is written in observable, measurable terms. Specify time limits in the plan. explanation: The nurse should not rewrite the plan of care just so the client meets the outcomes. The other choices are appropriate actions for the nurse to take when evaluating the plan of care.

Which is a psychomotor client goal?

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.

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

Cognitive explanation: 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.

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. 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.

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 take during the evaluation phase of the nursing process?

Document reassessment of pain after medication administration. explanation: 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, orienting a new client to the facility, explains that the staff will ask for and honor the client's preferences and choices while providing care. This represents which expectation of the health care environment?

Individualization explanation: Individualization is represented by allowing the client to express his or her choices and preferences and then honoring them. The other choices represent other expectations of the health care environment. Transparency is the expectation that the information on all aspects of a client's health and care will be disclosed to the client. Control is the expectation that the client will retain autonomy and the right to self-determination. Safety is the expectation that the client will remain free from harm.

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

Meeting the care needs of clients explanation: The priority concern for nurses should always be related to meeting the care needs of clients. The other choices are all activities related to evaluation that serve this priority.

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 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 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 explanation: Physical changes are related to actual body changes in the infant. 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.

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.

Post-discharge client questionnaires Chart review Telephone interviews of discharged clients explanation: 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.

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

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.

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 explanation: 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.

A nurse is caring for a postoperative client after a scheduled ileostomy. Which action by the nurse reflects an effective cognitive outcome?

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, such as planning to attend the support group at the hospital. Physiologic outcomes are physical changes in the client, such as being able to eat a soft diet within 3 days after surgery. Psychomotor outcomes describe the client's achievement of new skills, such as emptying the ileostomy bag.

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. 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, whereas the expression of a desire for change is an affective outcome. The maintenance of healthy blood blood glucose levels 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 statemen(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 working. 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 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. 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. 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.

A nurse manager tends to use the quality by inspection method of ensuring quality on the unit. Which actions, taken by this manager, are evidence of use of this technique? Select all that apply.

The manager threatens to "write up" a nurse if the nurse is late to work again. The nurse requests transfer off the unit for a nurse who has made three medication errors in three months. explanation: Quality by inspection focuses on finding deficient workers and removing them. Quality as opportunityfocuses on finding opportunities for improvement and fosters an environment that thrives on teamwork. Holding education sessions regarding problem-prone procedures reflects this technique. Not participating in celebrations and making client rounds are not related to either quality style.

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

Which nursing action reflects evaluation?

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 characteristic is the most important indicator of high-quality nursing practice?

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 mostimportant act of evaluation performed by the nurse?

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.

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 explanation: 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.

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

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.

The client demonstrates stair climbing using a quad cane. This is an example of:

a psychomotor outcome. explanation: Psychomotor outcomes describe the client's achievement of new skills, such as stair climbing using a quad cane. An affective outcome involves changes in the client's values, beliefs, and attitude. Cognitive outcomes demonstrate increases in client knowledge. Physiologic outcomes are physical changes in the client.

Once a nurse has collected and interpreted the data on a client's outcome achievement, the nurse then makes a judgment and documents a statement summarizing those findings. This statement is called:

an evaluative statement. explanation: An evaluative statement is a statement summarizing the client's outcome achievement. Criteria are "measurable qualities, attributes, or characteristics that identify skill, knowledge, or health status." Standards are the "levels of performance accepted by and expected of nursing staff or other health team members." Evidence-based practice incorporates delivering nursing care that evidence supports as likely to result in meeting the expected client outcomes.

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. explanation: Evaluation using the functional health approach provides a framework for organizing and evaluating data allowing the nurse to modify the client care plan. Evaluation has no influence upon meeting accreditation standards, implementation of medical orders, or the need for health care consultations.

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

standards. explanation: 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.

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. explanation: 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.

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 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."