Ch16 Evaluating
The nurse participates in a quality assurance program and reviews evaluation data for the previous month. Which of the following does the nurse recognize as an example of process evaluation?
A nursing care plan was developed within the 8 hours of admission for 97% of all admissions
What guides professional practice?
ANA Standards of Nursing Practice
The client reports participating in water aerobics for 60 minutes three times each week. What type of outcome is this an example of?
Affective outcome
The nurse is giving shift report to the oncoming nurse who will be caring for a client with a portacath access device. The oncoming nurse states, "I have never taken care of a client with a portacath. Would you give me the basics, so I know what to do?" Which standard for establishing and sustaining healthy work environments is the oncoming nurse breaching?
Appropriate staffing
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, which type of crucial conversation category is this an example?
Broken rules
The nurse is caring for the client with pneumonia. An expected client outcome is, "The client will maintain adequate oxygenation by discharge." Which outcome criterion indicates the goal is met?
Client no longer requires oxygen.
The client's expected outcome is "The client will maintain skin integrity by discharge." Which of the following measures is best in evaluating the outcome?
Condition of the skin over bony prominences.
An elderly patient has lost significant muscle mass during her recovery from a systemic infection. As a result, she has not yet met the outcomes for mobility and activities of daily living that are specified in her nursing plan of care. How should her nurses best respond to this situation?
Continue with the plan of care with the aim of helping the patient achieve the outcomes.
Place the following steps for performance improvement in correct sequence.
Discover a problem. Plan a strategy using indicators. Implement a change. Assess the change.
Identifying the kind and amount of nursing services required is a possible solution for:
Inadequate staffing.
The nurse has responded to a patient's request to view her medical chart by arranging a meeting between the patient, the clinical nurse leader, and her primary care physician. The nurse is exemplifying which of the following characteristics of quality healthcare?
Information
Mr. Jacobs has been recently diagnosed with diabetes mellitus after receiving emergency treatment for a hyperglycemic episode. Which of Mr. Jacobs' actions indicates that he has achieved a cognitive outcome in the management of his new health problem?
Mr. Jacobs is able to explain when and why he needs to check his blood sugar
The nurse is reviewing the charts of clients admitted to the hospital for stroke and identifying complications related to nursing care that occurred during hospitalization. Which type of activity is the nurse engaged?
Nursing audit
The client's pulse oximetry reading is 97% on room air 30 minutes after removal of a nasal cannula. What type of outcome is this an example of?
Physiologic outcome
Nursing care and patient outcomes may be evaluated by use of a retrospective evaluation process. Which of the following is an example of a retrospective evaluation process?
Postdischarge questionnaire.
When a nursing supervisor evaluates the staff nurse's performance with a group of clients to whom the staff nurse has provided nursing care, the supervisor is performing which type of evaluation?
Process evaluation
The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted?
Quality assurance
A nurse is caring for a client who is recovering from stroke. Which of the following would the nurse perform in the evaluation phase?
Revising the plan of care
Which client outcome is an example of a psychomotor outcome?
The client demonstrates stair climbing using a quad cane.
Which client outcome is a physiologic outcome? Select all that apply.
The client's HA1c is 7.4%. • The client's blood pressure is 118/74. • The client rates their pain rating as 6.
The nurse is conducting a peer review of a nursing colleague. Which action by the nurse is an example of peer review?
The nurse preceptor provides feedback to the new graduate nurse after six weeks of orientation.
Upon evaluation of the patient's plan of care, the nurse determines that the expected outcomes have been achieved. Based upon this response, the nurse will:
terminate the plan of care.
Which activity does the nurse engage in during evaluation? Select all that apply.
• Collect data to determine whether desired outcomes are met. • Assess the effectiveness of planned strategies. • Adjust the time frame to achieve the desired outcomes.
Which client outcome is a cognitive outcome? Select all that apply.
• The client lists the side effects of digoxin (Lanoxin). • The client describes how to perform progressive muscle relaxation. • The client identifies signs and symptoms of hypoglycemia.
When the nurse prepares to discharge a client, to evaluate the effectiveness of the nursing care, the nurse should determine whether the
Client's goals have been achieved
The client identifies three strategies for minimizing leakage of an ileostomy bag. What type of outcome is this an example of?
Cognitive outcome
Which statement related to the evaluation of outcome attainment for a patient is correct?
Collecting data related to outcome attainment requires the nurse to know when to collect the data based upon established time criteria.
Which of the following outcomes result from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)? Select all that apply.
Criteria by which consumers can compare hospitals • Incentives for hospitals to maximize the quality of care they provide • Increased accountability and transparency of hospital care
The nurse manager on an orthopedic unit has determined that the nurses are not keeping the nursing diagnoses up to date on patient care plans and, in turn, the nurses 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 client who is experiencing an asthma attack. Ten minutes after administering an inhaled bronchodilator to the client, the nurse returns to ask if the client's breathing is easier. The nurse is engaging in which phase of the nursing process?
Evaluating
The nurse manager is dedicated to creating a healthy work environment for the nursing unit. She secures funding to display a plaque on the unit identifying all unit nurses who have earned certification. Which standard for establishing and sustaining healthy work environments does this action represent?
Meaningful recognition
The nurse participates in a quality assurance program. Data from the previous year indicates a 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery. The nurse recognizes this is which type of evaluation?
Outcome evaluation
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
Which nursing action is an example of incompetence?
The nurse administers packed red blood cells through an existing IV infusing 5% dextrose in water.
Which nursing action reflects evaluation?
The nurse assesses the client's response to pain medication.
Which of the following nursing actions reflect evaluation?
The nurse assesses urine output following administration of a diuretic.
Based upon chart reviews, it is determined that documentation on a telemetry unit is inadequate and incomplete. What is an appropriate nursing response to this problem?
The nurse educator reviews the legal reasons for careful and complete documentation.
One of the outcomes that has been identified in the care of a patient 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
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 manager of a medical unit regularly reviews the incident reports that result from errors and near misses that occur on the unit. How should the manager best respond to these incident reports?
Use them to inform improvements and education on the unit.
Which expected client outcome is an example of a psychomotor outcome? Select all that apply.
• Accurately drawing up insulin. • Safely ambulating using a walker
Which nursing action reflects the evaluation stage? Select all that apply.
• The nurse documents the client's response to suctioning. • The nurse determines the client did not lose the expected 2 lbs.
Which National Quality Initiative focuses on indicators and assessment tools that evaluate the quality of nursing care in acute care settings, such as nosocomial infection rates, patient injury rates, and patient satisfaction with nursing care, pain management, educational information, and care during hospitalization?
American Nurses Association
A nurse is evaluating and revising a plan of care for a client with cardiac catheterization. Which of the following actions should the nurse perform before revising a plan of care?
Discuss any lack of progress with the client.
The nurse assesses urine output following administration of a diuretic. Which step of the nursing process does this nursing action reflect?
Evaluation
Nurses have identified the following outcome in the care of a patient who is recovering from a stroke: "Patient will ambulate 100 feet without the use of mobility aids by 12/12/2011." Several nurses have evaluated the patient's progression towards this outcome at various points during her care. Which of the following evaluative statements is most appropriate?
"12/12/2011 - Outcome partially met. Patient ambulated 75 feet without the use of mobility aids"
A nursing student asks the clinical instructor to explain the difference between quality improvement and quality assurance. Which response by the clinical instructor is appropriate?
"Quality improvement focuses on processes, data, and statistical thinking."
The nurse is preparing to mail a patient satisfaction questionnaire to a client who was discharged from the hospital 4 days ago. Which type of evaluation is the nurse conducting?
Retrospective evaluation
The nurse is participating in a retrospective evaluation. Which activity would the nurse engage in with this type of evaluation?
Mailing a questionnaire
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
An expected client outcome is, "The client will remain free of infection by discharge." When evaluating the client's progress, the nurse notes the client's vital signs are within normal limits, the white blood cell count is 12,000 and the client's abdominal wound has a half-inch gap at the lower end with yellow-green discharge. Which statement would be an appropriate evaluation statement?
Goal not met; white blood cell count elevated, presence of yellow-green discharge from wound.
The administrators of a community hospital have determined that the number of patient 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?
Planning a strategy using indicators
Nurse C. witnessed a more senior nurse make 6 unsuccessful attempts at starting an intravenous (IV) line on a patient. The nurse persisted stating, "I refuse to admit defeat." This resulted in unnecessary pain for the patient. How should Nurse C. best respond to this colleague's incompetent practice?
Report the nurse's practice and have the nurse manager address the matter.
The nurse has contacted the physician regarding a client who is experiencing shortness of breath, tachycardia, and hypotension. The nurse conveys information using SBAR. Which standard for establishing and sustaining healthy work environments does this action represent?
Skilled communication
The American Nurses Association defines components of quality care: structure evaluation, process evaluation, and outcome evaluation. Which of the following best defines structure evaluation?
Standards that describe physical facilities and equipment; organizational characteristics, policies, and procedures; fiscal resources; and personnel resources.
When a charge nurse evaluates the need for additional staff nurses and additional monitoring equipment to meet the client's needs, the charge nurse is performing an evaluation termed
Structure evaluation
Which client outcome is an example of a cognitive outcome?
The client identifies three strategies for minimizing leakage of an ileostomy bag.
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 large university hospital has commissioned a multidisciplinary group to review patient records following discharge in order to evaluate patient outcomes and the character and quality of nursing care that patients receive. This evaluative program is:
a nursing audit.
The focus of a hospital's current quality assurance program is a comparison between the health status of patients on admission and at the time of discharge. This form of quality assurance is characteristic of:
outcome evaluation.
Which activity does the nurse perform during the evaluating stage? Select all that apply.
• Collects data to determine the number of catheter-associated infections on the nursing unit. • Increases the frequency of repositioning from every 2 hours to every 1 hour.
Which client outcome is a psychomotor outcome? Select all that apply.
• The client measures capillary blood sugar level. • The client catheterizes self, using clean technique.