Chapter 16: Outcome Identification and Planning

A male client is scheduled to be fitted with a prosthesis following the loss of his nondominant hand in a farm accident several weeks earlier. Nurses have documented the following outcome during this stage of his care: "After attending an educational session, client will demonstrate correct technique for applying his prosthesis." Which of this client's following statements would signal a need to amend this outcome? A) "I'm not interested one bit in wearing an artificial hand." B) "I'm worried that I'm going to get some really strange looks when I wear this thing." C) "I don't have a clue how this thing goes on and comes off." D) "I don't understand the technology that's used in this artificial hand."

A) "I'm not interested one bit in wearing an artificial hand." It is imperative that interventions and outcomes be valued by the client. The client's resistance to using a prosthesis likely invalidates the outcome that addresses his technique for its use. The other statements express cognitive and affective learning needs that would need to be addressed, but none of those precludes his eventual mastery of the prosthesis.

A nurse is assigned to care for a client diagnosed with asthma who has just been admitted to the health care facility. The nurse determines the client's priorities for care using which of the following? A) Assessment skills B) Nursing books C) Client's records D) Supervisor's advice

A) Assessment skills The nurse should use assessment skills to determine the priority of nursing care for the client. Books on nursing can give only the theoretical aspect of nursing care. Client's records reveal information about the client's condition but do not convey the client's needs. Advice from supervisors can be taken if confronted with a problem.

The nurse develops long-term and short-term outcomes for a client admitted with asthma. Which of the following is an example of a long-term goal? A)Client returns home verbalizing an understanding of contributing factors, medications, and signs and symptoms of an asthma attack. B) By day 3 of hospitalization, the client verbalizes knowledge of factors that exacerbate the symptoms of asthma. C) Within one hour of a nebulizer treatment, adventitious breath sounds and cough are decreased. D) Within 72 hours of admission, the client's respiratory rate returns to normal and retractions disappear.

A) Client returns home verbalizing an understanding of contributing factors, medications, and signs and symptoms of an asthma attack. An example of a long-term outcome is "Patient returns home verbalizing an understanding of contributing factors, medications, and signs and symptoms of an asthma attack." The other three examples are short-term outcomes that focus on short-term goals related to the period of time during hospitalization.

What common problem is related to outcome identification and planning? A) Failing to involve the client in the planning process B) Collecting sufficient data to establish a database C) Stating specific and measurable outcomes based on nursing diagnoses D) Writing nursing orders that are clear and resolve the problem

A) Failing to involve the client in the planning process One of the most important considerations in outcome achievement is to encourage the client and family to be as involved in goal development as their abilities and interest permit. The more involved they are, the greater the probability that the outcomes will be achieved.

The nursing diagnosis Impaired Gas Exchange, prioritized by Maslow's hierarchy of basic human needs, is appropriate for what level of needs? A) Physiologic B) Safety C) Love and belonging D) Self-actualization

A) Physiologic Because basic human needs must be met before a person can focus on higher-level needs, client needs may be prioritized according to Maslow's hierarchy. Physiologic needs, including the need for oxygen, are the most basic and have the highest priority.

The nurse is planning the care of a male client who is receiving treatment for acute renal failure and who has begun dialysis three times weekly. The nurse has identified the following outcome: "Client will demonstrate the appropriate care of his arteriovenous fistula." This outcome is classified as which of the following? A) Psychomotor B) Affective C) Cognitive D) Holistic

A) Psychomotor Psychomotor outcomes describe the client's achievement of new skills, such as the safe and aseptic care of a new fistula. Cognitive outcomes are focused on knowledge and effective outcomes address values, beliefs, and attitudes. Outcomes are not classified as holistic.

The nurse is caring for a client who has been newly diagnosed with diabetes. One of the outcomes the nurse read on the client's plan of care this morning was: "Client will demonstrate correct technique for self-injecting insulin." The client required insulin prior to his lunch and successfully drew up and administered his insulin while the nurse observed. How should the nurse follow up this observation? A) Record an evaluative statement in the client's plan of care. B) Remove the outcome from the client's care plan. C) Ask the nurse who wrote the plan of care to document this development. D) Reassess the client's psychomotor skills at dinner time.

A) Record an evaluative statement in the client's plan of care. The client has successfully met this outcome, and the nurse should note the time and date that it was achieved in the client's plan of care. The outcome should not be removed from the plan of care and it is unnecessary to have the original author of the plan update it. Further observation may or may not be necessary at dinner time, but an evaluative statement should nonetheless be recorded at the present time.

Increasingly, health care institutions are implementing computerized plans of nursing care. A benefit of using computerized plans includes which of the following? A) Reduction in the time spent on care planning B) Increased autonomy related to the nursing care planning process C) Enhanced individualization of a care plan D) Increased nursing expertise in care planning

A) Reduction in the time spent on care planning The benefits of using computerized plans include ready access to a large knowledge base; improved record keeping, with resultant improvement in audits and quality assurance; documentation by all members of the health care team; and reduced time spent on paperwork. Research cautions that computerized systems for client care planning contribute to loss of autonomy, loss of individualization of care, and loss of nursing expertise.

Which intervention does the nurse recognize as a collaborative intervention? A) Teach the client how to walk with a three-point crutch gait. B) Administer spironolactone (Aldactone). C) Perform tracheostomy care every eight hours. D) Straight catheterize every six hours.

A) Teach the client how to walk with a three-point crutch gait. Collaborative interventions are treatments initiated by other providers, such as pharmacists, respiratory therapists, physical therapists, and other members of the health care team. Teaching the client how to walk with crutches would be a collaborative intervention. Administering medications, performing tracheostomy care, and catheterizing a client require a physician's order and are physician-initiated interventions.

Nurses make common errors in the identification and development of outcomes. Which of the following is a common error made when writing client outcomes? A) The nurse expresses the client outcome as a nursing intervention. B) The nurse develops measurable outcomes using verbs that are observable. C) The nurse develops a target time when the client is expected to achieve that outcome. D) The outcome should include a subject, verb, conditions, performance criteria, and target time.

A) The nurse expresses the client outcome as a nursing intervention. A common error made when writing client outcomes includes the nurse expressing the client outcome as a nursing intervention. The other mentioned criteria for writing client outcomes are correct.

Which of the following statements accurately describes the impact on nursing of using NIC/NOC standardized languages? Select all that apply. A) They demonstrate the impact that nurses have on the system of health care delivery. B) They standardize and define the knowledge base for nursing curricula and practice. C) They limit the number of appropriate nursing interventions to be selected. D) They hinder the teaching of clinical decision making to novice nurses. E) They enable researchers to examine the effectiveness and cost of nursing care.

A, B, E Using NIC/NOC standardized language demonstrates the impact that nurses have on the system of health care delivery; standardizes and defines the knowledge base for nursing curricula and practice; facilitates the selection of appropriate nursing interventions; facilitates the teaching of clinical decision making to novice nurses; enables researchers to examine the effectiveness and cost of nursing care; assists educators to develop curricula that better articulate with clinical practice; assists administrators in planning more effectively for staff and equipment needs; promotes the development and use of nursing information systems; and communicates the nature of nursing to the public.

In which of the following clients has the order of priorities for nursing diagnoses changed? Select all that apply. A) A client in a long-term care facility who had a stroke B) A client who is recovering from a broken leg C) A client who insists on using the bathroom instead of a bedpan D) A client who appears confused after taking pain medication E) A pregnant client whose contractions are progressing as anticipated

A, C, D The work of setting priorities demands careful critical thinking. When planning nursing care, the nurse should consider the following: Have changes in the client's health status influenced the priority of nursing diagnoses? Have changes in the way the client is responding to health and illness (or the plan of care) affected those nursing diagnoses that can be realistically addressed? Are there relationships among diagnoses that require that one be worked on before another can be resolved? Do several client problems need to be dealt with together.

Which of the following is a correctly written client goal? Select all that apply. A) The client will identify five low-sodium foods by October 9. B) The client will know the signs and symptoms of infection. C) The client will rate pain as a 3 or less on a 10-point scale by 5 pm today. D) The client will understand the side effects of digoxin (Lanoxin). E) The client will eat at least 75% of all meals by May 5.

A, C, E. Outcomes are client-centered, use action verbs, identify measurable criteria, and include a time frame as to when the outcome should be achieved. A correctly written outcome will identify who (the client) will do what (eat), how well (75%) under what circumstances (not always included), and by when (May 5). Understand and know are vague and are not action-oriented.

Critical thinking is an essential component in all phases of the nursing process. What question might be used to facilitate critical thinking during outcome identification and planning? A) "How do I best cluster these data and cues to identify problems?" B) "What problems require my immediate attention or that of the team?" C) "What major defining characteristics are present for a nursing diagnosis?" D) "How do I document care accurately and legally?"

B) "What problems require my immediate attention or that of the team?" Questions to facilitate critical thinking during outcome identification and planning include those related to setting priorities, such as "Which problems require my immediate attention or that of the team?" and "Which problems are most important to the client?"

Which of the following is not appropriate in writing client-centered measurable outcomes? A) The client or a part of the client B) A flexible time frame C) Observable, measurable terms D) The action the client will perform

B) A flexible time frame In writing client-centered measurable outcomes, a target time is required. This target time specifies when the client is expected to be able to achieve the outcome. The other options given (the client or part of the client; observable and measurable terms; the action the patient will perform) are all part of client-centered measurable outcomes.

The nursing student asks the nurse about nurse-initiated and physician-initiated interventions. Which of the following is a physician-initiated intervention? A) Teach client how to transfer from bed to chair and chair to bed. B) Administer oxygen 4 L/min per nasal cannula. C) Assist the client with coughing and deep breathing every hour. D) Monitor intake and output every 2 hours.

B) Administer oxygen 4 L/min per nasal cannula. A physician-initiated intervention is an intervention initiated by a physician in response to a medical diagnosis but carried out by a nurse in response to a physician's order. A physician's order is required for the nurse to administer drugs, such as oxygen. A nurse-initiated intervention is an autonomous action based on scientific rationale that a nurse executes to benefit the client in a predictable way related to the nursing diagnosis and expected outcomes. Nursing- initiated interventions, such as teaching client how to transfer, assisting with coughing and deep breathing, and monitoring intake and output do not require a physician's order.

A nurse is discharging a client from the hospital. When should discharge planning be initiated? A) At the time of discharge from an acute health care setting B) At the time of admission to an acute health care setting C) Before admission to an acute health care setting D) When the client is at home after acute care

B) At the time of admission to an acute health care setting Discharge planning is best carried out by the nurse who worked most closely with the client and family. In acute care settings, comprehensive discharge planning begins when the client is admitted for treatment.

Which of the following groups of terms best describes a nurse-initiated intervention? A) Dependent, physician-ordered, recovery B) Autonomous, clinical judgment, client outcomes C) Medical diagnosis, medication administration D) Other health care providers, skill acquisition

B) Autonomous, clinical judgment, client outcomes A nursing intervention is any treatment, based on clinical judgment and knowledge, that a nurse performs to enhance client outcomes. Nurse-initiated interventions are autonomous (independently performed).

A nurse has developed a plan of care with nursing interventions designed to meet specific client outcomes. The outcomes are not met by the time specified in the plan. What should the nurse do now in terms of evaluation? A) Continue to follow the written plan of care. B) Make recommendations for revising the plan of care. C) Ask another health care professional to design a plan of care. D) State "goal will be met at a later date."

B) Make recommendations for revising the plan of care. Client outcomes are meaningless unless the nurse evaluates the client's progress toward their achievement. If the plan is not achieved (not met), recommendations for revising the plan of care are included in the evaluative statement.

Which of the following is an example of a well-stated nursing intervention? A) Client will drink 100 mL of water every 2 hours while awake. B) Offer client 100 mL of water every 2 hours while awake. C) Offer client water when he complains of thirst. D) Client will continue to increase oral intake when awake.

B) Offer client 100 mL of water every 2 hours while awake. Nursing interventions describe in writing the specific nursing care to be implemented for the client. They include information that answers the questions who, what, where, when, and how.

A client is scheduled for surgery for an abdominal hysterectomy. During the preoperative assessment, the client states, "I am very nervous and scared to have surgery." What client outcome is the priority? A) Evaluate the need for antibiotics. B) Resolve the client's anxiety. C) Provide preoperative education. D) Prepare the client for surgery.

B) Resolve the client's anxiety. A priority is something that takes precedence in position, deemed the most important among several items. The client's preparation for surgery is important, but to have a successful outcome, the nurse must address the psychosocial issues related to anxiety.

While developing the plan of care for a new client on the unit the nurse must identify expected outcomes that are appropriate for the new client. What is a resource for identifying these appropriate outcomes? A) Community Specific Outcomes Classification (CSO) B) The Nursing-Sensitive Outcomes Classification (NOC) C) State Specific Nursing Outcomes Classification (SSNOC) D) Department of Health and Human Resources Outcomes Classification (HHROC)

B) The Nursing-Sensitive Outcomes Classification (NOC) Resources for identifying appropriate expected outcomes include the Nursing-Sensitive Outcomes Classification (NOC) (Chart 3-6) and standard outcome criteria established by health care agencies for people with specific health problems. The other options are incorrect because they do not exist.

A resident of a long-term care facility refuses to eat until she has had her hair combed and her make-up applied. In this case, what client need should have priority? A) The need to have nutrition B) The need to feel good about oneself C) The need to live in a safe environment D) The need for love from others

B) The need to feel good about oneself When setting priorities, it is best to first meet the needs that the client believes are most important. In this situation, the woman is not refusing food altogether; rather, she wants to feel good about herself (self-esteem) when she does eat.

A nurse is developing outcomes for a specific problem statement. What is one of the most important considerations the nurse should have? A) The written outcomes are designed to meet nursing goals B) To encourage the client and family to be involved C) To discourage additions by other healthcare providers D) Why the nurse believes the outcome is important

B) To encourage the client and family to be involved One of the most important considerations in writing outcomes is to encourage the client and family to be involved in goal development as their abilities and interest permit. The more involved they are, the greater the probability the goals will be achieved.

Nurses identifying outcomes and related nursing interventions must refer to the standards and agency policies for setting priorities, identifying and recording expected client outcomes, selecting evidence-based nursing interventions, and recording the plan of care. Which of the following are recognized standards? Select all that apply. A) Professional physicians' organizations B) State Nurse Practice Acts C) The Joint Commission D) The Agency for Health Care Research and Quality E) The Patient Health Partnership

B, C, D To plan health care correctly, the nurse must be familiar with standards and agency policies for setting priorities, identifying and recording expected client outcomes, selecting evidence based nursing interventions, and recording the plan of care. These standards include the law, national practice standards, specialty professional nursing organizations, The Joint Commission, the Agency for Health Care Research and Quality, and employers.

Which of the following illustrates a common error when writing client outcomes? A) Client will drink 100 mL of fluid every 2 hours from 6 a.m. to 9 p.m. B) Client will demonstrate correct sequence of exercises by next office visit. C) Client will be less anxious and fearful before and after surgery. D) On discharge, client will list five symptoms of infection to report.

C) Client will be less anxious and fearful before and after surgery. Common errors when writing client outcomes include expressing the outcome as a nursing intervention, using verbs that are not observable and measurable (as is done here), and writing vague outcomes (also done here).

What name is given to tools that are used to communicate a standardized interdisciplinary plan of care for clients within a case management health care delivery system? A) Kardex care plans B) Computerized plans of care C) Clinical pathways D) Student care plans

C) Clinical pathways Clinical pathways (critical pathways, CareMaps) are tools used to communicate the standardized interdisciplinary plan of care for clients. The emphasis in case management is on clearly stating expected client outcomes and the specific times targeted to achieve these outcomes.

What part of the nursing diagnosis statement suggests the nursing interventions to be included in the plan of care? A) Problem statement B) Defining characteristics C) Etiology of the problem D) Outcomes criteria

C) Etiology of the problem In contrast to the client goals, which are suggested by the problem statement of the diagnosis, it is the cause of the problem (etiology) that suggests the nursing interventions. Effective nurses select nursing interventions that specifically address factors that cause, or contribute to, the client's problem.

The nurse formulates the following client outcome: Client will correctly draw up morning dose of insulin and identify four signs and symptoms of hypoglycemia by September 7. Which error has the nurse made? A) Expressed the client outcomes as a nursing intervention B) Wrote vague outcomes that will confuse other nurses C) Included more than one client behavior in the outcome D) Used verbs that are not observable and measurable

C) Included more than one client behavior in the outcome Two client behaviors have been included in the outcome statement: drawing up insulin and identifying four signs and symptoms.

Which of the following outcomes is correctly written? A) Abdominal incision will show no signs of infection. B) On discharge, client will be free of infection. C) On discharge, client will be able to list five symptoms of infection. D) During home care, nurse will not observe symptoms of infection.

C) On discharge, client will be able to list five symptoms of infection. To be measurable, outcomes should have a subject (client or part of the client), verb (action to be performed), conditions (not always included), performance criteria (observable, measurable), and target time (to achieve the outcome).

Which of the following is a correctly written client goal? A) The client will eliminate a soft formed stool. B) The client understands what foods are low in sodium. C) The client will ambulate 10 feet with a walker by October 12. D) The client correctly self-administers the morning dose of insulin.

C) The client will ambulate 10 feet with a walker by October 12. Outcomes are client-centered, use action verbs, identify measureable criteria, and include a time frame as to when the outcome should be achieved. A correctly written outcome will identify who (the client) will do what (ambulate), how well (10 feet), under what circumstances (with a walker), and by when (October 12). Understand is vague and not action-oriented. The outcomes regarding eliminating a stool and self-administering insulin are missing the time frame.

During outcome identification and planning, from what part of the nursing diagnoses are outcomes derived? A) The defining characteristics B) The related factors C) The problem statement D) The database

C) The problem statement Outcomes are derived from the problem statement of the nursing diagnosis. For each nursing diagnosis, at least one outcome should be written that, if achieved, demonstrates a direct resolution of the problem statement.

Which of the following types of care plans is most likely to enable the nurse to take a holistic view of the client's situation? A) Kardex B) Case management C) Critical pathways D) Concept map care plan

D) Concept map care plan A concept map care plan is a diagram of client problems and interventions. The nurse's ideas about client problems and treatments are the "concepts" that are diagrammed. These maps are used to organize client data, analyze relationships in the data, and enable the nurse to take a holistic view of the client's situation (Schuster, 2002).

Which of the following client outcomes best describes the parameters for achieving the outcome? A) The client will eat a well-balanced diet. B) The client will consume a 2,400-calorie diet, with three meals and two snacks, starting tomorrow. C) The client will cleanse his wound with soap and water and apply a dry sterile dressing. D) The client will be without pain in 24 hours.

D) The client will be without pain in 24 hours. The client will consume a 2,400-calorie diet, with three meals and two snacks, starting tomorrow possesses all parameters for achieving the outcome.

What is the primary purpose of the outcome identification and planning step of the nursing process? A) To collect and analyze data to establish a database B) To interpret and analyze data so as to identify health problems C) To write appropriate client-centered nursing diagnoses D) To design a plan of care for and with the client

D) To design a plan of care for and with the client The primary purpose of outcome identification and planning is to design a plan of care for (and with) the client that, once implemented, results in the prevention, reduction, or resolution of client health problems and the attainment of the client's health expectations, as identified in the client outcomes.