Chapter 18: Evaluating

The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted? Quality improvement Peer review Magnet status Quality assurance

Quality assurance

A nurse is following the rules recommended by the Institute of Medicine's Committee on Quality of Health Care in America to help redesign and improve client care. Which nursing actions are based on these rules? Select all that apply. The nurse acknowledges that continuous decrease in waste improves client care. The nurse customizes care based on client needs and values. The nurse customizes care based on availability of resources. The nurse promotes shared knowledge and the free flow of information. The nurse becomes the source of control for client care. The nurse bases care on evidence-based decision making.

The nurse acknowledges that continuous decrease in waste improves client care. The nurse bases care on evidence-based decision making. The nurse promotes shared knowledge and the free flow of information. The nurse customizes care based on client needs and values.

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? Cost-effectiveness Structure Process Outcome

Outcome

"The client will verbalize appropriate cast care on discharge" represents which type of outcome? Psychomotor Physical change Cognitive Affective

cognitive

The nursing staff on a hospital unit uses peer review to improve professional performance. Who performs the review? Visitors Unit manager Nurses Clients

nurses E: Peer review is the evaluation of one staff member by another staff member on the same level of the hierarchy of the organization

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: nursing audit. process evaluation. structure evaluation. outcome evaluation.

outcome evaluation

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

psychomotor

"The levels of performance accepted by and expected of nursing staff or other health team members" defines: standards. evaluation. criteria. evidence-based practice.

standards

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" "Inadequate skills" "Extremely well-mannered" "Demonstrated steps"

"Demonstrated steps"

Which action is appropriate when evaluating a client's responses to a plan of care? Reinforce the plan of care when each expected outcome is achieved. Continue the plan of care if more time is needed to achieve the goals/outcomes. Terminate the plan of care upon client discharge. Terminate the plan if there are difficulties achieving the goals/outcomes.

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

Which action should the nurse perform in the evaluation phase? Set priorities for care. Revise the plan of care. Record interventions. Carry out treatment procedures.

Revise the plan of care.

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

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.

Which nursing action reflects evaluation? The nurse assesses the client's response to pain medication. The nurse identifies that the client has wound drainage. The nurse performs colostomy irrigation. The nurse sets an anxiety level of 3 or less with the client.

The nurse assesses the client's response to pain medication.

Why are quality-assurance programs important in nursing? They specify how resources are used or not used. They enable nursing to be accountable for the quality of care. They facilitate increased enrollment in educational programs. They allow increased retention of qualified nurses.

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 psychomotor outcome. a cognitive outcome. an affective outcome. a physiologic outcome.

a cognitive outcome E:Cognitive outcomes demonstrate increases in client knowledge, such as strategies for minimizing leakage of an ileostomy bag.

A new mother is having difficulty breastfeeding a newborn. A goal was established stating that the infant 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 4 days ago. The nurse evaluates the original goal as: partially met. met. completely unmet. inappropriately chosen for this client.

completely unmet

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? Assessing the change Planning a strategy using indicators Discovering a problem Implementing a change

discovering a problem

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? Maintenance Psychomotor Surveillance Educational

surveillance

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 Psychomotor Cognitive Affective

physical changes

Which statement related to the evaluation of outcome attainment for a client is correct? The nurse should initially evaluate the plan of care at the time of the client's discharge. Celebrating outcome achievement with a client often interferes with attainment of future goals. Evaluation of the client's attainment of outcome goals is determined by the nurse and health care provider. Collecting data related to outcome attainment requires the nurse to know when to collect the data, based upon established time criteria.

Collecting data related to outcome attainment requires the nurse to know when to collect the data, based upon established time criteria. E:It is important for the nurse to evaluate client outcome achievement as early as possible and not wait until discharge

The nurse works as a client advocate for an older adult client admitted with hyponatremia. Which action can the nurse take to help the client advocate for oneself? Encourage the client to ask questions. Incorporate therapeutic use of self. Coordinate client activities. Help the client with skin care.

Encourage the client to ask questions.

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? Time and resources Feedback from the family The client's condition Finances of the client

Finances of the client The nursing code of ethics states that clients should receive the same treatment regardless of their ability to pay

An older adult client who is recovering from a stroke is scheduled to be transferred to the rehabilitation unit in the morning. The client is tearful and reports feeling lonely and abandoned in the hospital unit. The family visits daily, and flowers and cards are in the room. Documentation in the chart indicates that the client's pastor has been by twice in the past week to visit. Which nursing diagnosis and outcome criteria need to be addressed immediately for this client? Ineffective Coping; verbalizes support systems. Altered Mobility; able to tie shoes. Dysfunctional Family Processes; family contact daily. Impaired Walking; unilateral neglect.

Ineffective Coping; verbalizes support systems.

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. The client has maintained blood glucose levels within acceptable range in the days prior to discharge. The client expresses a desire to change the way that the client eats and exercises. The client can demonstrate the correct technique for using a new glucometer.

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

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 On 3/2 On 3/3 At the client's direction

at the completion of each meal E: 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

Which are purposes of the evaluation phase of the nursing process? Select all that apply. To ensure that the plan of care was followed as it was originally prepared To appraise the extent to which client goals were attained To determine the involvement and collaboration of the client, family members, nurses, and health care team members in health care decisions To collect subjective and objective data to make judgments about nursing care delivered To determine the client's responses to nursing interventions

-To appraise the extent to which client goals were attained -To determine the client's responses to nursing interventions -To determine the involvement and collaboration of the client, family members, nurses, and health care team members in health care decisions -To collect subjective and objective data to make judgments about nursing care delivered

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 Another nurse manager One of the staff critical care health care provider Another staff nurse from the medical-surgical unit

Another registered nurse with critical care certification E: Peer review is the evaluation of one staff member by another staff member on the same level in the hierarchy of the organization

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 perception Quality as initiative Quality as opportunity Quality by inspection

Quality by inspection 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.

Which nurse is using criteria to determine expected standards of performance? The nurse preceptor provides feedback to the new graduate nurse after 6 weeks of orientation. The nurse manager provides the staff nurse feedback regarding job performance for the previous year. The nurse seeks information from the unlicensed assistive personnel (UAP) regarding the family's response to the nurse's education. The new graduate nurse consults the policies and procedures of the institution prior to skill implementation.

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

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. The nurse interviews the client while the client is receiving the care. The nurse reviews the client chart while the client is being cared for. The nurse directly observes the nursing care being provided.

The nurse devises a postdischarge questionnaire to evaluate client satisfaction.

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

Document reassessment of pain after medication administration.

A mother brings an infant into the clinic for a well-infant 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 infant is gaining weight appropriately. Which is an appropriate evaluative statement for this client? "Goal met" "8FEB2016. Goal met." "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." "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."

"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." The evaluative statement should include the time frame/date, a judgment as to whether the goal was met, and data to support the decision.

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. Provide additional relief with non-pharmacologic measures. Create a new nursing diagnosis to reflect new goals. Request a stronger analgesic from the provider.

Evaluate the use of current pain relief measures.

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 Quality and Safety Education for Nurses (QSEN) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) American Association of Critical-Care Nurses (AACN)

Peer review E: 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 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? Promptly modify the plan of care. Continue the plan of care. Terminate the plan of care. Suggest increasing the pain medication.

continue the plan of care E: The nurse should continue the plan of care, as the client is progressing toward the ultimate outcome—

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? Cognitive Physical changes Affective Psychomotor

physical changes