FN - Unit 2 - Chapter 19: Evaluating

A nurse has been providing discharge teaching to a client with type 1 diabetes. Which outcome indicates that the teaching has been effective? Before discharge, the client will attempt to administer a subcutaneous injection. By a certain date, the client will talk to a dietitian regarding information for a diabetic diet. Before discharge, the client will understand proper foot care and eye care. By a certain date, the client will verbalize signs and symptoms of hypoglycemia.

By a certain date, the client will verbalize signs and symptoms of hypoglycemia. Teaching has been effective when the client verbalizes signs and symptoms of hypoglycemia, indicating that the client knows the information. Attempting to administer an injection is not an outcome that is effective. If the client was actually able to demonstrate an injection by oneself, then this outcome would be effective. Talking to a dietitian and understanding care do not demonstrate to the nurse that the teaching has been effective, but rather represent passive learning without a measurable outcome.

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. 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. 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 are components of an evaluative statement? Select all that apply. Description of how the client outcome was met Client's health history Name of the client's health care provider Client data that support how the outcome was met Client's health insurance information

Description of how the client outcome was met Client data that support how the outcome was met An evaluative statement includes a description of how the client's outcome was met and the data that support that decision. The name of the health care provider, information on the client's health insurance, and the client's health history would only be included if they contributed to the client's outcome.

A nurse is evaluating the plan of care for a client in the clinic. Which actions should the nurse perform, as classic elements of evaluation? Select all that apply. Identifying evaluative criteria and standards Documenting only the facts related to the plan of care Collecting data to determine whether criteria and standards are being met Interpreting and summarizing findings Terminating, continuing, or modifying the plan of care

Identifying evaluative criteria and standards Collecting data to determine whether criteria and standards are being met Interpreting and summarizing findings Terminating, continuing, or modifying the plan of care The nurse must document findings as they relate to the plan of care but should also include the nurse's judgement as to whether the outcomes are being met. All of the other choices are criteria for evaluation.

For the second time this week, a nurse reports to the nurse manager failing to perform an ordered dressing change due to a lack of time. The nurse manager recognizes that the nurse normally is very punctual and known to provide good care for clients and that the unit census has been very high this week. However, the nurse manager knows that quality care must be provided and reports this occurrence. Which approach to quality assurance does this scenario represent? Quality by inspection Quality as opportunity Quality by design Quality as promotion

Quality as opportunity Quality as opportunity is focused on finding opportunity to improve quality through teamwork and sharing in a nonthreatening environment. Mistakes are seen as a breakdown in the system rather than a lack of motivation or sign of incompetence in the nurse. Quality by inspection focuses on finding deficient workers and removing them. Quality by design and quality as promotion are not specific approaches to quality assurance.

Which statement regarding quality improvement or quality assurance is correct? Quality improvement focuses on organization, structure, and individuals. Quality assurance promotes empowerment and collaboration. Quality improvement focuses on processes, data, and statistical thinking. Quality assurance is concerned with client satisfaction.

Quality improvement focuses on processes, data, and statistical thinking. Quality improvement focuses on processes, data, statistical thinking, and client satisfaction and promotes empowerment and collaboration. Quality assurance focuses on organization structure and individuals and is externally driven.

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

Revise the plan of care. The nurse should revise the plan of care during the evaluation phase. It provides the feedback mechanism that starts the entire chain of events again. Setting priorities is part of the planning phase. Carrying out treatment procedures and recording interventions are activities in the implementation phase of the nursing process.

A nurse assures a client newly admitted to the clinical unit that the client will not be harmed by any errors and can expect to be safe in the facility. This assurance represents which expectation of the health care environment? Transparency Individualization Control Safety

Safety Safety is represented by the expectation that the client won't be harmed by any errors and will be safe in the facility. The other choices represent other expectations of the health care environment. Transparency is the expectation that information on all aspects of a client's health and care will be provided and explained to the client and that nothing will be kept from the client. Individualization is the expectation that a client's care will be individualized or customized to meet that client's unique needs. Control is the expectation that the client will retain autonomy and the right to self-determination while receiving care.

A hospital is evaluating its policies and procedures. What type of evaluation is the hospital conducting? Outcome Process Quality Structure

Structure A structure evaluation or audit focuses on the environment in which care is provided. Standards describe physical facilities and equipment, organizational characteristics, policies and procedures, fiscal resources, and personnel resources. Process/implementation evaluation determines whether program activities have been implemented as intended. Outcome/effectiveness evaluation measures program effects in the target population by assessing the progress in the outcomes or outcome objectives that the program is to achieve. Quality evaluation does not exist.

Which parts of the nurse's decision about care occur after evaluating the client's responses to the plan of care? Select all that apply. Terminate the plan of care Modify the plan of care Continue the plan of care Begin the plan of care Communicate the plan of care

Terminate the plan of care Modify the plan of care Continue the plan of care Based on the client's responses to the plan of care, the nurse decides to terminate the plan if expected outcomes are achieved, modify the plan if there are difficulties in achieving the outcomes, or continue the plan if more time is needed to achieve the outcomes. Beginning the plan of care occurs in the implementation phase, and communicating the plan of care occurs in the outcome identification and planning phase.

The client identifies three strategies for minimizing leakage of an ileostomy bag. This is an example of: an affective outcome. a psychomotor outcome. a physiologic outcome. a cognitive outcome.

a cognitive outcome. 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.

"Measurable qualities, attributes, or characteristics that identify knowledge or health status" defines: standards. criteria. evaluations. evidence-based practice.

criteria. 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. Evaluation involves measuring how well the client has achieved the outcomes that were set forth in the plan of care.

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

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.

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 when the client is discharged during the first home health care visit once the primary care health care provider has written a discharge order

throughout the client's hospital admission 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."

A mother is bringing an infant into the clinic for a well-infant checkup. The infant's weight gain is on target for age. A correctly written evaluative statement for this client is: "Goal met" "8FEB2016. Goal met." "Progressing well." "8FEB2016. Goal met. The infant's weight gain is appropriate for age."

"8FEB2016. Goal met. The infant's weight gain is appropriate for age." An appropriately written evaluative statement should be dated, clearly state the judgement as to whether the outcome was met, and provide data to support the judgment.

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

"Demonstrated steps" 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.

A large university hospital has commissioned a multidisciplinary group to review client records following discharge to evaluate client outcomes and the character and quality of nursing care that clients receive. Which type of evaluation process will take place? A nursing audit An accreditation inspection A structure evaluation A process evaluation

A nursing audit A nursing audit is a method of evaluating nursing care that involves reviewing client records to assess the outcomes of nursing care, or the process by which these outcomes were achieved. Structure evaluation addresses the environment in which care is provided. A process evaluation addresses performance expectations during the various stages of the nursing process. A nursing audit may be performed during an accreditation inspection, but this is not the only time that it takes place.

The client outcome, "The mother will express confidence in being able to meet nutritional needs of the infant," is an example of which type of outcome statement? Psychomotor Cognitive Affective Physical

Affective Affective outcomes are related to feelings and attitudes. This client's outcome statement addresses confidence, which is a subjective feeling of efficacy. Psychomotor outcomes are those that are related to new skill attainment and execution of those skills. Cognitive outcomes are those related to achieving greater knowledge and information, not different feelings or perceptions. Physical changes are related to actual body changes in the infant.

A client reports to the nurse quitting smoking 6 months ago after being diagnosed with lung cancer. The nurse recognizes this change in behavior is which type of outcome? Affective Cognitive Psychomotor Physiologic

Affective Affective outcomes pertain to changes in client values, beliefs, and attitudes and are more complex to evaluate. Changes in behaviors, such as the cessation of smoking or nutritional changes that lead to weight loss, are examples of affective outcomes. Cognitive outcomes involve an increase in client knowledge and are evaluated by asking the client to repeat information. Psychomotor outcomes describe the client's achievement of a new skill and are evaluated by having the client perform the skill. Physiologic outcomes result in physical changes and are evaluated through physical assessment.

A nurse is documenting evaluation of the care provided for an infant born with Down syndrome. Which nursing actions exemplify the appropriate documentation process? Select all that apply. After the data have been collected to determine client outcome achievement, the nurse writes an evaluative statement to summarize the findings. The nurse writes a 2-part evaluative statement that includes a decision about how well the outcome was met, along with client data that support the decision. The nurse has three decision options for how goals have been met. The nurse determines whether a client goal has been met or not met. In each case, the goal is discontinued. The nurse does not increase the complexity of a goal after it has been achieved to prevent client anxiety and distrust. If a nurse writes a properly written goal, it is not affected by client, nurse, or health care variables.

After the data have been collected to determine client outcome achievement, the nurse writes an evaluative statement to summarize the findings. The nurse writes a 2-part evaluative statement that includes a decision about how well the outcome was met, along with client data that support the decision. The nurse has three decision options for how goals have been met. After the data have been collected and interpreted to determine client outcome achievement, the nurse makes and documents a judgment summarizing the findings. The 2-part evaluative statement includes a decision about how well the outcome was met, along with client data or behaviors that support this decision. Outcomes may have been met, partially met, or not met. The goal is not discontinued if not met; it can be modified. The complexity of a goal may be increased in complexity if it will benefit the client. The client, nurse, or other health care variables may affect correctly written goals.

The nurse should evaluate client outcomes at which time? As early as possible The day of discharge Within 24 hours after identifying them Several days after discharge

As early as possible Nurses should evaluate client outcome achievement as early as possible. Celebrating outcome attainment with the client usually helps encourage the client and leads to further outcome achievement. When failure to meet designated outcomes is detected early, the care plan can be modified to remedy the failure. Waiting until the day of discharge may be too late. Evaluating outcomes after the client has been discharged would be difficult. Evaluating outcomes within 24 hours may be too soon or unnecessarily late, depending on the nature of the outcomes.

For a client with a self-care deficit, the long-term goal is that the client will be able to dress oneself by the end of the 6-week therapy. For best results, when should the nurse evaluate the client's progress toward this goal? When the client is discharged At the end of the 6-week therapy Only when the client shows some progress As soon as possible

As soon as possible Evaluating the progress of a long-term goal prior to the end date encourages and motivates the client to continue working toward the goal. Waiting until the client is discharged or at the end of the 6 weeks does not provide the client the opportunity to feel a sense of accomplishment and motivation to continue working toward the goal. Only evaluating when the client shows progress may lead to the client becoming discouraged.

The nurse performs discharge teaching for a client. How would the nurse best evaluate the effectiveness of the discharge teaching? Review it to see if all health care provider prescriptions were covered. Ask the client to repeat back to the nurse how care will be conducted at home. Determine if critical pathways were completed. Ask if the client understands the teaching.

Ask the client to repeat back to the nurse how care will be conducted at home. Evaluation is defined as the judgment of the effectiveness of nursing care to meet client goals based on the client's behavioral responses. This phase involves a thorough, systematic review of the effectiveness of nursing interventions and a determination of client goal achievement. The best way to evaluate the effectiveness of discharge teaching is to have the client repeat back to the nurse how care will be conducted at home. The nurse does not evaluate whether health care provider prescriptions or critical pathways have been completed during discharge teaching. Asking if the client understands the teaching does not allow the nurse to fully evaluate if the teaching was indeed successful.

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 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. Rewrite the plan of care so that the client meets the expected outcomes. Specify time limits in the plan.

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. 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 value health sufficiently to quit smoking. By 18AUG2015, the client will demonstrate improved motion in the left arm. By 18AUG15, the client will list three foods that are low in salt. By 18AUG2015, the client will learn three exercises designed to strengthen leg muscles.

By 18AUG2015, the client will demonstrate improved motion in the left arm. 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 nurse is preparing to evaluate the goals set for a newborn and mother. What physiologic goals will the nurse evaluate for effectiveness? Select all that apply. By 4/6/20, the newborn will demonstrate 2 hours of sleep prior to breastfeeding at night. Before discharge, the parents of the infant will verbalize decreased anxiety about taking care of a newborn. By 4/6/20, the parents will list appropriate resources in case questions arise after discharge. By 4/6/20, the mother will demonstrate a pain rating of 0 on a 0 to 10 scale. Before discharge, the infant with a birth weight of 7 lb, 6 oz (3.3 kg) will have reached a target weight of 8 lb (3.6 kg). Before discharge, the parents will demonstrate confidence in bathing and feeding their infant.

By 4/6/20, the newborn will demonstrate 2 hours of sleep prior to breastfeeding at night. By 4/6/20, the mother will demonstrate a pain rating of 0 on a 0 to 10 scale. Before discharge, the infant with a birth weight of 7 lb, 6 oz (3.3 kg) will have reached a target weight of 8 lb (3.6 kg). Physiologic goals meet the need of normal, healthy body functioning. An infant's sleep-wake patterns, comfort level, and weight are all examples of physiologic goals/outcomes. Decreased anxiety of the parents and demonstration of confidence in bathing their infant are affective outcomes. Listing appropriate resources is a cognitive goal.

A nurse caring for an older adult client who has dementia observes another nurse putting restraints on the client without a health care provider's order. The client is agitated and not cooperating. What would be the best initial action of the first nurse in this situation? Report the nurse applying the restraints to the supervisor. 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 health care provider for an order for the restraints.

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 health care provider should not be contacted for an order unless it is decided that the restraint is going to be left on the client.

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. Terminate the plan if there are difficulties achieving the goals/outcomes. Terminate the plan of care upon client discharge. Continue the plan of care if more time is needed to achieve the goals/outcomes.

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

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? Terminate the plan of care. Continue the plan of care. Promptly modify the plan of care. Suggest increasing the pain medication.

Continue the plan of care. The nurse should continue the plan of care, as the client is progressing toward the ultimate outcome—the healing of the surgical site. There is no need to modify the plan, as the client is responding. The client is still having some pain, so it would not be appropriate to discontinue the plan of care. With the improvement in the client's pain, there is no need to increase pain medication; the nurse should just remind the client to take it when pain is uncomfortable.

A nurse is evaluating a client to determine outcome achievement. The nurse determines that the client's outcome was partially met. When documenting the evaluative statement, the nurse records which other information? Data that support the decision of the outcome being partially met The client's verbal agreement of the outcome not being met The reason the outcome was only partially met The revision to the initial outcome identified

Data that support the decision of the outcome being partially met The two-part evaluative statement includes a decision about how well the outcome was met, along with client data or behaviors that support this decision. Client statements, reasons for not meeting the outcome, and revisions to the outcome statement are not included.

A nurse is reviewing a client's plan of care. What would the nurse determine is a problem related to the assessment phase of the nursing process? Nursing diagnoses are too vague. Database does not reflect changes in the client condition. Plan of care is vague and only contains information that nurses would utilize without a plan of care. There is inefficient use of nursing resources.

Database does not reflect changes in the client condition. Database input is done during the assessment phase of the plan of care. Nursing diagnoses are formed during the diagnosis phase of the nursing process. The plan of care is established during the planning phase of the nursing process. Inefficient use of nursing resources is part of the implementation phase.

The nurse manager on an orthopedic unit has determined that the nurses are not keeping the nursing diagnoses up-to-date on client care plans and, in turn, 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. Request that a staff development nurse instruct the nurses on concept mapping to use instead of care planning. Provide an in-service on interviewing and physical assessment skills; discuss the importance of these skills with the staff. Delegate the updating of nursing diagnoses for all clients on the unit to one nurse for each shift.

Develop a process for periodic review of care plans that focuses on deleting and updating the nursing diagnoses. Upon recognizing that the nursing diagnoses are not up-to-date, an effective approach by the nurse manager is to establish a process for periodic review of the plan of care. This review process will require deletion of nursing diagnoses that have been resolved and, conversely, adding new diagnoses as needed. Implementing concept mapping will not correct the problem of poorly updated nursing diagnoses, as concept mapping requires the identification of nursing diagnoses. Developing interviewing and assessment skills is an important component of the assessment phase of the nursing process. Also, one nurse should not be responsible for updating nursing diagnoses for all client care plans on the unit.

To improve quality care for clients, there are four steps that the nurse recognizes as being crucial for the process. Place them in the correct order. Evaluate a change. Discover a problem. Implement a change. Plan a strategy using indicators.

Discover a problem. Plan a strategy using indicators. Implement a change. Evaluate a change. In order to improve quality performance the nurse should discover a problem, plan a strategy using appropriate indicators, implement a change, and evaluate the change.

A nurse overhears a coworker telling a somewhat offensive joke to a client. Which nursing action is indicated? Report what was overheard to the charge nurse. Discuss the occurrence with the coworker. Apologize to the client for the coworker's behavior. Investigate whether the coworker and client have a previous relationship.

Discuss the occurrence with the coworker. The first step is to confront the coworker. If the behavior continues or the nurse does not seem to understand the gravity of the mistake, it would be appropriate to discuss the situation with the charge nurse. It makes no difference if the client and coworker have a previous relationship or not, given the unprofessional nature of the incident. The client-nurse boundary should be protected. Apologizing to the client may draw attention to the issue.

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. 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 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 Micromanagement Appropriate staffing Meaningful recognition

Effective decision making Effective decision making ensures nurses are active, valued partners in making policy, directing and evaluating clinical care, and leading organizational operations. Appropriate staffing ensures that client needs are effectively matched with nurse competencies. Micromanagement would be demonstrated by the manager not asking for opinions and proceeding with decision making without input. Meaningful recognition highlights the value each nurse brings to the work for the organization, such as certification.

The nurse in a burn intensive care unit (BICU) is caring for a 3-year-old child who was burned with scalding hot water. The client has burns covering 75% of the body. The client's condition is critical but stable. At 1000, the nurse reassesses the client and finds that the client is agitated and pulling at the endotracheal tube. Which is the nurse's priority intervention for this client at this time? Providing medication for agitation Repositioning to prevent pressure injuries Ensuring that the endotracheal tube is secure Changing the dressing to prevent infection

Ensuring that the endotracheal tube is secure The ABCs (airway, breathing, and circulation) are always top priority in client care. In this example, ensuring that the client maintains a patent airway will always be top priority. Each of these nursing tasks is important and will need to be accomplished at some point during client care.

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? Create a new nursing diagnosis to reflect new goals. Evaluate the use of current pain relief measures. Request a stronger analgesic from the provider. Provide additional relief with non-pharmacologic measures.

Evaluate the use of current pain relief measures. Prior to proceeding with any changes in the plan of care, the nurse must first perform evaluation of the client's current pain relief measures. Once this has been performed, it might be appropriate to request a stronger analgesic or reinforce education for nonpharmacologic pain relief measures. Creating a new nursing diagnosis and goals would come after evaluating the current pain relief measures.

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

Finances of the client The client's condition, time and resources, and feedback or input from the family are all of great value when the nurse is prioritizing the client's nursing diagnoses. The client's finances, however, should not influence the nurse's priority setting. 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. Impaired Walking; unilateral neglect. Altered Mobility; able to tie shoes. Dysfunctional Family Processes; family contact daily.

Ineffective Coping; verbalizes support systems. When considering appropriate evaluation criteria, be certain they relate directly to the diagnosis and the diagnosis relates to the assessment data. There are no data to support unilateral neglect. Tying shoes evaluates a client's abilities, not mobility. The nurse assesses that the family visits daily, so the family process is functional. Ineffective coping is appropriately evaluated by identification of coping mechanisms, such as support systems.

Which nursing action would be most effective in helping a client learn self-care behaviors? Check with the client to ensure that personal self-care goals are being met. Model self-care behaviors for the client. Collect data on the number of self-care activities the client has performed that day. Ask client to discuss the client's goals for the day at the start of the shift.

Model self-care behaviors for the client. Modeling self-care behaviors is a nursing intervention and is the action most effective in helping the client learn the self-care behaviors. The other answer options refer to evaluation of the client's response to interventions related to learning self-care behaviors.

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

Nurses Peer review is the evaluation of one staff member by another staff member on the same level of the hierarchy of the organization. Peer review is not done by the unit manager, clients, or visitors.

While evaluating a client's plan of care, the nurse would be most likely to identify which problem as being associated with the implementation phase? Nursing orders are superficial. Outcomes are incorrectly developed. Nurses are not aware of client priorities and the plan of care. A long-term goal is vague and generalized.

Nurses are not aware of client priorities and the plan of care. During implementation of care, nurses should be aware of client priorities and adjust care accordingly. The other options are all rooted in the planning phase.

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? Process Structure Outcome Cost-effectiveness

Outcome Outcome evaluation focuses on measurable changes in the health status of the client or the end results of nursing care, such as an expedited discharge of the client based on the client recovering more quickly due to an intervention. The focus of a process evaluation is the nature and sequence of activities carried out by nurses implementing the nursing process. A structure evaluation or audit focuses on the environment in which care is provided. Cost-effectiveness is not a type of evaluation identified by the American Nurses Association.

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 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.

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 Psychomotor Physical changes Affective

Physical changes Physical changes are related to actual body changes in the individual, represented here by the 10-lb (4.50-kg) weight loss. Psychomotor outcomes are related to new skill attainment. Cognitive outcomes are related to achieving greater knowledge. Affective outcomes are related to feelings and attitudes.

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? Psychomotor Cognitive Affective Physical changes

Physical changes 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 identifies an area where client care has been compromised. What steps should the nurse take to improve performance? Select all that apply. Plan a strategy using indicators. Assess the change. Discover a problem. Ask the client if there is a problem. Implement a change.

Plan a strategy using indicators. Assess the change. Discover a problem. Implement a change. Clients are not always aware of problems on a clinical unit. For example, if blankets are not being supplied to the unit per facility policy the client may not be aware because the nurse went and got one from another unit; however, there is a problem that should be addressed. The other choices are all part of the process to improve performance.

The nurse is assessing the self-care capabilities of a client who will be discharged from the hospital. Which are barriers this client will likely face in meeting established nursing goals pertaining to self-care? Select all that apply. Referrals to specialists Poor communication skills Inadequate emotional coping skills Debilitating illness Family's lack of interest in the plan of care

Poor communication skills Inadequate emotional coping skills Debilitating illness Family's lack of interest in the plan of care Barriers to goal attainment may involve the client, family members or significant others, or the nurse or other health care team members. Factors such as communication, health, motivation, emotions, and coping skills can be powerful barriers to adherence to treatment. Referrals to specialists would facilitate self-care, not be a barrier to it.

The nurse participates in a quality assurance program and reviews evaluation data for the previous month. The data indicates a nursing plan was developed within 8 hours of admission for 97% of all admissions. The nurse recognizes this as which type of evaluation? Design evaluation Outcome evaluation Structure evaluation Process evaluation

Process evaluation Quality assurance programs focus on three types of evaluation: structure, process, and outcome. Process evaluation focuses on the nature and sequence of activities carried out by nurses implementing the nursing process, such as the timing of nursing care plan creation. Outcome evaluation focuses on measurable changes in the health status of clients. Structure evaluation focuses on the environment in which care is provided. There is no "design evaluation."

A nurse is evaluating the outcome of the plan of care after teaching a client how to prepare and administer an insulin pen. Which type of outcome is the nurse addressing? Cognitive Psychomotor Affective Physiologic

Psychomotor Preparing and administering an insulin pen is a psychomotor outcome. Psychomotor outcomes describes the client's achievement of new skills. Cognitive outcomes describe increase in client knowledge or intellectual behaviors. Affective outcomes describe changes in client values, beliefs, and attitudes. Physiologic outcomes are concerned with how the human body works.

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

Psychomotor Psychomotor outcomes are those that are related to new skill attainment, such as learning aseptic dressing changes. Cognitive outcomes are related to achieving greater knowledge. Affective outcomes are related to feelings and attitudes. Physical changes are related to actual body changes in the individual.

"The client will demonstrate cast care prior to discharge" is which type of evaluative statement? Psychomotor Cognitive Affective Physical changes

Psychomotor This is an example of a psychomotor evaluative statement. 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. Physical changes are related to actual body changes in the individual.

Which are major premises of a quality-improvement (QI) program? Select all that apply. QI determines whether nursing standards are being upheld. QI programs may be mandated by some governmental agencies. QI focuses on processes rather than individuals. QI should ideally be performed 1 or 2 times per year. QI's focus is on ensuring excellence in care.

QI determines whether nursing standards are being upheld. QI programs may be mandated by some governmental agencies. QI focuses on processes rather than individuals. QI's focus is on ensuring excellence in care. The major premises of QI include a focus on processes and standards that lead to quality care. Numerous governmental agencies either encourage or require QI. It is an ongoing process that is not necessarily an annual or biannual event.

The nurse determines that the client is not meeting some of the expected outcomes in the plan of care. What are the next steps in the process? Select all that apply. Reevaluate each step of the nursing process. Identify contributing factors. Collect additional data. Delete all of the expected outcomes and write new ones. Add or alter nursing diagnoses.

Reevaluate each step of the nursing process. Identify contributing factors. Collect additional data. Add or alter nursing diagnoses. There would not be a need to delete all of the expected outcomes. The ones that the client is not making progress toward meeting may need to be altered, but it would not be necessary to delete them all. The other choices would be appropriate in modifying the plan of care.

Which action should the nurse take when client data indicate that the stated goals have not been achieved? Collect more data for the database. Review each preceding step of the nursing process. Implement a standardized plan of care. Change the nursing orders.

Review each preceding step of the nursing process. If a client's goal has not been achieved the nurse should review each of the preceding steps of the nursing process in order to try to identify the contributing factors causing problems with the plan of care. By conducting the evaluation this way, the nurse may find that more data must be collected or the plan of care needs revision. An individualized plan of care rather than a standardized plan of care is often warranted.

Which are areas of focus in quality improvement? Select all that apply. Systems Processes Nurses Data use Individuals

Systems Processes Data use According to the U.S. Department of Health and Human Services, Health Resources and Services Administration, quality improvement focuses on four key principles: systems and processes; clients; being part of a team; and use of the data. Nurses and individuals are not areas of focus in quality improvement.

A client who was admitted to the acute care unit with angina pectoris is no longer having chest pain. Based on this assessment, what does the nurse decide to do with the plan of care for chest pain? Establish a new plan of care. Keep the diagnosis of chest pain since it could occur again to prevent rewriting it. Continue the current plan of care since it is already complete. Terminate the plan of care related to the nursing diagnosis of chest pain.

Terminate the plan of care related to the nursing diagnosis of chest pain. Terminate the plan of care for chest pain as the expected outcome has been achieved. The plan of care for chest pain does not need to be continued or modified. A new plan of care is not indicated at this time.

Which are psychomotor outcomes? Select all that apply. The client accurately draws up insulin. The client safely ambulates using a walker. The client identifies signs and symptoms of infection. The client rates pain as a 2 on a 0 to 10 pain rating scale. The client reports increased confidence in testing blood glucose level.

The client accurately draws up insulin. The client safely ambulates using a walker. 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 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 can demonstrate the correct technique for using a new glucometer. 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 is able to explain when and why the client needs to check the blood glucose level. 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 glucose levels is a physiologic outcome.

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. The client correctly ambulates with a walker. 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. 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.

Which client outcomes are psychomotor outcomes? Select all that apply. The client identifies five low-sodium foods. The client describes how to empty a Jackson-Pratt drain. The client measures capillary blood glucose level. The client self-catheterizes using clean technique. The client reports imagery is effective in controlling anxiety.

The client measures capillary blood glucose level. The client self-catheterizes using clean technique. Psychomotor outcomes describe the client's achievement of new skills, such as measuring capillary blood glucose level and self-catheterization. Cognitive outcomes demonstrate increases in client knowledge, such as identifying low-sodium foods and describing how to empty a wound drain. An affective outcome involves changes in the client's values, beliefs, and attitude, such as using imagery to control anxiety.

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 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 nurse preceptor provides feedback to the new graduate nurse after 6 weeks of orientation.

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. 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 of the following best summarizes the evaluation step of the nursing process? The nurse completes a health assessment to establish a database. The client and family have met health care goals and no longer need care. The nurse and client identify nursing diagnoses and appropriate interventions. The nurse and client measure achievement of planned outcomes of care.

The nurse and client measure achievement of planned outcomes of care. In evaluation, which is the fifth step of the nursing process, the nurse and client together measure how well the client has achieved the outcomes specified in the plan of care. Establishing a health assessment is the first stage of the nursing process. Identifying nursing diagnosis is the second stage and implementation of care is the fourth stage. When the client no longer needs care, the relationship is terminated.

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

The nurse assesses the client's response to pain medication. 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 identifies that the client does not tolerate activity. The nurse sets a tolerable pain rating with the client. The nurse auscultates the client's lungs and abdomen. The nurse assesses urine output following administration of a diuretic.

The nurse assesses urine output following administration of a diuretic. 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 is organized and efficient in client care. The nurse follows the policies and procedures of the institution. The nurse takes measures to ensure accurate medication administration. The nurse considers the individual needs of clients.

The nurse considers the individual needs of clients. 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 is evaluating nursing care and client outcomes by using a retrospective evaluation. Which action would the nurse perform in this approach? The nurse directly observes the nursing care being provided. The nurse reviews the client chart while the client is being cared for. The nurse interviews the client while the client is receiving the care. The nurse devises a postdischarge questionnaire to evaluate client satisfaction.

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

A nurse manager attempts to achieve performance improvement in the emergency department of a busy inner-city hospital. Which nursing actions follow Haase and Miller's recommended steps in performance improvement? Select all that apply. The nurse discovers that there is a problem with the triage system that is in place in the emergency department. The nurse calls a meeting of the emergency department interdisciplinary team to effect change in the triage process. The nurse organizes a task force to implement change in the triage process of a busy emergency department. The nurse meets with the emergency department staff to assess changes made to the triage process. When the goal of making changes to the triage process in the emergency department is not met, the nurse discontinues efforts to force change. When met with resistance to change from the emergency department staff, the nurses involves management to force the changes.

The nurse discovers that there is a problem with the triage system that is in place in the emergency department. The nurse calls a meeting of the emergency department interdisciplinary team to effect change in the triage process. The nurse organizes a task force to implement change in the triage process of a busy emergency department. The nurse meets with the emergency department staff to assess changes made to the triage process. Nurses committed to healthier clients, quality care, reduced costs, and the personal satisfaction of knowing that they are actually making a difference (versus merely wishing things were different) value performance improvement. The four steps, according to Haase & Miller, that are crucial in improving performance include: 1. Discover a problem. 2. Plan a strategy using indicators. 3. Implement a change. 4. Assess the change; if the outcome is not met, plan a new strategy.

A nurse evaluates clients prior to discharge from a hospital setting. Which action is the most important act of evaluation performed by the nurse? The nurse evaluates the client's goal/outcome achievement. The nurse evaluates the plan of care. The nurse evaluates the competence of nurse practitioners. The nurse evaluates the types of health care services available to the client.

The nurse evaluates the client's goal/outcome achievement. 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.

Which nursing actions reflect the evaluation stage of the nursing process? Select all that apply. The nurse identifies that a client's pain is not being adequately treated. The nurse sets an anxiety level of 3 or less with the client. The nurse performs tracheostomy care using sterile technique. The nurse documents the client's response to suctioning. The nurse determines the client did not lose the expected 2 lb (0.90 kg).

The nurse identifies that a client's pain is not being adequately treated. The nurse documents the client's response to suctioning. The nurse determines the client did not lose the expected 2 lb (0.90 kg). Examples of evaluation include documenting the client's response to suctioning and making a judgment that the client did not reach the expected outcome of a 2-lb (0.90-kg) loss or adequate pain control. Setting an anxiety rating with the client is an example of planning. Performing tracheostomy care is an example of implementation.

Which action by the nurse is an example of peer review? The nurse seeks feedback from the nurse manager 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 nurse preceptor provides feedback to the new graduate nurse after 6 weeks of orientation.

The nurse preceptor provides feedback to the new graduate nurse after 6 weeks of orientation. Peer review involves the evaluation of one staff member by another staff member on the same level in the hierarchy of the organization for the purpose of professional performance improvement. The nurse preceptor providing feedback to the new graduate nurse after 6 weeks of orientation is an example of peer review. The nurse manager and the UAP are not on the same level in the organization as the nurse. Consulting policies and procedures is not peer review.

Which statements are true of factors that influence client responses and outcome achievement and of how the nurse should use them? Select all that apply. The nurse should draw on positive factors to deal with other variables in the future. The nurse should reinforce negative behaviors to achieve desired outcomes. A client's strong motivation to learn appropriate health behaviors is an example of a positive factor. A nurse uses only positive factors to manipulate client outcomes. The nurse should identify which factors are helpful to attaining outcomes and manipulate them to achieve goals.

The nurse should draw on positive factors to deal with other variables in the future. A client's strong motivation to learn appropriate health behaviors is an example of a positive factor. The nurse should identify which factors are helpful to attaining outcomes and manipulate them to achieve goals. The nurse should reinforce positive, not negative, behaviors to achieve the outcomes for the client. The nurse can manipulate both positive and negative factors to improve client outcomes. The other choices are all true regarding positive factors.

A nurse is reviewing the plan of care for a client. Which should the nurse identify as problems related to the planning phase of the nursing process? Select all that apply. The plan of care only contains standard knowledge that most nurses would implement if there was no plan of care. Long-term goals are vague. Outcomes are incorrectly developed. Nursing orders are superficial. Database input does not reflect changes in a client's condition.

The plan of care only contains standard knowledge that most nurses would implement if there was no plan of care. Long-term goals are vague. Outcomes are incorrectly developed. Nursing orders are superficial. Database input is done during the assessment phase of the plan of care. The other choices are all completed during the planning phase of the nursing process.

What outcome does the nurse hope to achieve by evaluating the plan of care of a client who is being discharged? To direct future nurse-client interactions To formulate a database of nursing diagnoses To allow the nurse to terminate the nurse-client relationship To transfer medical prescriptions to the plan of care

To direct future nurse-client interactions The purpose of evaluation is to allow the client's achievement of expected outcomes and, when necessary, to modify the plan of care to direct future nurse-client interactions. The plan of care encompasses more than the relationship between the nurse and the client. It is important to evaluate the achievements by the client. The nurse develops nursing diagnoses during the diagnosis phase of the nursing process, not the evaluation phase. Medical prescriptions are health care provider interventions, not nursing interventions, and thus would not be included in the nursing plan of care. The purpose or outcome of evaluating the plan of care is not to terminate the nurse-client relationship.

Which purpose of the evaluation phase of the nursing process is a priority during client care? To examine the client's behavioral response to the care received To provide basis for the revision of plan of care To limit assessment to only the beginning phase of the nursing process To appraise the collaboration of the client and family

To examine the client's behavioral response to the care received During evaluation, nurses continually assess responses of clients to particular nursing interventions, establish different priorities for nursing diagnoses, and alter plans of care as necessary. During client care, the priority purpose of evaluation is to examine the client's behavioral response to the care received. After that, the nurse may need to establish different priorities for nursing diagnoses and alter the plan of care. Appraising the collaboration of the client and family is a type of evaluation but is not necessarily the priority in all situations. Limiting assessment to the first phase of the nursing process is not a purpose of the nursing process.

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: met. partially met. completely unmet. inappropriately chosen for this client.

completely unmet. After collecting data and evaluating the client's behavioral responses, the nurse makes a judgment about goal attainment by comparing the client's actual behavioral responses with the predicted responses or predetermined outcome criteria developed in the planning phase. In this case the mother abandoned breastfeeding, which represents a complete failure to meet the collaborative goal established. If the mother reported breastfeeding the infant every 4 to 5 hours, the nurse could consider the goal partially met. There is no evidence that the goal was inappropriately chosen for the client.

After the nursing plan of care has been developed, the nurse knows that: each encounter with the client is an opportunity to reassess and revise the plan of care, if necessary. the plan will be followed by other health care providers and filed with the client's chart upon discharge. the responsibility for the assessment of the client has ended. the plan of care can only be changed by the nurse who developed it.

each encounter with the client is an opportunity to reassess and revise the plan of care, if necessary. During each encounter with clients, nurses assess function, ensuring prompt attention to emerging problems. Because a client's condition can change quickly and dramatically, astute nurses remain alert to subtle cues and inferences. As they initiate the plan of care, nurses must ensure that the planned interventions are still relevant. Each of the remaining responses is untrue.

Identifying the kind and amount of nursing services required is a possible solution for: inadequate staffing. clients who fail to communicate their needs. nurses who are bored. nurses frustrated with substandard care.

inadequate staffing. A possible solution for inadequate staffing is to identify the kind and amount of nursing services required. Using a team conference to develop a consistent plan of care is a possible solution for the client who fails to communicate needs. Educating the client to become an assertive health care consumer is a possible solution for the client who quietly accepts whatever care is delivered or not delivered. A possible solution for the nurse who is a candidate for burnout is to learn to give quality care during the designated work period. An initiative to focus on quality improvement is a possible solution to nurses frustrated with substandard care. Reviewing task assignments and work schedules is a possible solution to bored nurses.

All of the activities listed are related to evaluation, but which evaluation activity is the priority concern for nurses? measuring client outcome achievements with the client helping targeted groups of clients to achieve their specific outcomes measuring the competence of individual nurses collecting data related to the expected outcome

measuring client outcome achievements with the client The priority concern for nurses should always be evaluating the outcome achievement with the client. The other choices are all activities related to evaluation that serve this priority.

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

outcome evaluation. Outcome evaluation focuses on measurable changes in the health status of the client or the end results of nursing care. Whereas the proper environment for care and the right nursing actions are important aspects of quality care, the critical element in evaluating care is demonstrable changes in client health status. Process evaluation addresses performance expectations during the various stages of the nursing process. Structure evaluation addresses the environment of care. A nursing audit focuses on the review of records.