Fundamentals- Ch.18

When recording or documenting outcome attainment in the chart, nurses are to be very clear with the descriptions used. Which term is appropriate?

"Demonstrated steps" p.439-440

Which are psychomotor outcomes? Select all that apply.

-Accurately drawing up insulin -The client will safely ambulate using a walker. Explanation: Examples of psychomotor outcomes include accurately drawing up insulin and ambulating safely using a walker. Identifying signs and symptoms of infection is an example of a cognitive outcome. Rating pain as a 2 on a 0 to 10 scale is a physiologic outcome. An example of an affective outcome is reporting increased confidence in testing blood glucose level. p.438-429

Which is a psychomotor client goal?

By 18AUG2015, the client will demonstrate improved motion in the left arm.

A nurse overhears a coworker telling a somewhat offensive joke to a client. Which nursing action is indicated?

Discuss the occurrence with the coworker.

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 p,419

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 p.444

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

The nurse considers the individual needs of clients. p.448

A new mother is having difficulty breastfeeding a newborn infant. A goal was established stating that the baby 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. The nurse evaluates the original goal as:

completely unmet. p.443

"Measurable qualities, attributes, or characteristics that identify knowledge or health status" defines:

criteria

Which statement regarding quality improvement or quality assurance is correct?

Quality improvement focuses on processes, data, and statistical thinking.

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?

Terminate the plan of care related to the nursing diagnosis of chest pain. p.435

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. p.439

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 Explanation: 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. p.451

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 p.442-444

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. p.440

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?

Discovering a problem p.445

While evaluating a client's plan of care, the nurse would be most likely identify which problem as being associated with the implementation phase?

Nurses are not aware of client priorities and the plan of care. p.444

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

Quality assurance

Which client outcomes are psychomotor outcomes? Select all that apply.

-The client measures capillary blood glucose level. -The client self-catheterizes using clean technique. Explanation: 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. p.439

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 p.440

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. p.187

Which action should the nurse take when client data indicate that the stated goals have not been achieved?

Review each preceding step of the nursing process. Explanation: 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. p.435

Which action should the nurse perform in the evaluation phase?

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. p.444

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?

Affective Explanation: 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. p.439

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?

Safety p.437

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?

As soon as possible Explanation: 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. p.443

Which are components of an evaluative statement? Select all that apply.

Description of how the client outcome was met Client data that support how the outcome was met Explanation: 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 physician, 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. p.440

The primary purpose for evaluating data about a client's care according to a functional health approach is to:

revise or modify the client care plan. Explanation: Evaluation using the functional health approach provides a framework for organizing and evaluating data allowing the nurse to modify the client care plan. Evaluation has no influence upon meeting accreditation standards, implementation of medical orders, or the need for health care consultations. p.442

Which action should the nurse take during the evaluation phase of the nursing process?

Document reassessment of pain after medication administration.

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. Explanation: 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. p.447

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

standards. p.438

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 p.451

The nursing supervisor is evaluating how many clients each of the department nurses has been assigned for the shift. This type of evaluation would be considered:

structure. p.447

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

Cognitive p.439

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. p.440

Which are areas of focus in quality improvement? Select all that apply.

-Systems -Processes -Data use Explanation: 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. p.448

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 bases client care on established nursing needs and values. -The nurse bases care on evidence-based decision making. -The nurse promotes shared knowledge and the free flow of information. -The nurse acknowledges that continuous decrease in waste improves client care. p.442-444

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. Explanation: 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. p.445

The nurse participates in a quality assurance program and reviewing evaluation data from the previous year. Which should the nurse recognize as an example of outcome evaluation?

A 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery Explanation: Quality assurance programs focus on three types of evaluation: structure, process, and outcome. Outcome evaluation focuses on measurable changes in the health status of clients, such as a 2% reduction in the number of repeat admissions for clients who underwent hip replacement surgery. Structure evaluation focuses on the environment in which care is provided, such as the number of baccalaureate-prepared nurses employed in the facility and bed occupancy rates. Process evaluation focuses on the nature and sequence of activities carried out by nursing implementing the nursing process, such as a rate of 98% of clients admitted to the hospital who had a nursing history completed within 24 hours after admission. p.446-447

The nurse should evaluate client outcomes at which time?

As early as possible Explanation: 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. Evaluting 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. p.440

A client is administered an anxiolytic. Which nursing action demonstrates the nurse evaluating the client?

Asking whether the client feels less anxious 30 minutes after administering the medicine p.435

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

Confront the nurse and explain how this could be dangerous for the client. p.445

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?

Continue the plan of care. Explanation: 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. p.435

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. Explanation: 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. p.443

Which action should the nurse take during the evaluation phase of the nursing process?

Document reassessment of pain after medication administration. p.444

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. p.438

A facility has participated in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and received the results. A nurse is part of the team reviewing the information. For which areas should the nurse expect the survey to provide information? Select all that apply.

Facility cleanliness Courteous treatment Pain control

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

Meeting the care needs of clients p.435

The nursing staff on a hospital unit uses peer review to improve professional performance. Who performs the review?

Nurses. p.444

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?

Psychomotor Explanation: 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. p.451

The nurse manager observes one of the unit nurses failing to wash hands on entering a client room. Hospital protocol is to wash hands before and after entering a client room. This scenario is an example of which approach to quality assurance?

Quality by inspection Explanation: Quality by inspection is an approach to quality assurance in which nurses watch for deficient workers and remove them in an effort to prevent harm to clients. Quality as opportunity, on the other hand, focuses on finding opportunities for improvement and fosters an environment that thrives on teamwork, with people sharing the skills and lessons they have learned. Quality by perception and quality as initiative are not specific approaches to quality assurance. p.446

A client with a new diagnosis of diabetes will be discharged on insulin therapy. Which client psychomotor outcome does the nurse expect after client education?

The client demonstrates administration of insulin. p.188

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. p.451

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. Explanation: 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. p.439

Which of the following best summarizes the evaluation step of the nursing process?

The nurse and client measure achievement of planned outcomes of care. p.440

Which nursing action reflects evaluation?

The nurse assesses the client's response to pain medication. p.435-438

Why are quality-assurance programs important in nursing?

They enable nursing to be accountable for the quality of care. p.446

The health care team has convened to discuss the care of an end-of-life client who is not able to achieve an acceptable level of comfort. The physician asks for the nurse's perspective of the situation. Which standard for establishing and sustaining healthy work environments does this action represent?

True collaboration Explanation: This scenario represents true collaboration, as nurses and other health care team members are demonstrating mutual respect, shared responsibility, and shared decision making. Although skilled communication and effective decision making are likely to be involved in true collaboration, these are not the focus of this scenario. There is no evidence of whether staffing is appropriate in this scenario. p.447

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

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:

criteria. Explanation: 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. p.438

Identifying the kind and amount of nursing services required is a possible solution for:

inadequate staffing. Explanation: 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. p.441

The nurse is assessing the client's behavioral response to a nursing intervention. This type of evaluation is known as:

outcome evaluation. Explanation: Outcome evaluation, which focuses on the client and the client's function, is currently receiving a great deal of emphasis. Outcome evaluation determines the extent to which the client's behavioral response to nursing intervention reflects the desired client goal and outcome criteria. 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. Behavior modification is not a type of evaluation but a type of intervention that focuses on helping clients make lifestyle changes to achieve health goals. p.447

One of the outcomes that has been identified in the care of a client with a new suprapubic catheter is that he will demonstrate the correct technique for cleaning his insertion site and changing his catheter prior to discharge. When should this outcome be evaluated?

throughout the client's hospital admission Explanation: It is important to evaluate client outcomes early and frequently. Reserving evaluation for the time of discharge or after discharge is inappropriate, even if the designated time criteria for the outcome specifies "by time of discharge." p.440

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 Explanation: 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. p.447

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?

Ensuring that the endotracheal tube is secure p.427-430

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

Psychomotor Explanation: 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. p.439

"The client will demonstrate cast care prior to discharge" is which type of evaluative statement?

Psychomotor Explanation: 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. p.439

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. p.448

Which action by the nurse is an example of peer review?

The nurse preceptor provides feedback to the new graduate nurse after 6 weeks of orientation. Explanation: 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. p.444