Fundamentals PrepU Chapter 15: Evaluating
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" -Avoid ambiguous terminology, such as "inadequate," "good," or "extremely well," which can be interpreted differently by different people
A nurse manager notes an increase in the frequency of client falls during the last month. To promote a positive working environment, how would the nurse manager most effectively deal with this problem?
Investigate the circumstances that contributed to client falls.
Prior to the first postoperative visit postgastrectomy, the client will have a weight loss of 10 lb (4.5 kg). This is an example of which type of evaluative statement?
Physical changes
The mother brings her 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 what type of outcome statement?
Physical changes
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
Before discharge the client will demonstrate aseptic dressing changes. This is an example of which type of evaluative statement?
Psychomotor
The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted?
Quality assurance
A nurse is caring for a client who is recovering from stroke. Which action would the nurse perform in the evaluation phase?
Revise the plan of care.
Nurses formulate different types of goals for clients when planning client care. What is considered a psychomotor client goal?
By 18AUG2015, client will demonstrate improved motion in left arm.
A nurse has been providing discharge teaching to a client with type 1 diabetes. Which outcome indicates that the teaching has been effective?
By a certain date, the client will verbalize signs and symptoms of hypoglycemia
Which action is appropriate when evaluating a client's responses to a plan of care?
Continue the plan of care if more time is needed to achieve the goals/outcomes.
Which action should the nurse take during the evaluation phase of the nursing process?
Document reassessment of pain after medication administration.
Once a nurse has collected and interpreted the data on a client's outcome achievement, the nurse will then make a judgment and document a statement summarizing those findings. This is called:
Evaluative statement
Priority setting is based on the information obtained during reassessment. Priority setting is used to rank nursing diagnoses. Each of the following contributes to priority setting except which of the following?
Finances of the client
Which component would a nurse know is a part of an evaluative statement? Select all that apply.
-Description of how the client outcome was met -Client data that supports how the outcome was met
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.
Which nursing actions reflect the evaluation stage of the nursing process? Select all that apply. - The nurse sets an anxiety level of 3 or less with the client. -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 performs tracheostomy care using sterile technique. -The nurse documents the client's response to suctioning.
-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).
The nurse participates in a quality assurance program and reviewing evaluation data from the previous year. Which of the following does 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
The nurse is collecting data on a client presenting to the medical short-stay unit for a colonoscopy. A client reports to the nurse that he quit smoking 6 months ago after being diagnosed with lung cancer. The nurse recognizes this change in behavior is which type of outcome?
Affective outcome -Affective outcomes pertain to changes in client values, beliefs, and attitudes and are more complex to evaluate.
A client is about to leave the hospital after having surgery for a fractured left femur. It is now in a plaster cast. The client asks how long before the cast will be dry. The nurse notes on the client's plan of care a learning outcome stating "Client will verbalize appropriate cast care upon discharge." This represents what type of outcome?
Cognitive
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
The nurse is orienting a new client to the facility. The client is told that her preferences and choices would be sought and honored. This represents which expectation of the health care environment?
Individualization
The nurse is caring for Mr. H., a 35-year-old man who is hospitalized following a motorcycle accident. He has a traumatic brain injury. The nurse is working with Mr. H. on self-care behaviors. The following would help the nurse to assess the success of the nursing interventions except which of the following?
Model self-care behaviors for the client.
The nurse is assessing the client's behavioral response to a nursing intervention. This type of evaluation is known as:
Outcome Evaluation - Outcome evaluation determines the extent to which the client's behavioral response to nursing intervention reflects the desired client goal and outcome criteria.
The nurse is caring for a client who has a fractured left femur. The client will be discharged home this afternoon. The outcome on the plan of care states "Client will demonstrate cast care prior to discharge" What type of evaluative statement is this?
Psychomotor
A nurse just reported to the oncoming shift that she had failed to perform an ordered dressing change. She reported to the nurse manager that this was the second time this week she had not had time to do the dressing change. The nurse manager recognized that the nurse normally was very punctual and was known to provide good care for her clients. However, the unit census had been very high on this particular week. The nurse manager knows that quality care must be provided and reports this occurrence as what type of quality approach?
Quality by opportunity -Quality by 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 competence of the nurse.
A client with a recently fractured left femur has been reluctant to comply with his physical therapy for fear of the pain associated with movement. A goal for this client is to attend therapy treatments 3 times each day. The nurse is evaluating the goal for this client. The client states, "I don't like therapy; it hurts, but I have been going twice a day." The client chart has an entry from the last shift nurse stating the client went to therapy 2 times with encouragement. The nurse evaluates the goal as:
goal partially met.
Identifying the kind and amount of nursing services required is a possible solution for:
inadequate staffing.
The nurse manager observes one of the unit nurses failing to wash her hands upon entering a client room. Hospital protocol is washing hands before and after entering a client room. The nurse manager knows that this is an example of:
quality by inspection -Quality by inspection is met by nurses watching for deficient workers and removing them in an effort to prevent harm to clients.
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 -Availability of equipment, layout of physical facilities, nurse-client ratios, administrative support, and maintenance of nursing staff competence are some areas of concern for structure evaluation.
Nurse Mayweather is auscultating lung sounds. She notes crackles in the LLL which were not present at the start of the shift. Nurse Mayweather is engaged in which type of nursing intervention?
Surveillance Intervention
A male client has been recently diagnosed with diabetes after receiving emergency treatment for a hyperglycemic episode. Which of the client's actions indicates that he has achieved a cognitive outcome in the management of his new health problem?
The client is able to explain when and why he needs to check his blood sugar
At the beginning of prenatal care, the goal for the client was to gain 25 lb (11.25 kg) by the end of the pregnancy. At 30 weeks of pregnancy, the client has only gained 1 lb (0.45 kg). Which statement(s) would help the nurse most appropriately interpret these data?
The client is not achieving the goal. The nurse should determine the reasons the client has not been gaining weight.
Which nurse is using criteria to determine expected standards of performance?
The new graduate nurse consults the policies and procedures of the institution prior to skill implementation.
Which nursing action reflects evaluation?
The nurse assesses the client's response to pain medication.
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.
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. -retrospective means looking back on or dealing with past events or situations.
The nurse is conducting a peer review of a nursing colleague. Which action by the nurse is an example of peer review?
The nurse preceptor provides feedback to the new graduate nurse after 6 weeks of orientation.
The health care team has convened to discuss the care of an end-of-life client who is not able to achieve an acceptable level of comfort. The physician asks for the nurse's perspective of the situation. Which standard for establishing and sustaining healthy work environments does this action represent?
True collaboration
The client identifies three strategies for minimizing leakage of an ileostomy bag. This is an example of:
a cognitive outcome
A large university hospital has commissioned a multidisciplinary group to review client records following discharge in order to evaluate client outcomes and the character and quality of nursing care that clients receive. What type of evauation process will take place?
a nursing audit
The client demonstrates stair climbing using a quad cane. This is an example of:
a psychomotor outcome
For a client with self-care deficit, the long-term goal is that the client will be able to dress himself 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
A client is administered an anxiolytic. Which nursing action demonstrates the nurse evaluating the client?
asking if the client feels less anxious 30 minutes after administering the medicine
A new mother is having difficulty breastfeeding her newborn infant. A goal was established stating 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 the she discontinued breastfeeding. The nurse evaluates the original goal as:
completely unmet
The terms "criteria" and "standards" are often used interchangeably, but they actually have distinct definitions. "Measurable qualities, attributes, or characteristics that identify knowledge or health status" are known as:
criteria
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 focus of a hospital's current quality assurance program is a comparison between the health status of clients upon admission and at the time of discharge. This form of quality assurance is characteristic of:
outcome evaluation
The primary purpose for evaluating data about a client's care according to a functional health approach is to:
revise or modify the patient care plan
The terms "criteria" and "standard" are often used interchangeably but actually have distinct, separate definitions. "The levels of performance accepted by, and expected of, nursing staff or other health team members" is known as:
standards
Nurses are involved in many types of evaluation. All of the activities listed are related to evaluation, but which activity is the priority concern for nurses?
Clients and their care
The nurse in a Burn Intensive Care Unit (BICU) is caring for a 3-year-old boy who was burned with scalding hot water. He has burns covering 75 percent of his body. His condition is critical but stable. At 1000, the nurse reassesses the client and finds that he is agitated and pulling at his endotracheal tube. What would be the nurse's priority?
ensuring that the endotracheal tube is secure
Which expected client outcome is an example of a psychomotor outcome? Select all that apply. - Rating pain as a 2 on a 0 to 10 pain rating scale -Reporting increased confidence in testing blood sugar -Safely ambulating using a walker Identifying signs and symptoms of infection -Accurately drawing up insulin
-Accurately drawing up insulin -Safely ambulating using a walker
A nurse finds that her client is not achieving the set outcomes for care and reviews the plan. Which actions are appropriate changes for the nurse to make in the plan of care? Select all that apply.
-Modify the nursing diagnosis. -Make the outcome statement more realistic. -Adjust the time limits on the outcome statement. -Increase the complexity of the outcome statement.
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. -Add or alter nursing diagnose
Which client outcome is a cognitive outcome? Select all that apply. - The client correctly ambulates with a walker. -The client reports cycling 30 minutes three times each week. -The client describes how to perform progressive muscle relaxation. -The client identifies signs and symptoms of hypoglycemia. -The client lists the side effects of digoxin.
-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.
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.
