N2 CH. 18 evaluating

In the implementation step of the nursing process, which activity will the nurse perform first? Reassess client needs Document nursing care Prioritize evaluation of care Differentiate between subjective and objective data

Reassess client needs During each encounter with patients during the implementation phase, the nurse assesses, ensuring prompt attention to emerging problems; assessment is not limited solely to the specific assessment phase. Differentiation between subjective and objective data is most associated with the assessment phase of the nursing process. Documentation occurs after client encounters and evaluation follows implementation.

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? SATA. he nurse customizes care based on client 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.

he nurse customizes care based on client 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.

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

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.

When caring for a client in the emergency room who has presented with symptoms of a myocardial infarction (MI), the nurse orders laboratory tests and administers medication to the client before the health care provider has examined the client. For the nurse to be operating within the nurse's scope of practice, what conditions must be present? The nurse is using the standards of care for clients with MIs. The nurse is operating under standing orders for clients with suspected MIs. The nurse is

The nurse is operating under standing orders for clients with suspected MIs. For the nurse to administer medications or order laboratory tests, the nurse must have a health care provider's order. In special circumstances, such as in the emergency room, there are standing orders in place to authorize the nurse's actions in certain situations. The other three statements may also be true, but they do not give the nurse the authority to institute these actions independent of a health care provider's order.

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

They enable nursing to be accountable for the quality of care. Quality-assurance (QA) programs enable nursing to be accountable to society for the quality of nursing care. They are a response to the public mandate for professional accountability. QA programs do not facilitate increased enrollment in education programs, specify how resources are to be used, or increase retention of nurses.

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 health care provider asks for the nurse's perspective of the situation. Which standard for establishing and sustaining healthy work environments does this action represent? Skilled communication Effective decision making True collaboration Appropriate staffing

True collaboration 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.

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

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.

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

Discovering a problem

While auscultating a client's lung sounds, the nurse notes crackles in the left lower lobe, which were not present at the start of the shift. The nurse is engaged in which type of nursing intervention? Educational Psychomotor Maintenance Surveillance

Surveillance interventions include detecting changes from baseline data and recognizing abnormal response. Nurses rely on the senses to detect changes, such as observing the appearance and characteristics of clients and hearing by auscultation, pitch, and tone. Nurses use these surveillance activities to determine the current status of clients and changes from previous states. Educational interventions require instruction, demonstration, and return demonstration of knowledge or a skill set. Psychomotor interventions involve the nurse physically working with the client. Maintenance interventions involve the nurse assisting the client with performing routine activities of daily living.

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.

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 Ensuring that the endotracheal tube is secure

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.

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

Quality assurance Accreditation by the Joint Commission evaluates quality assurance. Quality assurance is an externally driven process, demonstrating nursing excellence by meeting professional standards of care. Quality improvement is an internally driven, continuous process focusing on the processes of client care. Peer review is a process whereby individual nurses improve their professional performance through the evaluation of one staff member by another staff member on the same level of the hierarchy. Magnet status is awarded by the American Nurses Credentialing Center, recognizing health care organizations for their excellence in nursing.

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.

The nurse at a large, tertiary care hospital will soon be participating in a quality-improvement program. What characteristics of the program will the nurse identify? Select all that apply. The program determines whether nursing standards are being upheld. The program may be mandated by some governmental agencies. The program focuses on processes rather than individuals. The program should ideally be performed 1 or 2 times per year. The key focus is on ensuring excellence in care.

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

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.

When the nurse is administering medication, an older adult client states, "Why does everyone keep asking my name? I've been here for days." How should the nurse respond to the client? "It is a habit that nurses develop in school." "It is a hospital policy to reduce the potential for errors." "We ask your name to ensure that we are treating the right client." "We ask your name to show that we respect your rights."

"We ask your name to ensure that we are treating the right client." The primary reason for asking the client to state the client's name is to ensure that the nurse is dealing with the correct client. Asking the client to state the client's name is a habit that should be developed in nursing school, but that is not the reason nurses ask clients for their names. It is not just a hospital-specific policy to ask the client for the client's name, but it is a step that is used in all client care situations. Respecting clients' rights is important but that is not why nurses ask for their names.

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 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.

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

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 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.

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.

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 intervi

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.

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 nursing supervisor visits the ED and informs the dept. manager that tornado victims are expected to arrive within the hour. The department manager requests information regarding possible numbers of victims. The department manager reports supplies were just fully stocked, but two nurses are ill with influenza and were unable to report for their shift. Which resource does the department manager need to organize to respond to the disaster? Personnel Environment Clients Equipment

Personnel A sufficient number of nurses are needed to respond to the disaster. The department is functional and is not full of clients. Sufficient supplies are available.

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 Quality as opportunity Quality by perception Quality as initiative

Quality by inspection Quality by inspection is an approach to quality assurance in which nurses watch for deficient workers and remove them in an effort to prevent harm to clients. 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.

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 we

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 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. 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.

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.

Standards are the "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.