Prep U Chapter 15

A mother is bringing her infant into the the clinic for a well baby check. The infant's weight gain is on target for age. A correctly written evaluative statement is which of the following?

"8/2/2014. Goal met. The infant's weight gain is appropriate for age." Explanation: 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.

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

Document improved pain after pain medication administered Explanation: Documenting improved pain after pain medication is an evaluation of pain relief after an intervention. 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 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 Explanation: Individualization is represented by allowing the client to express their choices and preferences and then honoring them. The other choices represent expectations of the health care environment but do not define individualization.

A group of nurses of 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. The nurses know that this program is termed which of the following?

Peer review Explanation: Peer review is a process by which one nurse evaluates the performance of another in an effort to improve their professional performance. QSEN has as its goal the preparation of nurses with the knowledge, skills, and attitudes (KSAs) necessary to improve the quality and safety of healthcare systems. AACN strives to provide safe work environments and HCAHPS measures client satisfaction with health care.

A nurse is evaluating nursing care and patient outcomes by using a retrospective evaluation. Which action would the nurse perform in this approach?

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

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."

Nurses formulate different types of goals for patients when planning patient care. What is considered a psychomotor patient goal?

By 8/18/15, patient will demonstrate improved motion in left arm. Explanation: Psychomotor patient goals refer to the patient's achievement of new skills, such demonstrating improved motion in the left arm. Valuing health by quitting smoking is an example of a quality of life goal/outcome. Listing three foods low in salt is a cognitive goal/outcome. Learning exercises to strengthen leg muscles is an affective goal/outcome.

The client identifies three strategies for minimizing leakage of an ileostomy bag. This is an example of what type of outcome?

Cognitive outcome Explanation: 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.

Prior to the first postoperative visit post gastrectomy, the client will have a weight loss of 10 lbs. This is an example of which type of evaluative statement?

Physical changes Explanation: 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 and physical changes are related to actual body changes in the individual which is represented by the 10 lb weight loss..

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

Revise or modify the nursing care plan Explanation: Evaluation using the functional health approach provides a framework for organizing and evaluating data

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.

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 which of the following?

Evaluative statement Explanation: An evaluative statement is a statement summarizing the client's outcome achievement. Criteria are "measurable qualities, attribute, 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 patient outcomes.

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 Explanation: The most effective method to address the increased frequency of client falls and to promote a positive working environment would be to determine the circumstances that contributed to the clients' falls. Attempting to identify and reprimand individual nurses does not lead to an atmosphere of openness and honesty in determining the causes. Instituting a new policy to prevent falls is premature before identifying why the falls are occurring. It may be relevant later to determine if other nursing units are having the same problem, but it is not necessary at this time.

A client has come into the clinic for a postoperative visit. The client states that the postoperative pain continues to be 6 on a 10-point rating scale. The nurse evaluates the patient and the current plan of care. Based on the information provided by the client, the nurse should do which of the following?

Modify the plan of care Explanation: The nurse should evaluate the current status of the client and modify the plan of care to better meet the needs of the client at this time. There is no need to terminate the entire plan of care and continuation with the current plan will most likely keep the client dealing with pain. The nurse should ask the client if they are taking their pain medication as part of the assessment, not call the pharmacy.

The mother brings her infant into the clinic. The infant is two 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 Explanation: 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 and physical changes are related to actual body changes in the infant.

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

Quality assurance Explanation: 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.

Which client outcome is an example of a cognitive outcome?

The client identifies three strategies for minimizing leakage of an ileostomy bag. Explanation: 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, such as blood sugar values and pulse rate. Psychomotor outcomes describe the client's achievement of new skills, such as taking a radial pulse.

The mother of an infant comes to the clinic and asks the nurse if the infant can eat bananas now. The outcome statement on the infants plan of care states "The mother will explain proper nutrition for infants." this is an example of what type of outcome statement?

Cognitive Explanation: 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 and physical changes are related to actual body changes in the infant.

A nurse is evaluating the plan of care for the client under her care. Which of the following problems might the nurse note that is associated with the implementation phase of the plan of care?

Nurses are not aware of client priorities and the plan of care. Explanation: 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.

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. Explanation: 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 six 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.

Which nursing action reflects evaluation?

The nurse assesses the client's response to pain medication. Explanation: 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 is an example of planning. Performing colostomy irrigation is an example of implementation.

A nurse evaluates patients prior to discharge from a hospital setting. Which action is the most important act of evaluation performed by the nurse?

The nurse evaluates the patient's goal/outcome achievement. Explanation: The priority is to evaluate the patient's goal/outcome achievement. This determines if the nursing diagnosis has been resolved. If the patient'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 patient but his is not the purpose of the evaluation phase of the nursing process.

When the nurse prepares to discharge a client, and subsequently evaluate the effectiveness of the nursing care, the nurse should determine whether the ...

client's goals have been achieved Explanation: 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.

A nurse caring for an elderly patient who has dementia observes another nurse putting restraints on the patient without a physician's order. The patient 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 patient. Explanation: Confronting the nurse and explaining the danger for the patient 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 and 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 physician should not be contacted for an order unless it is decided that the restraint is going to be left on the patient.

The nurse manager observes one of the unit nurses failing to was 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 Explanation: Quality by inspection is obtained by nurses watching for deficient workers and removing them in an effort to prevent harm to clients.

A client has just been admitted to the clinical unit. The nurse is providing her with the expectations she may have of the health care she will receive. She is told that she will not be harmed by any errors that might be made and she can expect to be safe in the facility. This assurance represents which expectation of the health care environment?

Safety Explanation: Safety is represented by the expectation that the client won't be harmed by any errors and they will be safe in the facility. The other choices represent expectations of the health care environment but do not define safety.

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 which of the following?

Standards Explanation: Standards are the "levels of performance accepted by and expected of nursing staff or other health team members." Criteria are "measurable qualities, attribute, 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 patient outcomes. Evaluation involves measuring how well the patient has achieved the outcomes that were set forth in the plan of care.

At the beginning of prenatal care, the goal for the client was to gain 25 pounds by the end of the pregnancy. At 30 weeks of pregnancy, the client has only gained 1 pound. Which of the following would help the nurse most appropriately interpret this data?

The client is not achieving the goal. The nurse should determine the reasons the client has not been gaining weight. Explanation: The client is not achieving the goal. The nurse should determine what the causes are in order to revise the plan of care. It is important to determine as early as possible if the plan of care is being successful. This will allow sufficient time to revise the plan of care. It is unrealistic to think the client will achieve the goal in the next 10 weeks. The client may not achieve the goal, but the priority at this time is to determine the reasons and revise the plan of care.

Quality assurance programs are important for ensuring quality nursing care. Which of the following situations need to be reported to the nurse manager? Select all that apply.

• Nurse assesses client after sneezing into hand. • Nurse administers medications to wrong client. • Nurse delays answering call lights to an abusive client. • Nurse refuses to provide care to a client with HIV. Explanation: Nurse assesses client after sneezing into hands; nurse needs to wash hands before touching client. Nurse needs to admit to administering a medication to a wrong client; client may be harmed by wrong medication. Nurse cannot delay answering a call light to an abusive client; clients are to be treated with respect. Nurse cannot refuse to provide care to a client with HIV; clients are to be treated with respect. Cleaning a stethoscope between clients is providing quality care.

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. Explanation: 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.

A client presents to the clinic for a routine postoperative visit. The nurse assesses the site of the incision and determines that the edges of the incision are approximated, sutures have been removed, and there is no redness or edema at the site. The incision appears to be well healed. The nurse reviews the plan of care and notes that one nursing diagnosis is related to potential infection related to impaired skin integrity. The nurse determines that this is no longer an issue for the client. Which of the following changes should the nurse make to the plan of care?

Terminate the plan of care as it relates to infection Explanation: The nurse should terminate the section of the plan of care that relates to infection. Other parts of the plan of care may still need to be monitored. There is no need to modify the plan of care as it relates to infection because at this time it is no longer an issue. The current plan of care should not be continued as the client is progressing toward outcome achievement.

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. Explanation: 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, while the expression of a desire for change is an affective outcome. The maintenance of healthy blood sugars is a physiologic outcome.

Which client outcome is a cognitive outcome? Select all that apply.

The client lists the side effects of digoxin (Lanoxin). • The client describes how to perform progressive muscle relaxation. • The client identifies signs and symptoms of hypoglycemia. Explanation: 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. A psychomotor outcome involves changes in the client's values, beliefs, and attitude. 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.

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 patient outcome achievement, the nurse writes an evaluative statement to summarize the findings. • The nurse writes a two-part evaluative statement that includes a decision about how well the outcome was met, along with patient data that support the decision. • The nurse has three decision options for how goals have been met. Explanation: After the data have been collected and interpreted to determine patient outcome achievement, the nurse makes and documents a judgment summarizing the findings. The two-part evaluative statement includes a decision about how well the outcome was met, along with patient 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 patient. The patient, nurse, or other health care variables may affect correctly written goals.