Taylor's Chapter 15: Evaluating (Prep U)
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
A nurse is evaluating the outcome of the plan of care after teaching a client how to prepare and administer an insulin pen. Which of the following types 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 client demonstrates stair climbing using a quad cane. What type of outcome is this an example of?
Psychomotor outcome
The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted?
Quality assurance
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
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.
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 client has returned to the clinic for a postoperative visit. The nurse reviews the plan of care and could choose to take which action based on the client's previous responses to the current plan of care? Select all that apply.
Terminate the plan of care if outcomes have been achieved. Modify the plan of care if difficulty has been encountered with achieving outcomes. Continue the plan of care if more time could result in achievement of outcomes.
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
Which client outcome is an example of a psychomotor outcome?
The client demonstrates stair climbing using a quad cane.
Which nursing action reflects evaluation?
The nurse assesses the client's response to pain medication.
Which of the following nursing actions reflects evaluation?
The nurse assesses urine output following administration of a diuretic.
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.
A mother brings her infant into the clinic for a well baby visit. The mother was concerned when she left the hospital about being able to get the infant to latch on for breast feeding. Which of the following is an appropriate evaluative statement?
"8FEB2016. Goal met. Mother reports that breast feeding is going well with the infant eating every 2-3 hours and attaching to the nipple easily. Infant is gaining weight."
A new graduate nurse has come to your unit to work. She asks the charge nurse what the difference is between collecting data in the patient assessment and in the evaluation phase of the nursing process. The charge nurse bases her response on her knowledge of which of the following statements?
"Data collected in the patient assessment identifies patient health issues, whereas data collected in the evaluation phase is to determine if patient outcomes are being achieved.
A nursing student asks the clinical instructor to explain the difference between quality improvement and quality assurance. Which response by the clinical instructor is appropriate?
"Quality improvement focuses on processes, data, and statistical thinking."
A hospital is revising its quality improvement program. The goal of the program is to improve quality in the facility. Which of the following are major premises of the program? (Select all that apply)
-Focus on the organizational mission -Customer orientation -Leadership commitment -Empowerment
A nurse is evaluating the plan of care for a client in the clinic. Which actions will be performed as a classic element of evaluation? Select all that apply.
-identifying evaluative criteria and standards -collecting data to determine if criteria or standards are being met -interpreting and summarizing findings -terminating, continuing, or modifying the plan of care
Which authoritative statements guide current professional nursing practice?
ANA Standards of Nursing Practice
The nurse is caring for a newborn who is scheduled to be discharged tomorrow. The mother of the newborn expresses concern about being able to properly breast feed her infant. The nurse reviews the plan of care and finds that there is an outcome that states "The mother will express confidence in being able to meet nutritional needs of her infant." This is an example of which type of outcome statement?
Affective
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 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 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 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.
Which of the following actions should the nurse take during the evaluation phase of the nursing process?
Document improved pain after pain medication administered
Prior to the first postoperative visit post gastrectomy, the client will have a weight loss of 10 lb (4.50 kg). This is an example of which type of evaluative statement?
Physical changes
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.
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.
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.
The nurse is assessing the client's behavioral response to a nursing intervention. This type of evaluation is known as:
outcome evaluation.
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. Outcome evaluation focuses on measurable changes in the health status of the client or the end results of nursing care. Structure evaluation addresses the environment of care. A nursing audit focuses on the review of records.
The nursing supervisor is presenting the staff nurse with yearly performance evaluations. What type of evaluation is the supervisor presenting to the staff?
process evaluation. Process evaluation focuses on the nurse's performance and whether the nursing care provided was appropriate and competent
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. 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.
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.
The nurse is preparing to evaluate the goals set for an newborn and newly delivered client. What physiologic goals will the nurse evaluate for effectiveness? (Select all that apply.)
-By 4/6/15, the newborn will demonstrate 2 hours of sleep prior to breastfeeding at night. -By 4/6/15, the mother will demonstrate pain rating of 0 on a 0-10 scale -Before discharge, the baby will have reached a target weight gain of 8 lb (birth weight: 7 lb, 6 oz). Physiologic goals meet the need of normal, healthy body functioning. An infant's sleep-wake patterns, comfort level, and weight are all examples of physiologic goals/outcomes. Decreased anxiety of the parents and demonstration of confidence in bathing their baby is an affective outcome. Listing appropriate resources demonstrates cognitive goals.
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 affect 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.
Which nursing actions reflect the evaluation stage of the nursing process? Select all that apply.
-The nurse identifies that a client's pain is not being adequately treated. -The nurse 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. 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 98% of all hospital admissions had a nursing history completed within 24 hours of admission.
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 his plan of care a learning outcome stating "Client will verbalize appropriate cast care upon discharge." This represents what type of outcome?
Cognitive
The client identifies three strategies for minimizing leakage of an ileostomy bag. This is an example of what type of outcome?
Cognitive outcome
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 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.
A nurse is reviewing a client's plan of care. What would the nurse determine is a problem related to the assessment phase of the nursing process?
Database does not reflect changes in the patient condition. Database input is done during the assessment phase of the plan of care. Nursing diagnoses are formed during the diagnosis phase of the nursing process. The plan of care is established during the planning phase of the nursing process
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 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.
Identifying the kind and amount of nursing services required is a possible solution for:
Inadequate staffing.
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.
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.
The nurse is caring for Mr. M., a 48-year-old man with congestive heart failure. The nurse manager informs the nurse that Mr. M. was enrolled in a clinical trial to assess whether a 10-minute walk, 3 times per day, leads to expedited discharge. Which type of evaluation best describes what the researchers are examining?
Outcome evaluation
Nurses are involved in many types of evaluation. All of the following are activities that are related to evaluation, but which of the following is the priority concern for nurses?
Patients and their care
A nurse identifies an area where client care has been compromised. What steps should the nurse take to improve performance? Select all that apply.
Plan a strategy using indicators Assess the change Discover a problem Implement a change
The nurse is caring for a client who has a fractured left femur that will be discharged home this afternoon. The outcome on the plan of care state "Client will demonstrate cast care prior to discharge" What type of evaluative statement is this?
Psychomotor
A nurse is caring for a client who is recovering from stroke. Which of the following would the nurse perform in the evaluation phase?
Revise the plan of care
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.
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 True collaboration involves skilled communication, mutual respect, shared responsibility, and decision making among nurses, and between nurses and other health team members. Skilled communication requires health team members to communicate in a non-intimidating manner with colleagues, allowing all voices to be heard regarding a matter. Effective decision making ensures nurses are valued and active partners in making policy, directing and evaluating clinical care, and leading organizational operations.
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
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 diagnoses.
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 Individualization is represented by allowing the client to express their choices and preferences and then honoring them
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.
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. A nursing audit is a method of evaluating nursing care that involves reviewing client records to assess the outcomes of nursing care, or the process by which these outcomes were achieved. Structure evaluation addresses the environment in which care is provided. A process evaluation addresses performance expectations during the various stages of the nursing process. A nursing audit may be performed during an accreditation inspection, but this is not the only time that it takes place.
The 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 ABCs (Airway, Breathing and Circulation) are always top priority in client 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. 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).
The nurse is caring for Mr. M., a 48-year-old man with congestive heart failure. The nurse manager informs the nurse that Mr. M. was enrolled in a clinical trial to assess whether a 10-minute walk, 3 times per day, leads to expedited discharge. Which type of evaluation best describes what the researchers are examining?
"Speaking to me that way is unacceptable. We should work together for the benefit of the client."
The nurse is working with Ms. V. today. Ms. V. is having a difficult time accepting her new diagnosis of type 2 diabetes. Thenurse pulls up a chair next to Ms. V.'s bed and holds her hand while listening to her story. What type of nursing intervention is the nurse engaging in?
Supportive intervention
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.
Which of the following would a nurse know is a part of an evaluative statement? Select all that apply.
-Description of how the patient outcome was met -Patient data that supports how the outcome was met An evaluative statement includes a description of how the patient's outcome was met and the data that supports that decision. The name of the physician and the health history would only be included if it contributed to the patient's outcome.
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. Psychomotor client goals refer to the client's achievement of new skills, such as demonstrating improved motion in the left arm. Valuing health by quitting smoking is an example of 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.
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. 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.
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 During implementation of care, nurses should be aware of client priorities and adjust care accordingly.
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. 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. 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.
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.
A nurse has committed to quality improvement in care delivery and identifies that quality improvement will require what action? Select all that apply
-Leadership commitment -Continuous improvement -Focus on data collection -Focus on the mission of the organization
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 The nursing code of ethics states that clients receive the same treatment regardless of their ability to pay.
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" Avoid ambiguous terminology, such as "inadequate," "good," or "extremely well," which can be interpreted differently by different people.
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 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.
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. 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.
Which expected client outcome is an example of a psychomotor outcome? Select all that apply.
Accurately drawing up insulin. Safely ambulating using a walker.
Which client outcome is a psychomotor outcome? Select all that apply.
The client measures capillary blood sugar level. The client catheterizes self, using clean technique.
