CH 18 PrepU Flashcards
Which characteristic is the most important indicator of high-quality nursing practice?
The nurse is organized and efficient in client care.
The nurse takes measures to ensure accurate medication administration.
The nurse follows the policies and procedures of the institution.
The nurse considers the individual needs of clients.
The nurse considers the individual needs of clients.
A client has been recently diagnosed with diabetes after receiving emergency treatment for a hyperglycemic episode. Which of the client’s actions indicates that the client has achieved a cognitive outcome in the management of this new health problem?
The client has maintained blood glucose levels within acceptable range in the days prior to discharge.
The client is able to explain when and why the client needs to check the blood glucose level.
The client can demonstrate the correct technique for using a new glucometer.
The client expresses a desire to change the way that the client eats and exercises.
The client is able to explain when and why the client needs to check the blood glucose level.
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?
Psychomotor
Educational
Maintenance
Surveillance
Surveillance
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 allow increased retention of qualified nurses.
They specify how resources are used or not used.
They enable nursing to be accountable for the quality of care.
A mother brings an infant into the clinic. The infant is 2 months old and has not been gaining weight appropriately. The outcome statement on the plan of care states, “The infant will double birth weight by 6 months of age.” This is an example of which type of outcome statement?
Cognitive
Affective
Psychomotor
Physical changes
Physical changes
Which nursing action reflects evaluation?
The nurse sets an anxiety level of 3 or less with the client.
The nurse identifies that the client has wound drainage.
The nurse assesses the client’s response to pain medication.
The nurse performs colostomy irrigation.
The nurse assesses the client’s response to pain medication.
A group of nurses on the orthopedic floor of a hospital wish to improve their clinical performance. The nurse manager suggests a program in which the nurses will evaluate each other and provide feedback for improved performance. This program is termed:
Peer review
Quality and Safety Education for Nurses (QSEN)
American Association of Critical-Care Nurses (AACN)
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
Peer review
The nurse is preparing to evaluate the goals set for a newborn and mother. What physiologic goals will the nurse evaluate for effectiveness? Select all that apply.
Before discharge, the parents of the infant will verbalize decreased anxiety about taking care of a newborn.
By 4/6/20, the parents will list appropriate resources in case questions arise after discharge.
Before discharge, the parents will demonstrate confidence in bathing and feeding their infant.
By 4/6/20, the newborn will demonstrate 2 hours of sleep prior to breastfeeding at night.
By 4/6/20, the mother will demonstrate a pain rating of 0 on a 0 to 10 scale.
Before discharge, the infant with a birth weight of 7 lb, 6 oz (3.3 kg) will have reached a target weight of 8 lb (3.6 kg).
By 4/6/20, the newborn will demonstrate 2 hours of sleep prior to breastfeeding at night.
By 4/6/20, the mother will demonstrate a pain rating of 0 on a 0 to 10 scale.
Before discharge, the infant with a birth weight of 7 lb, 6 oz (3.3 kg) will have reached a target weight of 8 lb (3.6 kg).
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.
Provide additional relief with non-pharmacologic measures.
Request a stronger analgesic from the provider.
Evaluate the use of current pain relief measures.
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
when the client is discharged
during the first home health care visit
once the primary care health care provider has written a discharge order
throughout the client’s hospital admission
The nurse is reassessing a client with leukemia who has received several packed red blood cell transfusions over the past week. Which question should the nurse ask the client to evaluate the treatment?
Have you experienced any tenderness in your joints?
Have you noticed any bruising?
Have you had any fevers?
Have you experienced any headaches?
Have you had any fevers?
Priority setting is based on the information obtained during reassessment and is used to rank nursing diagnoses. Each factor contributes to priority setting except which?
Finances of the client
The client’s condition
Time and resources
Feedback from the family
Finances of the client
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?
Implementing a change
Planning a strategy using indicators
Discovering a problem
Assessing the change
Discovering a problem
Which action should the nurse take during the evaluation phase of the nursing process?
Document reassessment of pain after medication administration.
Provide the client with a follow-up appointment after discharge.
Discontinue the indwelling urinary catheter per the provider’s order.
Have the client give input into plan of care upon admission.
Document reassessment of pain after medication administration.
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
Changing the dressing to prevent infection
Repositioning to prevent pressure injuries
Ensuring that the endotracheal tube is secure
A client with a new diagnosis of diabetes will be discharged on insulin therapy. Which client psychomotor outcome does the nurse expect after client education?
The client demonstrates administration of insulin.
The client identifies signs and symptoms of hypoglycemia.
The client identifies correct insulin injection sites.
The client reports testing blood sugar before meals.
The client demonstrates administration of insulin.
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?
On 3/3
At the completion of each meal
On 3/2
At the client’s direction
At the completion of each meal
The Joint Commission is conducting an accreditation visit at the hospital. What is the focus of the evaluation being conducted?
Magnet status
Quality improvement
Peer review
Quality assurance
Quality assurance
A nurse is reviewing the plan of care for a client. Which should the nurse identify as problems related to the planning phase of the nursing process? Select all that apply.
The plan of care only contains standard knowledge that most nurses would implement if there was no plan of care.
Nursing orders are superficial.
Outcomes are incorrectly developed.
Database input does not reflect changes in a client’s condition.
Long-term goals are vague.
The plan of care only contains standard knowledge that most nurses would implement if there was no plan of care.
Long-term goals are vague.
Outcomes are incorrectly developed.
Nursing orders are superficial.
“The levels of performance accepted by and expected of nursing staff or other health team members” defines:
evidence-based practice.
criteria.
evaluation.
standards.
standards
A nurse manager is conducting peer reviews of the staff on the critical care unit. Which person would the nurse manager select to evaluate a registered nurse who is certified in critical care?
Another registered nurse with critical care certification
Another nurse manager
Another staff nurse from the medical-surgical unit
One of the staff critical care health care provider
Another registered nurse with critical care certification
Which is a psychomotor client goal?
By 18AUG2015, the client will demonstrate improved motion in the left arm.
By 18AUG2015, the client will learn three exercises designed to strengthen leg muscles.
By 18AUG2015, the client will value health sufficiently to quit smoking.
By 18AUG15, the client will list three foods that are low in salt.
By 18AUG2015, the client will demonstrate improved motion in the left arm.
Identifying the kind and amount of nursing services required is a possible solution for:
nurses frustrated with substandard care.
nurses who are bored.
clients who fail to communicate their needs.
inadequate staffing.
inadequate staffing.
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:
process evaluation.
outcome evaluation.
structure evaluation.
nursing audit.
outcome evaluation.
Quality improvement in care delivery requires which components? Select all that apply.
Leadership commitment
Total client care by the nursing unit
Focus on the mission of the organization
Focus on data collection
Continuous improvement
Leadership commitment
Continuous improvement
Focus on data collection
Focus on the mission of the organization
An older adult client who is recovering from a stroke is scheduled to be transferred to the rehabilitation unit in the morning. The client is tearful and reports feeling lonely and abandoned in the hospital unit. The family visits daily, and flowers and cards are in the room. Documentation in the chart indicates that the client’s pastor has been by twice in the past week to visit. Which nursing diagnosis and outcome criteria need to be addressed immediately for this client?
Altered Mobility; able to tie shoes.
Dysfunctional Family Processes; family contact daily.
Impaired Walking; unilateral neglect.
Ineffective Coping; verbalizes support systems.
Ineffective Coping; verbalizes support systems.
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.
Terminate the plan of care upon client discharge.
Terminate the plan if there are difficulties achieving the goals/outcomes.
Reinforce the plan of care when each expected outcome is achieved.
Continue the plan of care if more time is needed to achieve the goals/outcomes.
