CH 18 PrepU

Question 1

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.

Answer 1

The nurse considers the individual needs of clients.

Question 2

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.

Answer 2

The client is able to explain when and why the client needs to check the blood glucose level.

Question 3

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

Answer 3

Surveillance

Question 4

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.

Answer 4

They enable nursing to be accountable for the quality of care.

Question 5

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

Answer 5

Physical changes

Question 6

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.

Answer 6

The nurse assesses the client’s response to pain medication.

Question 7

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)

Answer 7

Peer review

Question 8

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).

Answer 8

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).

Question 9

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.

Answer 9

Evaluate the use of current pain relief measures.

Question 10

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

Answer 10

throughout the client’s hospital admission

Question 11

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?

Answer 11

Have you had any fevers?

Question 12

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

Answer 12

Finances of the client

Question 13

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

Answer 13

Discovering a problem

Question 14

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.

Answer 14

Document reassessment of pain after medication administration.

Question 15

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

Answer 15

Ensuring that the endotracheal tube is secure

Question 16

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.

Answer 16

The client demonstrates administration of insulin.

Question 17

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

Answer 17

At the completion of each meal

Question 18

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

Answer 18

Quality assurance

Question 19

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.

Answer 19

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.

Question 20

“The levels of performance accepted by and expected of nursing staff or other health team members” defines:

evidence-based practice.

criteria.

evaluation.

standards.

Answer 20

standards

Question 21

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

Answer 21

Another registered nurse with critical care certification

Question 22

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.

Answer 22

By 18AUG2015, the client will demonstrate improved motion in the left arm.

Question 23

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.

Answer 23

inadequate staffing.

Question 24

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.

Answer 24

outcome evaluation.

Question 25

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

Answer 25

Leadership commitment

Continuous improvement

Focus on data collection

Focus on the mission of the organization

Question 26

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.

Answer 26

Ineffective Coping; verbalizes support systems.

Question 27

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.

Answer 27

Continue the plan of care if more time is needed to achieve the goals/outcomes.