Fundamentals Of Nursing Chapter 19 Review Questions

Front 1

In order to determine whether an intervention was successful, the nurse evaluates the success of attaining a goal. The following is an example of an evaluation:
A. Client will ambulate 500 feet 4 times a day with minimal assistance.
B. Client performed quadriceps setting exercises to right leg every 4 hours.
C. Dressing changed every 8 hours using sterile technique.
D. Wound filling in with granulation tissue, is red to pink without signs of infection.

Back 1

D

Front 2

A client was in pain following surgery. The nurse administered the prescribed analgesics, but the client’s pain rating stayed the same (8 out of 10). The nurse recognizes that:
A. The client is overrating the pain.
B. The pain plan needs changing.
C. Nonpharmacological pain-relieving strategies are now appropriate.
D. Complications from surgery are occurring

Back 2

B

Front 3

The nurse caring for a client with a nursing diagnosis of impaired physical mobility for the past 3 days recognizes that the client is not eating as expected. The nurse recognizes the need to:
A. Change the nursing diagnosis to feeding self-care deficit
B. Consult with occupational therapy about feeding aids
C. Order a liquid diet to make it easier for the client to swallow
D. Place the client on NPO (nothing by mouth) status until the physician assesses the client

Back 3

A

Front 4

The nurse determines that the current care plan for a client needs to be changed because the goal has not been reached even after a sufficient period of time. New interventions are implemented. What is essential for the nurse to do after the implementation of these new interventions?
A. Determine the safety of the interventions
B. Ascertain appropriateness of the interventions
C. Confirm the availability of the interventions
D. Reevaluate the interventions

Back 4

D

Front 5

Although assessment may be part of the evaluation, evaluation may not be part of the assessment. The nurse understands that the difference between assessment and evaluation is _______________________.

Back 5

For evaluation to occur, one or more interventions must have been implemented. Although assessment may assist in identifying the attainment of goals and outcomes, and thus help in the evaluation, it a

Front 6

Match the following statements on the left with whether they are considered assessment data or evaluation.
1. Assessment
2. Evaluation
3. Both


1 2 3 A. Lungs clear to auscultation
1 2 3 B. Wound healing without signs of infection.
1 2 3 C. Voiding without difficulty
1 2 3 D. Oriented × 3

Back 6

A:3, B:2, C:, D:1

Front 7

Professional outcomes and client outcomes differ in their focus. Match the statements on the left with their appropriate type of outcome on the right.
1. Professional outcome
2. Client outcome


1 2 A. Clients are discharged within 4 hours of order.
1 2 B. Use of restraints is reduced by 25%.
1 2 C. The average client pain rating is 3 out of 10.
1 2 D. Clients receive all medications within 1 hour of time scheduled.

Back 7

A:, B:, C:2, D:1

Front 8

The following are steps in the evaluation process, comparing expected and actual findings. Place them in correct order.
a. Compare outcome criteria with actual client response.
b. Examine goal to determine desired client behavior.
c. Judge agreement between desired and actual findings.
d. Assess client for expected behavior.
e. Determine why expected and actual findings do not agree.

Back 8

b, d, a, c, e. This process allows for a logical sequence of evaluation and is easier to perform once the nurse has cared for the client over a period of time.

Front 9

The nurse develops a nursing diagnosis of sleep deprivation. What evaluative measure would the nurse use to determine the client’s progress in alleviating this problem?

Back 9

The nurse would compare the amount of sleep the client had usually been getting when he was sleep deprived and compare it to the amount of sleep he is currently receiving after implementing interventions. If the number of hours of sleep increased and the client was feeling more rested, this would indicate a partial or full resolution of the problem.

Front 10

In order for a nursing quality improvement (QI) process to be successful, which of the following is true? (Select all that apply.)
A. Process should be limited to registered nurses.
B. Outcomes are based on standards of care.
C. Client satisfaction is an important indicator.
D. Recurrent problems are identified.

Back 10

B, C, D

Front 11

EVALUATION IS AN IMPORTANT PART OF NURSING CARE. DURING THIS PROCESS YOU DETERMINE THE EFFECTIVENESS OF A SPECIFIC ACTION BY:
A. REASSESSING THE CLIENT FOR NEW PROBLEMS
B. DETERMINING THAT THE SPECIFIC NURSING ACTION WAS COMPLETED
C. COMPARING THE CLIENTS RESPONSE TO THE NURSING ACTION WITH OTHER CLIENTS RECEIVING THE SAME NURSING ACTION
D. COMPARING THE CLIENTS RESPONSE WITH EXPECTED OUTCOMES ESTABLISHED DURING THE PLANNING PHASE

Back 11

D. COMPARING THE CLIENTS RESPONSE WITH EXPECTED OUTCOMES ESTABLISHING DURING THE PLANNING PHASE

Front 12

EVALUATION IS ONE OF THE MOST CRITICAL PHASES OF THE NURSING PROCESS BECASUE IT DETERMINES THE USEFULNESS AND EFFECTIVENESS OF NURSING PRACTICE AND IS:
A. CLIENT DRIVEN AND CLIENT CENTERED
B. NURSE CENTERED AND CLIENT DRIVEN
C. PHYSCIAN AND NURSE CENTERED
D. CLIENT AND NURSE DRIVEN

Back 12

A. CLIENT DRIVEN AND CLIENT CENTERED

Front 13

EVALUATION IS ONGOING WHENEVER THE NURSE HAS CONTACT
A. WITH THE CLIENT
B. WITH THE FAMILY
C. WITH THE PHYSICIAN
D. WITH THE PHYSICIAN AND FAMILY

Back 13

A. WITH THE CLIENT

Front 14

THE NURSE MUST REALIZE THAT EVALUATION IS
A. THE SECOND STEP IN NURSING CARE
B. DYNAMIC AND EVER CHANGING
C. THE RESSESSMENT OF THE CLIENT FOR NEW PROBLEMS
D. AT THE DIRECTION OF THE PHYSCIANS ORDERS

Back 14

B. DYNAMIC AND EVER CHANGING

Front 15

THE EVALUATION PROCESS, WHICH DETERMINES THE EFFECTIVENESS OF NURSING CARE INCLUDES FIVE ELEMENTS THESE ARE
A. IMPLEMENTING, EVALUATING, DOCUMENTING, REVISING, AND CONTINUING
B. PLANNING, DIAGNOSINS, INTERPRETING, EVALUATING, AND REVISING
C. IDENTIFYING, COLLECTING, INTERPRETING, DOCUMENTING, AND TERMENINATING, CONTINUING OR REVISING THE CARE PLAN
D. ASSESSING, DIAGNOSING, PLANNING, IMPLEMENTING, AND EVALUATING

Back 15

C. IDENTIFYING, COLLECTING, INTERPRETING, DOCUMENTING, AND TERMINATING, CONTINUING OR REVISING THE CARE PLAN

Front 16

A GOAL SPECIFIES THE EXPECTED BEHAVIOR OR RESPONSE THAT INDCATES
A. RESOLUTION OF A NURSING DIAGNOSIS OR MAINTENANCE OF A HEALTHY STATE
B. THE NURSE HAS MADE THE CORRECT NURSING DIAGNOSIS
C. THE VALIDATION OF THE NURSES PHYSICAL ASSESSMENT
D. THE SPECIFIC NURSING ACTION WAS COMPLETED

Back 16

A. RESOLUTION OF A NURSING DIAGNOSIS OR MAINTENANCE OF A HEALTHY STATE

Front 17

EXPECTED OUTCOMES ARE THE EXPECTED MEASURABLE RESULTS OF THE:
A. PHYSCIANS ORDERS
B. GOAL- ORIENTATED NURSING PROCESS
C. NURSE-INITIATED GOALS
D. NEED FOR ADDITIONAL HEALTH CARE PERSONNEL

Back 17

B. GOAL-ORIENTATED NURSING PROCESS

Front 18

EVALUATING A CLIENTS RESPONSE TO NURSING CARE REQUIRES THE USE OF EVALUATE MEASURES WHICH ARE.
A. COMPUTER GENERATED
B. PROVIDED BY ANCILLARY STAFF
C. DETERMINED BY THE PHYSCIAN
D. ASSESSMENT SKILLS AND TECHNIQUES USED TO COLLECT DATA FOR EVALUATION

Back 18

D. ASSESSMENT SKILLS AND TECHNIQUES USED TO COLLECT DATA FOR EVALUATION

Front 19

THE PRIMARY SOURCE OF DATA FOR EVALUATION IS THE
A. PHYSICIAN
B. CLIENT
C. FAMILY
D. NURSE

Back 19

B CLIENT

Front 20

UNMET AND PARTIALLY MET GOALS REQUIRE THE NURSE TO:
A. COMPARE THE CLIENTS REPSONSE WITH THAT OF ANOTHER CLIENT
B. RELINQUISH CARE OF THE CLIENT TO ANOTHER NURE
C. CONTINUE INTERVENTIOND.
D. BEGIN NEW INTERVENTIONS

Back 20

C. CONTINUE INTERVENTION