Kozier Chapter 14

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When initiating the implementation phase of the nursing process,
the nurse performs which of the following phases first?

A: Carrying out nursing interventions C: Reassessing the client

B: Determining the need for assistance
C: Reassessing the client
D: Documenting interventions
Under what circumstances is it considered acceptable practice for
the nurse to document a nursing activity before it is carried out?

A: When the activity is routine (e.g., raising the bed rails)

B: When the activity occurs at regular intervals (e.g., turning the D: It is never acceptable
client in bed)
C: When the activity is to be carried out immediately (e.g., a stat
medication)
D: It is never acceptable
The primary purpose of the evaluating phase of the care planning
process is to determine whether:

A: Desired outcomes have been met A: Desired outcomes have been met
B: Nursing activities were carried out
C: Nursing activities were effective
D: Client's condition has changed
The client has a high-priority nursing diagnosis for Risk for Im-
paired Skin Integrity related to the need for several weeks of
imposed bed rest. The nurse evaluates the client after 1 week
and finds the skin integrity is not impaired. When the care plan is
reviewed, the nurse should perform which of the following?
B: Keep the diagnosis since the risk factors are still present
A: Delete the diagnosis since the problem has not occurred
B: Keep the diagnosis since the risk factors are still present
C: Modify the nursing diagnosis to Impaired Mobility
D: Demote the nursing diagnosis to a lower priority
If the nurse planned to evaluate the length of time clients must wait
for a nurse to respond to a client need reported over the intercom
system on each shift, which process does this reflect?
B: Process evaluation
A: Structure evaluation
B: Process evaluation
C: Outcome evaluation
D: Audit
Which of the following is true regarding the relationship of imple-
menting to the other phases of the nursing process?

A: The findings from the assessing phase are reconfirmed in the

implementing phase A: The findings from the assessing phase are reconfirmed in the
B: After implementing, the nurse moves to the diagnosing phase implementing phase
C: The nurse's need for involvement of other health care team
members in implementing occurs during the planning phase
D: Once all interventions have been completed, evaluating can
begin
The care plan calls for administration of a medication plus client
education on diet and exercise for high blood pressure. The nurse
finds the blood pressure extremely elevated. The client is very
distressed with this finding. Which nursing skill of implementing
C: Interpersonal
would be needed most?

A: Cognitive
B: Intellectual

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C: Interpersonal
D: Psychomotor
Which of the following demonstrates appropriate use of guidelines
in implementing nursing interventions? (select all that apply)

A: No interventios should be carried out without the nurse having

A: No interventios should be carried out without the nurse having
clear rationales
clear rationales
B: Always follow the primary care provider's orders exactly, with-
D: When possible, give the client options in how interventions will
out variation
be implemented
C: Encourage all clients to be as dependent as desired and allow
E: Each intervention should be accompanied by client teaching
the nurse to perform care for them
D: When possible, give the client options in how interventions will
be implemented
E: Each intervention should be accompanied by client teaching
Which of the following represents application of the components
of evaluating?

A: Goal achievement must be written as either completely met or

unmet
B: Data related to expected outcomes must be collected
B: Data related to expected outcomes must be collected
C: If the outcome was achieved, conclude that the plan was
effective
D: After determining that the outcome was not met, start over with
a new nursing care plan
An element of quality improvement, rather than quality assurance,
is which of the following?

A: Focus is on individual outcomes D: Plans corrective actions for problems

B: Evaluates organizational structures
C: Aims to confirm that quality exists
D: Plans corrective actions for problems
Quality improvement is different than quality assurance. The main
difference is that:

A: Quality improvement reports are published. Quality assurance

reports are internal.
B: Quality improvement aims to evaluate and improve the quality
B: Quality improvement aims to evaluate and improve the quality
of health care based on internal assessment
of health care based on internal assessment
C: Quality improvement follows organizational structure and qual-
ity assurance follows client care
D: Quality improvement is internal and quality assurance is exter-
nal
The nurse, as a member of the quality assurance committee,
evaluates what components of care?

A: Structure, process, and outcome

B: Outcomes, client satisfaction, and evaluation of level of care A: Structure, process, and outcome
C: Client care improvement, evidence-based practices, and out-
come evaluations
D: Internal assessment, care plans, and methods of reimburse-
ment
Consider the following nursing diagnosis for a client who is on
bed rest. Risk for Impaired Skin Integrity related to bed rest. The
nursing interventions are derived from the etiologic portion of the
nursing diagnosis, which includes:
B: Turn and reposition every 2 hours
A: Select high-protein foods at each meal
B: Turn and reposition every 2 hours
C: Offer a back rub from time to time
D: Provide a daily bath

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The nurse may need to revise or modify a goal statement if:

A: The nursing diagnosis was inaccurate

A: The nursing diagnosis was inaccurate**
B: Nursing goals are appropriate
C: All databases are complete
D: The client has not met the goal
The nurse determines that the plan of care is not effective and that
modification is needed. The nurse reviews which of the following
prior to altering the plan of care? (select all that apply)
A: Are goals realistic?
B: Are nuring diagnoses relevant and accurate?
A: Are goals realistic?
C: Are data complete, accurate, and validated?
B: Are nuring diagnoses relevant and accurate?
E: Do new nursing diagnoses require new goals?
C: Are data complete, accurate, and validated?
D: Did the client agree that outcomes were not met?
E: Do new nursing diagnoses require new goals?
The nurse recognizes which of the following actions as an exam-
ple of an outcome evaluation?

A: A survey is conducted to analyze patterns of staffing

B: An audit is conducted to determine the number of postoperative B: An audit is conducted to determine the number of postoperative
infections infections
C: A nurse checks a client's blood pressure before administering
a new antihypertensive medication
D: Nursing documentation is reviewed for compliance with hospi-
tal standards
The nursing unit has decided to do a nursing audit to determine
the time from client admission until the admission history is fully
completed. Which of the following methods would be appropriate
for the nursing unit to use? (select all that apply)
A: Reviewing clinical records
A: Reviewing clinical records D: Directly observing nursing care
B: Interviewing the family
C: Conducting peer reviews
D: Directly observing nursing care
E: Interviewing the client
The evaluation statement is written by the nurse on the care plan
or in the nurse's notes and consists of:

A: Outcome evaluation and process D: Conclusion and supporting data

B: Process evaluation and conclusions
C: Structure evaluation and conclusion
D: Conclusion and supporting data
What are the two parts in a nursing evaluation statement?

A: Conclusion and implementation

D: Conclusion and supporting data
B: Implementation and data analysis
C: Implementation and summary
D: Conclusion and supporting data
The nurse preceptor tells the student to request assistance if:
(select all that apply)

A: It would cause less stress on the client A: It would cause less stress on the client
B: The student is unsure of how to perform the activity B: The student is unsure of how to perform the activity
C: Implementing an activity alone would be unsafe C: Implementing an activity alone would be unsafe
D: The student has already done the intervention three times and
does not want to do it again
E: Other nurses are not busy
When initiating the implementation phase of the nursing process,
the first step the nurse performs is:

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A: Reassessing the client
B: Determining the need for assistance
A: Reassessing the client
C: Carrying out nursing interventions
D: Documenting interventions
Effective evaluation of the client's response to nursing care re-
quires:

A: Judging conclusions about a problem status B: Collecting data for comparison to goals
B: Collecting data for comparison to goals
C: Performing interventions appropriately
D: Determining when other phases were implemented
When implementing nursing interventions, the nurse displays
cognitive skills by:

A: Performing nursing procedures appropriately C: Using critical thinking

B: Using strong verbal skills
C: Using critical thinking
D: Conveying cultural sensitivity
The nurse ensures positive client outcomes by using what skills?

A: Interpersonal A: Interpersonal
B: Technical B: Technical
C: Activity D: Problem Solving
D: Problem Solving
E: Psychomotor
The main purpose for the nurse to use a checklist for care plan
evaluation is:

A: It identifies areas that require the nurse's further examination

A: It identifies areas that require the nurse's further examination
B: To determine if the care plan was effective
C: It stays within a timeframe and does not look beyond the due
date of interventions
D: To see if all interventions were carried out
The nursing team on a specific unit decides to determine if client
call bells are answered in a timely manner. This will be measured
by someone on the team documenting time from call bell ringing
to nurse response. This reflects what type of quality assurance
process?
C: Process evaluation
A: Structure evaluation
B: Outcome evaluation
C: Process evaluation
D: Audit
The nurse develops a quality assurance (QA) program to evaluate
and promote excellence in the health care provided to clients and
recognizes the need for what components of care evaluation to
meet this goal?
A: Process evaluation
C: Outcome evaluation
A: Process evaluation
D: Structure evaluation
B: Nurse-client ratios
C: Outcome evaluation
D: Structure evaluation
E: Number of incident reports
The nurse documents that the goal or desired outcome was met,
partially met, or not met. What part of the evaluation statement is
the nurse documenting?
C: Conclusion
A: Supporting data
B: Planning

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C: Conclusion
D: Collecting data
The nurse understands that the implementation phase of the
nursing process concludes with:

A: Assessing the outcome of implementation B: Implementing the nursing interventions

B: Implementing the nursing interventions
C: Reassessing the client
D: Determining the nurse's need for assistance
Which of the following accurately explain how the nurse chooses
a nursing intervention?

A: Interventions are nurse-initiated activities only

D: Interventions focus on the etiology of the nursing diagnosis
B: Interventions are chosen to alleviate or reduce the impact of
the client's medical diagnosis
C: Most interventions are part of the nurse's dependent role
D: Interventions focus on the etiology of the nursing diagnosis
Prior to making modifications to the care plan, the nurse must:

A: Identify other nursing diagnoses

B: Complete the admission assessment C: Identify if the interventions chosen were appropriately imple-
C: Identify if the interventions chosen were appropriately imple- mented
mented
D: Determine if the client's input was used to choose the nursing
diagnoses
The nurse utilizes interpersonal skills when:

A: Turning the client in bed

B: Transferring a bilateral amputee from bed to chair using a Hoyer D: Orienting a new colleague
lift
C: Applying Buck's traction
D: Orienting a new colleague
The quality assurance staff of a hospital is conducting a study
to determine infection rates in postoperative clients. What type of
quality assurance program is this?
A: Outcome evaluation
A: Outcome evaluation
B: Quality improvement
C: Structure evaluation
D: Process evaluation
When performing an effective evaluation, the nurse compares
current assessment findings to data from the: (select all that
apply)
A: Assessment phase
A: Assessment phase
E: Planning phase
B: Diagnosing phase
C: Implementing phase
D: Documentation phase
E: Planning phase

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