Chapter 7 Implementation & Evaluation


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Chapter 7  Implementation & Evaluation



Complete Chapter Questions And Answers

Sample Questions


Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. A physician prescribes oral aripiprazole 10 mg daily for a client with schizophrenia. This medication is unfamiliar to the nurse, and she cannot find it in the hospital formulary or other references. How should she proceed?

Administer the medication as prescribed.
Hold the medication and notify the prescriber. 3)

Consult with a pharmacist before administering it.
Ask the patient’s nurse for information about the medication.

ANS: 3
The nurse must recognize when she does not have the knowledge or skill needed to implement an order. Because the nurse is unfamiliar with the medication, that does not mean she should hold it and delay patient treatment. It is wisest to first consult with the pharmacist for information before administering the medication to ensure safe practice. Administering the medication as prescribed, without knowing its expected actions and side effects, at the least prevents adequate reassessment; at the most, it is dangerous. Holding the medication and notifying the prescriber prevents the client from receiving timely treatment—many drugs are less effective if a consistent schedule is not maintained. Asking another nurse to administer the medication is also unsafe because it cannot be assumed that the other nurse has the correct knowledge. In addition, the nurse caring for the client must assess for adverse reactions to the medication.

PTS: 1 DIF: Moderate REF: p. 118
KEY: Nursing process: Implementation | Client need: SECE | Cognitive level: Analysis

____ 2. Which task can be delegated to nursing assistive personnel (NAP)? 1)
Turn and reposition the client every 2 hours.

Assess the client’s skin condition.
Change pressure ulcer dressings every shift.
Apply hydrocolloid dressing to the pressure ulcer.

Treas Fundamentals TB07-2 Test Bank, Chapter 07

ANS: 1
The nurse can delegate turning the client every 2 hours to the NAP. Assessing the client’s skin condition, changing pressure ulcer dressings, and applying a hydrocolloid dressing to a pressure ulcer are all interventions that require nursing knowledge and judgment.

PTS: 1 DIF: Moderate REF: pp. 122–124
KEY: Nursing process: Implementation | Client need: SECE | Cognitive level: Application

____ 3. The nurse has just finished documenting that he removed a patient’s nasogastric tube. Which is the next logical step in the nursing process?

2) Planning 3) Evaluation 4) Diagnosis

ANS: 3
The implementation phase ends when you document nursing actions on the client’s chart. Implementation evolves into the evaluation step when you document the client’s response to your interventions. As a general rule, the steps in order are as follows: assessment diagnosis, planning outcomes, planning interventions, implementation, and evaluation.

PTS: 1 DIF: Easy REF: p. 125
KEY: Nursing process: Implementation | Client need: SECE | Cognitive level: Comprehension

____ 4. Which nursing intervention is best individualized to meet the needs of a specific client?
Suction the client every 2 hours per unit policy.

Use incentive spirometry every hour while awake per postoperative protocols.
Institute swallowing precautions.
Move client out of bed to the chair daily; client prefers to be out of bed for dinner.

ANS: 4

Treas Fundamentals TB07-3 Test Bank, Chapter 07

Positioning the client in the chair for meals considers the client’s desire to be out of bed for dinner, so it is obviously individualized. An intervention performed according to unit policy or protocols is not necessarily individualized. “Institute swallowing precautions” does not provide instructions for the specific actions needed to do that for “this particular” client.

PTS: 1 DIF: Moderate REF: p. 118; high-level question, answer not given verbatim
KEY: Nursing process: Planning interventions | Client need: SECE | Cognitive level: Application

____ 5. The primary provider prescribes an indwelling urinary catheter for a client who is mildly confused and has been combative. How should the nurse proceed?
Ask a colleague for help, because the nurse cannot safely perform the procedure alone. 2)

Gather the equipment and prepare it before informing the client about the procedure. 3)
Obtain an order to restrain the client before inserting the urinary catheter.

Inform the provider that the nurse cannot perform the procedure because the client is confused.

ANS: 1
Before the nurse begins a procedure, she should review the care plan and look at the orders critically. Because this client is confused, she should ask a colleague to assist with the procedure to prevent undue stress for the client and nurse. The client should be informed about the procedure before the nurse gathers the equipment. Gathering the equipment and bringing it into the room before explaining the procedure might cause the client anxiety. Restraining the client should be done only as a last resort and to prevent client injury. Informing the primary provider that the procedure cannot be performed because the client is confused is inappropriate because the procedure can very likely be done with assistance.

PTS: 1 DIF: Moderate REF: p. 118
KEY: Nursing process: Implementation | Client need: SECE | Cognitive level: Analysis

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