Question 1

Planning care in the outcome identification phase allows:

Accepted Answer

Outcome identification serves the purpose of promoting client participation. Evaluation takes place after interventions have been performed. Efficiency is not the primary goal of care planning. The appropriateness of diagnoses can only be determined after care has been provided and evaluated.

Question 2

A client is rehabilitating from a fractured right leg and is learning to walk on crutches. Together, the client and the nurse have established a plan for the client to walk with a three-point gait for 20 feet by the next day. In outcome identification, what is this termed?

Accepted Answer

The activity in outcome identification is the establishment of client goals and outcome criteria.

Question 3

When a nurse notices the client is in pain and needs to learn to walk on crutches, which outcome identification is the priority?

Accepted Answer

In this scenario, pain management is the priority. In outcome identification, activities performed include establishing priorities.

Question 4

A client is unconscious and unable to provide input into outcome identification. With which group of individuals should the nurse consult for the formulation of goals and measurable outcomes?

Accepted Answer

The family is aware of the client's past experiences and accomplishments. Thus, the nurse should allow for the involvement of support people, particularly family.

Question 5

A nurse identifies outcomes of care for the hospitalized, postoperative client primarily to:

Accepted Answer

Outcome identification also promotes participation, provides care plans that are realistic and measurable, and allows for involvement of support people.

Question 6

A computerized information system developed to classify client outcomes is the:

Accepted Answer

The Nursing Outcome Classification (NOC) system is organized according to categories, classes, labels, outcome indicators, and measurement activities for outcomes.

Question 7

The Nursing-Sensitive Outcomes Classification system organizes outcomes by:

Accepted Answer

The outcomes are organized according to categories, classes, labels, outcome indicators, and measurement activities for outcomes.

Question 8

Which nursing diagnosis is high priority?

Accepted Answer

High-priority nursing diagnoses are those that are potentially life-threatening and require immediate action.

Question 9

For the postoperative client, which nursing diagnosis will require outcome identification that could contribute to a maladaptive postoperative recovery?

Accepted Answer

In this scenario, ineffective breathing patterns will promote the development of pneumonia in the postoperative phase.

Question 10

What is the purpose of the client outcome?

Accepted Answer

A client outcome addresses the problem stated in the nursing diagnosis.

Question 11

When establishing client outcomes with the client, what is the qualifier in the outcome?

Accepted Answer

The qualifier is a description of the parameter for achieving the outcome.

Question 12

What are specific, measurable, and realistic statements of goal attainment?

Accepted Answer

Outcome criteria are specific, measurable, realistic statements of goal attainment.

Question 13

According to the Nursing Intervention Classification (NIC), the most basic level of nursing intervention is:

Accepted Answer

The most basic domain of the seven domains of Nursing Intervention Classifications is Physiologic: Basic.

Question 14

A treatment based on a nurse's clinical judgment and knowledge to enhance client outcomes is a nursing:

Accepted Answer

A nursing intervention is any treatment based upon clinical judgment and knowledge that a nurse performs to enhance client outcomes.

Question 15

A nurse is demonstrating Foley catheter care to a client. Which type of nursing intervention does this best represent?

Accepted Answer

Demonstrating, teaching, and observing a return demonstration are classified as educational interventions.

Question 16

When a nurse assists a postoperative client to the chair, which type of nursing intervention does this represent?

Accepted Answer

Psychomotor interventions include activities such as positioning, inserting, and applying.

Question 17

The clinical nursing plan of care used by the registered nurse differs from the instructional nursing plan of care prepared by nursing students. The primary difference is that the clinical nursing care plan usually:

Accepted Answer

In clinical settings, nurses may use rationales to illustrate research findings or support controversial approaches to problems.

Question 18

One of the primary factors that the nurse considers when setting priorities for the client in the acute care setting after cardiac surgery is the client's:

Accepted Answer

Because a person's condition changes, priorities change. Priorities are based on information collected during reassessment.

Question 19

A nurse is applying the nursing process and is involved in establishing priorities. The nurse is most likely in which phase of the nursing process?

Accepted Answer

During outcome identification and planning, the nurse establishes priorities as well as client goals and outcome criteria for outcome identification. During this phase, the nurse also plans nursing interventions and writes the plan of care. Assessment involves data collection; diagnosis involves identifying client problems. Implementation involves putting the plan of care into action.

Question 20

A nurse is working with a newly admitted client with diabetes to develop client outcomes. When writing these outcomes, which verb would be appropriate to use in the statement. Select all that apply.

Accepted Answer

When writing client outcomes, it is important that an action verb is used so that the behavior can be evaluated. Verbs such as demonstrate, state, and explain are appropriate action verbs. Understand and know are difficult to evaluate because they lack a behavioral component.

Quiz 8: Outcome Identification and Planning