A nurse is assisting in the care of a client who is in active labor and is to undergo an amniotomy. Which of the following actions should the nurse take? (Move the steps into the box, placing them in the order of performance. Use all the steps.)

A. "Define the problem.": While defining the problem is important in the early stages of performance improvement, evaluating effectiveness requires looking at data or outcomes, not just the initial identification of the issue.

B. "Identify data collection methods.": Identifying data collection methods is part of the planning phase, but evaluating the effectiveness involves reviewing actual data to see if the goals of the program were achieved.

C. "Perform chart audits.": This is correct. Performing chart audits allows the nurse to assess if the desired improvements have been implemented and whether the performance outcomes are being met. Chart audits are a common method for evaluating the effectiveness of a performance improvement program.

D. "Review the facility's policy and procedure manual.": While reviewing policies is important for understanding standards of care, it does not directly evaluate the effectiveness of a performance improvement program. Data from actual practice, such as chart audits, would be more relevant for evaluation.

A. "Communicate with personnel about the need for prophylaxis" is incorrect. While it is important to consider prophylaxis for those who may have been exposed to tuberculosis, the first priority is to minimize the risk of transmission from the client to others.

B. "Place a mask on the client" is correct. Placing a mask on the client is the first step in preventing the spread of tuberculosis. This helps contain respiratory droplets that could transmit the bacteria to others.

C. "Contact those who live with the client" is incorrect. While it is important to contact close contacts to assess their risk, this action comes after implementing infection control measures, such as placing a mask on the client.

D. "Notify the local health department" is incorrect. While the health department must be notified about a tuberculosis diagnosis, the immediate priority is to protect others from exposure by masking the client and using appropriate isolation precautions.