Basic Nursing Skills Chapter 21: Teacher and Counselor PrepU

Mrs. Shields is a 46-year-old obese woman diagnosed with hypertension and type 2 diabetes. She tells the nurse that she knows she needs to lose weight. She recently visited her local fitness club, obtained a membership and has signed up for their next water aerobics class. According to the Transtheoretical Model of Change, what stage of change is Mrs. Shields in related to her weight loss?

Preparation Explanation: Mrs. Shields is in the preparation stage as she is actively making changes to lose weight. She has moved beyond the contemplation stage by obtaining a gym membership and enrolling in classes.

The parents of an infant suffering from apnea need to be educated on the apnea monitor and cardiopulmonary resuscitation. What should the nurse assess first regarding the parents?

Baseline knowledge of these concepts Explanation: Before educating parents on the apnea monitor and cardiopulmonary resuscitation, the nurse should determine the parents' baseline knowledge so that the nurse knows where to begin. Educational level would be the next assessment in order to plan the appropriate teaching delivery method.

A nurse is educating a 4-year-old client about cast care following a tibia-fibula fracture. Which action is not developmentally appropriate to include in the nurse's education?

Blocking 30 minutes of time for skill teaching. Explanation: Preschool age children (2 to 5 years) have short attention spans. Five- to ten-minute blocks of time are age appropriate. A 30-minute block is more appropriate for an older client.

The nurse has educated the client on the pathophysiology of osteoarthritis and degenerative joint disease. This is an example of what learning theory?

Cognitive learning theory Explanation: Cognitive learning theory is the result of people wanting to make sense of the world around them by assimilating and processing information to gain new understandings and insights.

When the newly diagnosed client with insulin-dependent diabetes tells the nurse that he has never received instruction on the administration of injections, an appropriately stated nursing diagnosis for the client is:

Deficient Knowledge of Injection Administration as verbalized by the client, related to the lack of instruction and experience Explanation: Many factors can contribute to deficient knowledge, such as a lack of exposure, lack of recall, information misinterpretation, cognitive limitations, lack of interest in learning, and unfamiliarity with information resources.

A nurse is preparing to teach a 6-year-old with a broken arm and her mother about caring for the child's cast. Which statement reflects the best education plan for these clients?

Include the child in the education; ask questions of both mother and child. Explanation: School-age children are able to make decisions and provide care for themselves. Focusing on the mother or teaching them separately does not make good use of time or validate the child's abilities.

An active, otherwise healthy, older adult client presents to the clinic with severe osteoarthritis in the bilateral knees. The nurse knows this client does not want to be a burden on his family, and he remains stoic even though he reports the pain as severe. He avoids the topic of surgery and attends church weekly. His family is supportive of any decisions he makes regarding his health. Which of the assessment data are most important to forming an individualized education plan for this client concerning treatment for his osteoarthritis?

Personal perception of health and aging Explanation: Knowing about the client's orthopedic history, religious beliefs, and barriers to mobility in the home are all helpful for an overall plan of care, but do not address individualism. Gaining insight into the client's own perceptions of health and aging, however, will allow the nurse to tailor the plan of care to the client's personal needs.

A nurse evaluates whether a middle-age client with chronic back pain has been performing the different exercises and physiotherapy procedures recommended by the physician. What would the nurse most likely use to evaluate the client?

Return demonstration Explanation: The nurse is evaluating psychomotor skills; thus, a return demonstration is a method of testing skill performance. Written tests are time-consuming, intimidating, and not always specific to the client. Oral tests can be useful in testing cognitive learning. Simulation evaluates whether the client can apply learning in different situations, but not his ability to perform the exercises.

A nurse is writing learner objectives for a client who was recently diagnosed with type 2 diabetes. Which statement best describes the proper method for writing objectives?

The nurse writes one long-term objective for each diagnosis, followed by several specific objectives. Explanation: The statement that best describes the proper method for writing objectives would be that the nurse writes one long-term objective for each diagnosis, followed by several specific objectives. The nurse would not use general statements that could be accomplished in any amount of time because this action is not addressing the specific needs of the client, and the setting in which the client is in. The nurse would not plan learner objectives with another nurse and would not always obtain input from the family of the client. The objectives need to be specific so the outcomes can be measured in the evaluation phase.

A parish nurse is preparing to provide a health promotion class to a group of adults in the parish. In preparing to meet the learning needs of this group, the nurse recognizes which of the following as a characteristic of an adult learner?

Their readiness to learn is often related to a developmental task or social role. Explanation: An adult's readiness to learn is often related to a developmental task or social role. The previous experience of the adult is a rich resource for learning. Most adults' orientation to learning is that material should be useful immediately. Peer group acceptance is a critical issue for the adolescent group.

The nurse is teaching an 80-year-old client how to instill eye drops for glaucoma. The client's daughter asks, "How do you know that my parent understands what to do?" What is the appropriate nursing response?

"When 15 minutes have passed, I will ask your parent to show me how to instill the drops." Explanation: Older clients may interact in a socially appropriate manner and may indicate that they understand the material being taught. Asking a client to recall what has been discussed after approximately 15 minutes have passed may help determine what information has actually been retained. The other responses do not demonstrate proper understanding of the condition.

The nurse is preparing to teach four clients. Which client will the nurse plan to teach using principles associated with gerogogy?

79-year old who has slight cognitive changes Explanation: Gerogogy is the unique techniques that enhance learning among older adults. Therefore, the nurse will use gerogogy with the 79-year-old client. Pedagogy is the science of teaching children or those with cognitive ability comparable to children, and would be appropriate for the 4-year-old client. Andragogy is the principles of teaching adult learners, and would be appropriate for the 31-year-old client and the 56-year-old client.

A 20-year-old client reads the nutritional chart and follows it accurately. The nurse also notes that the client understands the need of a balanced diet and its relationship with a quick recovery. Which domain correctly identifies the client's learning style?

Cognitive domain Explanation: As the client is able to understand the need for a balanced diet after the session and follows the nutritional chart accurately, the client's learning style falls in the cognitive domain. The cognitive domain is a style of processing information by listening to or reading facts and descriptions. The affective domain is a style of processing that appeals to a person's feelings, beliefs, or values. The psychomotor domain is a style of processing that focuses on learning by doing. The interpersonal domain is a style of processing that focuses on learning through social relationships.

The nurse needs to understand the teaching-learning process when administering

Educational interventions Explanation: Educational interventions require the application of the teaching-learning process.

A nurse is caring for an older adult client with arthritis. Which action is the priority for the nurse when conducting the health education for the client?

Find out what the client wants to know. Explanation: Finding out what the client wants to know helps the nurse in showing personal interest, which facilitates better learning to an adult client. Dividing information into manageable amounts, providing an environment that promotes learning, and identifying how long the education session will last can be done only when the assessment of the client is completed.

When providing client education it is essential for the nurse to incorporate what action so that learning can be optimized?

Include educational strategies that encourage clients to be active participants. Explanation: The teaching-learning relationship is a dynamic, interactive process that involves active participation from the nurse and client.

An older adult female client who is recovering from a stroke is scheduled to be transferred to the rehabilitation unit in the morning. She is tearful and verbalizes that she feels lonely and abandoned in the hospital unit. The nurse noticed that family visits daily and that there are flowers and cards in the room. Documentation in the chart indicates that the client's pastor has been by twice in the past week to visit. Which nursing diagnosis and outcome criteria need to be addressed immediately for this client?

Ineffective Coping; verbalizes support systems. Explanation: When considering appropriate evaluation criteria, be certain it relates directly to the diagnosis, and the diagnosis relates to the assessment data. There are not data to support unilateral neglect. Tying shoes evaluates client abilities, not mobility. The nurse assessed that the family visits daily, so the family process is functional. Ineffective coping is appropriately evaluated by identification of coping mechanisms, such as support systems.

A home health nurse states to her client, "I am very proud of you. You gave your first insulin injection without a problem. You have done wonderfully and are learning fast." What technique is the nurse using to compliment the client's progress?

Positive feedback Explanation: Important keys to success when evaluating learning are consistent, immediate, and frequent positive reinforcement, and teaching a small number of skills at any one time, thus creating a high possibility that the learner will master them.

The nurse completed education with a client. Which documentation entry is the most complete teaching plan?

Printed and verbal information provided on gluten-free diet. Questions answered. Verbalizes understanding. Follow-up scheduled. Explanation: Just like a plan of care, a teaching plan must show that evaluation of the intervention was performed, which demonstrates that learning occurred. Complete documentation records the topic taught, methods used to teach, clarification of concepts and the method used to evaluate how well the client understands the material.

A nurse assisting a new mother in the act of breastfeeding is represented by which form of learning?

Psychomotor Explanation: Psychomotor refers to the muscular movements learned to perform new skills and procedures.

The nurse has provided teaching for a client with a sinus infection who has been prescribed antibiotics and a decongestant. What is the appropriate nursing response when the client states, "I'm not sure how many days I'm supposed to take this antibiotic."

Re-teach the length of time to take the prescription. Explanation: Client teaching requires a circular approach, specifically if the client has not understood the teaching. The nurse needs to reteach the information that has not been understood. Asking the client to restate the teaching, telling the client to take the antibiotic, and proceeding with teaching about the decongestant are not effective teaching methods.

Which strategy should the nurse use when providing education to the older adult client?

Remain calm and conduct the teaching session in a quiet environment. Explanation: Remaining calm and conducting the teaching session in a quiet environment would decrease anxiety or distractions that interfere with learning for the older adult. Keeping the session short will increase concentration, but is not unique to older adults. The nurse is to use colorful materials in a variety of ways and the nurse's tone and pitch should vary.

A client is experiencing difficulty in adjusting to a new prosthesis despite conscientious client education by numerous members of the health care team. How should the team respond to the client's lack of learning to this point?

Revise the education plan that has guided education. Explanation: If evaluation of client education indicates that client learning has not met outcomes, it is appropriate to revise the education plan. This does not necessarily entail reducing the detail or referring the client to outside information sources. Exploring alternatives to prosthesis does not address the client's learning needs.

A pediatric nurse provides education to numerous clients in her care. Which group of children benefits most from being involved in the teaching-learning process?

School-age children Explanation: Education related to infants, toddlers, and preschool children should be directed at the parents. School-age children are capable of logical reasoning and should be included in the teaching-learning process whenever possible.

A nurse may attempt to help a patient solve a situational crisis during what type of counseling session?

Short-term counseling Explanation: Short-term counseling would help a client solve a situational crisis. A patient experiencing a developmental crisis, for example, might need long-term counseling. Motivational counseling is an evidence-based counseling approach that involves discussing feelings and incentives with the patient. Professional counseling is a general term.

When establishing a teaching-learning relationship with a client, it is most important for the nurse to remember that effective learning can best be achieved through which concept?

The client and the nurse are equal participants. Explanation: Effective learning occurs when clients and health care professionals are equal participants in the teaching-learning process.

A nurse is educating a client with a new diagnosis of diabetes. Which example demonstrates cognitive learning by the client?

The client describes signs and symptoms of hypoglycemia. Explanation: The client's ability to describe the signs and symptoms of hypoglycemia demonstrates cognitive learning (the storing and recalling of new knowledge in the brain). Demonstrating a skill, such as insulin injection, is an example of psychomotor learning. Affective learning includes changes in attitudes, values, and feelings (e.g., desire to lose weight).

The nurse is educating a client regarding a new skill. When evaluating the client's knowledge about the topic covered, what best represents that the client has learned a new skill?

The client organizes materials needed and gives return demonstration. Explanation: Skills require more than verbalization or passing a written test. Nodding and assisting with clean up does not indicate that learning has occurred, but may indicate a lack of readiness to learn. Being able to gather all equipment needed for a skill, and then performing it, demonstrates proficiency.

While applying dressings to a client's wound, the nurse teaches the client about his wound care. To promote the most effective teaching-learning relationship with this client, what would be most important for the nurse to keep in mind?

The nurse and client relationship is based on mutual sharing and negotiation. Explanation: When providing nursing care, the teaching-learning relationship between the nurse and client is special, characterized by mutual sharing, advocacy, and negotiation. Effective learning occurs when clients and health care professionals are equal participants in the teaching-learning process. Unlike some traditional views, nurses are not experts who generously bestow knowledge upon clients, nor do they barter knowledge for compliance. Both images represent the relationship as a power imbalance in which nurses, because of their knowledge and expertise, control the situation.

A nurse is providing teaching to patients in a short-term rehabilitation facility. Which examples are common teaching mistakes made by health care professionals? (Select all that apply.)

The nurse fails to accept that patients have the right to change their minds. The nurse uses medical jargon frequently when discussing the teaching plan. The nurse ignores the restrictions of the patient's environment. Explanation: Common teaching mistakes made by health care professionals would include the following: the nurse failing to accept that clients have the right to change their minds, the nurse using medical jargon frequently when discussing the teaching plan, and the nurse ignoring the restrictions of the client's environment. The nurse does negotiate goals with the client. The nurse would evaluate what the client had learned. The nurse would review educational media when planning learner objectives.