Chapter 9 - Teaching and Counseling

Which documentation example best reflects the complexity of client teaching by the nurse?

"Client and spouse taught how to use phone app to count carbohydrates; client return demonstrated carb counting for a hypothetical meal."

Effective Communication Techniques

-Introduction -Use attentive skills/Active listening -Open-ended questions -Share Observations with client -Clarification -Summarizing -Use of Silence

Affective learning

-involves feelings, beliefs, and ideals -example: a client listens to the nurse explain life changes necessary to manage diabetes and then discusses feelings regarding the diagnosis

Types of teaching

1. telling - give explicit instruction 2. selling - trying to convince 3. participating - nurse and pt involved in learning together 4. entrusting - pt can manage self care, nurse for assistance 5. reinforcing - requires the use of stimulus to achieve desired response, can be + or -

Which guideline is most important for the nurse to keep in mind when planning to teach an exercise class to a group of older adults?

Allow ample time for psychomotor skills.

The nurse is planning to provide teaching to a client who is recovering from abdominal surgery. When is the most appropriate time to teach the client?

As the client is sitting quietly, reading a book

The nurse is caring for a 70-year-old client with a fractured wrist. Which is the best method to determine whether the client has retained the information taught?

Ask the client to recall after approximately 15 minutes.

When caring for a client at the health care facility, the nurse observes that the client is having difficulty understanding the health education. Which action is most appropriate?

Assess for cultural differences.

A nurse is preparing to educate about the importance of contraception and safe-sex practices to a group of college students. Which factors can affect the nurse's teaching strategies? Select all that apply.

Availability of resources Learning style preferences of students Literacy level of target audience

The nurse is caring for a 60-year-old client with an improper bowel movement regimen. Which is the most appropriate method for the nurse to use in teaching this client?

Begin the session with a reference to the client's actual experience.

When caring for a client, the nurse observes that the client enjoys reading books and magazines. In which learning domain does the client's learning style fall?

Cognitive

COPE

Creative Optimism Planning Expert info

The nurse is preparing to teach a client from Generation X about hypertension. Which teaching approach should the nurse plan to implement?

Demonstrate the MyFoodPyramid phone app, to show the best food choices on a lunch tray.

A client diagnosed with type 2 diabetes has been prescribed insulin therapy in conjunction with an oral agent because the client has been experiencing difficulty controlling blood sugar levels with an oral agent alone. The nurse is preparing a teaching plan for this client. Which intervention would the nurse include in the teaching plan to address the psychomotor domain?

Demonstrating the technique for insulin self-injection

The nurse is caring for a client who has been admitted for a new diagnosis of hypertension. When should the nurse begin client teaching?

During the admission process

The spouse of a client who has recently been diagnosed with early-stage Alzheimer's disease asks the nurse to recommend websites that may supplement the spouse's learning about this diagnosis. How should the nurse respond to the spouse's request?

Identify and recommend some credible websites appropriate to the spouse's learning needs.

Which developmental consideration is a nurse assessing when determining that an 8-year-old child is not equipped to understand the scientific explanation of the child's disease?

Intellectual development

The nurse as a teacher

It is the right of the pt to know and to learn about their health and how to take care of themselves and promotes health care. A legal and professional responsibility to teach patients. Accreditation bodies look for evidence of it in documentation. Utilize the process of learning.

What is the most appropriate teaching strategy for the nurse to use for a 1-hour presentation on the prevention of osteoporosis to a group of 30 college-age women?

Lecture/discussion

Aims of teaching and counseling

Maintaining and promoting health Preventing illness Restoring health Facilitating coping

When a client says, "I don't care if I get better; I have nothing to live for, anyway," which type of counseling would be appropriate?

Motivational counseling

The nurse is teaching a client who does not speak the primary language of the hospital where the client was admitted. What is the appropriate nursing action?

Obtain an interpreter.

A client with a body mass index (BMI) of 40.3 kg/m2 states, "I know I need to get rid of this fat. I just don't know how." Which is the best assessment for the nurse to make at this time?

Past interventions for weight loss

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

Personal perception of health and aging

A client who recently underwent a coronary artery bypass graft is taking furosemide and metoprolol following the procedure. While developing a plan for a heart-healthy diet with the nurse, the client states that diet did not contribute to the heart disease and that the client should be fine just continuing to take the medications. According to the Transtheoretical Model of Change, which stage of change is the client in related to diet?

Precontemplation

A 46-year-old obese client has been diagnosed with hypertension and type 2 diabetes. The client acknowledges the need to lose weight. The client recently visited a 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 this client in related to her weight loss?

Preparation

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

Printed and verbal information provided on gluten-free diet. Questions answered. Verbalizes understanding. Follow-up scheduled.

A nurse assisting a new mother in the act of breastfeeding represents which form of learning?

Psychomotor

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

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

Short-term counseling

The nurse has completed teaching. Which client behavior demonstrates understanding within the affective domain?

States, "I feel comfortable using my walker"

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.

Which observation during the nursing assessment of a client supports the documentation of low health literacy?

The client avoids health care screenings and seeks care in the local emergency department.

A nurse is developing a contractual agreement with a client. Which statement is true of a contractual agreement?

The contract serves to meet the client's learning outcomes.

Affective Domain

The most intangible domain of the learning process. It involves affective behavior, which is conduct that expresses feelings, needs, beliefs, values, and opinions; the feeling domain.

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 as a characteristic of an adult learner?

Their readiness to learn is often related to a developmental task or social role.

TEACH

Tune into the patient Edit patient information Act on every teaching moment Clarify often Honor the patient as a partner in the education process

contactual agreement

both nurse and patient agree to a goal

A client shares with the nurse how much the client appreciates understanding the physiology of breastfeeding. The client states, "I felt very comfortable with what you explained to me, and I feel I will be successful at breastfeeding." In affective learning, this represents the nurse:

creating an atmosphere for discussion of feelings.

cognitive teaching

includes all intellectual behaviors and requires thinking Includes acquisition of knowledge, comprehension or ability to understand, application, analysis, relating ideas with an abstract manner, synthesis, relating ideas in an abstract manner, synthesis, recognizing parts of a whole and evaluation Methods - discussion, lecture, question-and-answer session, role play, discovery, independent project, field experience

Psycomotor learning

mentally and physically doing a task to learn

Formal is

planned

The nurse is conducting a community health promotion class and has developed scenarios that will involve active participation by the class attendees. What type of education strategy is the nurse incorporating into this class?

role-play

Andragogy

the art and science of teaching adults

Which statement made by a client who was recently admitted to the medical unit with a diagnosis of pneumonia indicates a physical inability to learn?

"I am having difficulty breathing."

A nurse is reviewing the teaching plan about heart failure with a client. The nurse determines that learning in the affective domain has been achieved based on which client statement?

"I realize now just how important it is to watch how much salt I use."

The nurse is discussing the use of the patient-controlled analgesia pump with the postoperative patient. Which statement by the patient indicates a need for additional education?

"I should not press the button more often than every 3 to 4 hours."

A 56-year-old client meets with the nurse for education about a recently diagnosed atrial fibrillation. The client verbalizes concerns about being away from work too long and doubts about the necessity of having blood tests every week, as the client has no symptoms. Which is the best motivational statement by the nurse for this client?

"The medicine and blood work can help prevent blood clots, which can lead to strokes. What do you know about warfarin therapy?"

While the nurse is caring for a hearing impaired client, and a family member of the client states, "What do you think is the best way to communicate?" What is the best response by the nurse?

"Use flash cards and writing pads."

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 mother understands what to do?" What is the appropriate nursing response?

"When 15 minutes have passed, I will ask your mother to show me how to instill the drops."

Which statement describes the person who is likely the most motivated to learn?

A 70-year-old female who is the client's spouse and is learning the care so the client can come home

Noncompliance

An informed decision on the part of the patient not to adhere to or follow a therapeutic plan or suggestion.

The nurse is assisting a client 55 years of age to understand the anatomy and physiology of the heart following a heart attack. What type of learning is taking place?

Andragogy

The nurse is caring for a 5-year-old child on the pediatric unit. Which activities would promote the psychomotor skills of this child? Select all that apply.

Assembling blocks Building a house with popsicle sticks Removing the toys from the toy box

The nurse must instruct a 35-year-old client with Down syndrome about the use of an albuterol rescue inhaler. Which documentation demonstrates appropriate individualization of the education plan for this client?

Assessed the client's understanding of illness; assessed motor skills and developmental stage; provided clarification

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 teaching?

Blocking 30 minutes of time for skill teaching

Before starting the education process, the nurse should determine the preferred learning style, age and developmental level, capacity to learn, motivation level, readiness to learn, and learning needs of the client. How does this help the nurse in the client's health education?

By implementing effective teaching

Which statement about providing client education before discharge is most accurate?

Client education focuses on identified home needs.

A client reads the nutritional chart and follows it accurately. The nurse also notes that the client understands the need for a balanced diet and its relationship with a quick recovery. In which domain is the client demonstrating successful learning?

Cognitive

Which learning domain is the focus for instruction when the nurse educates a new mother about the breast and its role in milk production for feeding the newborn?

Cognitive

The nurse is completing documentation after an education session with a client. Which statement best demonstrates detailed documentation of an effective teaching plan?

Demonstrated cord care to mother, who stated understanding and performed return demonstration using correct technique.

A nurse is working with an older adult client, educating the client on how to ambulate with the aid of a walker. The nurse notes that the client appears to lack the motivation to learn how to use the device. The client states, "I'm just too old to learn." What would be most appropriate for the nurse to do to motivate this client?

Describe how the walker can improve the client's quality of life.

During the health education session at the health care facility, the nurse notes that a client is able to recognize, describe to others, and explain the information learned. What is the final learning stage of the client in this case?

Independent use of new learning

The nurse is preparing discharge teaching for a client with diabetes. Which information should the nurse include? Select all that apply.

Meal planning Community resources Appropriate use of a glucometer Instructions to follow up with the health care provider

A nurse is preparing a teaching session about heart failure for a group of older adults. When planning this session, which action would be important for the nurse to integrate into the session? Select all that apply.

Plan sessions that are short in duration. Keep outside distractions to a minimum. Allow for extra time to answer questions. Tie in new information with things the group is familiar with.

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

A school nurse is discussing bike and outdoor safety measures with a group of Boy Scouts. What type of health education and counseling is the nurse providing to this group of children?

Preventing illness

Which diagnosis would best describe a situation in which a parent has a knowledge deficit concerning child safety for a toddler who is currently being treated for burns and was previously treated for a fracture from a fall?

Risk for Injury, related to mother's lack of knowledge about child safety

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

School-age children

A Chinese client who was previously treated at the health care facility for an open wound has been admitted again because the wound has become gangrenous. It has been identified that the client failed to understand proper wound care. What is the probable reason for the client failing to understand the instruction?

The client belongs to a different culture.

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.

The nurse is providing instructions to a client about performance of breast self-examination. What learning outcome would be most appropriate regarding this education?

The client will be able to perform proper breast self-examination for breast cancer detection and prevention.

A nurse is providing teaching to clients 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 clients 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 client's environment.

When teaching an adult client how to control stress through relaxation techniques, the nurse should proceed on the basis of which assumption concerning adult learners?

The nurse should be able to draw from the previous experience of the client to emphasize the importance of stress reduction.

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.

A client is admitted to the health center with chronic diarrhea. When should the nurse begin imparting health teaching about the benefits of proper diet to the client so that the risk of diarrhea is minimized?

When admitting the client

WRAT

Wide Range Achievement Test: brief achievement test measuring reading recognition, spelling, arithmetic computation

An experienced nurse is educating a client about the client's disease and how best to promote optimal health. The nurse is focusing the education on the cognitive domain of learning. Given this focus, the nurse would incorporate the client's:

critical thinking.

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

educational interventions.

A nurse and client are working together to help the client make lifestyle changes to promote improved health. The nurse is having the client sign a contractual agreement for the work they will do together. Which statements by the nurse reflect the proper purposes of such agreements? Select all that apply.

"Our goals are defined, as are ways to meet them." "With this contract, we show that we are both dedicated to improving your health."

The nurse is preparing to teach a client about postsurgical care after a laparoscopic cholecystectomy. Which factor should the nurse most consider when determining whether the client is ready and able to learn?

Physical condition

A client is reluctant to learn to do finger sticks for home international normalized ratio (INR) monitoring. What is the best statement by the nurse?

Tell me what you know about these tests.

A home health nurse is visiting a 40-year-old client who has had abdominal surgery. The client is unable to change a dressing because of obesity. The nurse is to instruct the client's spouse on the sterile dressing technique. During the visit, the nurse notes that the spouse has limited abilities due to mental disabilities. One assessment to determine the spouse's literacy would be:

to assess her reading with WRAT.

When preparing client teaching materials, how does the nurse best assess a client's preferred learning style?

Ask the client, "Do you learn best by observing, valuing, or doing?"

A client informs the nurse about being committed to quitting smoking to improve health. During discussion, the nurse asks the client "on a scale of 0 to 10, how likely are you to attend a support group?" Which strategy of motivational interviewing is the nurse using with the client?

Assessing importance

When teaching a client, the nurse notices the client tends to lose focus easily. The nurse would adapt client teaching in which way?

Talk with animation and vocal inflection to stimulate the client aurally.

When a nurse is planning for learning, who must decide who should be included in the learning sessions?

The nurse and the client

A couple has just learned that their newborn infant has a congenital cardiac anomaly that will require many lifestyle modifications, surgical corrections, and hospital stays. Place the following aspects of the couple's client education in the correct order that nurses should conduct them.

Determine their emotional readiness to learn. Draft learning outcomes. Select educational strategies. Implement various educational techniques. Revise the learning plan if needed.

A nurse is discussing the benefits of smoking cessation with a client. The nurse informs the client that smoking cessation will reduce the client's risk for cancer, improve respiratory status, and enhance the quality of life. The nurse also shares a personal story of smoking cessation, provides information on other individuals who have successfully quit, and encourages the client to attend a support group for smoking cessation. The client discusses feelings on smoking cessation and verbalizes a desire to quit smoking. What type of counseling did the nurse provide to this client?

Motivational

A nurse is counseling several clients for depression. Four of them do not seem to be improving, which leads the nurse to suggest a referral to a psychiatric nurse practitioner. Which of these clients would be most likely to attend the scheduled appointment?

A 28-year-old female who works nights, is willing to try, and asks about insurance coverage of the appointment

health literacy

a person's capacity to learn about and understand basic health information and services, and to use these resources to promote one's health and wellness

Informal is

unplanned

A nurse is assessing a client who has come to the clinic for a follow-up appointment. The client was diagnosed with asthma several months ago and has missed several appointments since that time. The client also has not been following the medication plan and has not kept the appointment for allergy testing. The nurse suspects that the client may be experiencing problems with health literacy. The nurse teaches the client about the condition and prescribed treatment. Which question from the nurse would help to assess the client's health literacy about the condition?

"How are you supposed to take your medication?"

A nurse is showing an older adult client with severe diabetes the correct method of self-administering an insulin injection. What should be the nurse's comment if the client continues making mistakes when learning how to self-administer an insulin injection? Select all that apply.

"Lots of people have the same concern." "You've just about figured out how to give yourself an injection." "Try to angle the syringe a little more this way."

The nurse has provided education to a client about home care for an open surgical wound on the lower left extremity. When evaluating learning through the cognitive domain, what statement by the nurse would be appropriate?

"Tell me about what signs of infection you will report to the health care provider."

The nurse is visiting a client who was released from inpatient rehabilitation 6 weeks ago after a 5-month recovery from a motor vehicle accident that left the client immobile. As the nurse enters the home, the client braces hands on the arms of a chair to rise and uses crutches to walk across the room. What is the best response by the nurse?

"You have made an amazing recovery."

A nurse has permission from the homebound client to educate any of the family members about providing care for the client. Which family member is the most appropriate choice?

A brother who visits daily, does laundry, and cooks all meals for the client

The nurse is teaching a client about enoxaparin sodium for the first time. This client has never given a self-injection before. Which actions are appropriate for the nurse to take? Select all that apply.

Have the client demonstrate the proper technique for injection. Gather all necessary supplies for injection teaching. Review medication data sheets to ensure correct dosage.

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

The client organizes materials needed and gives return demonstration.