Prep- U CH 9: Teaching and Counseling

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

-educational interventions

Which response from the client enables the nurse to determine the effectiveness of a recent medication teaching session for an older adult client who is diagnosed with tuberculosis (TB)

"I will be taking the TB medication for at least 6 months, because it takes a long time to kill the TB germs."

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 (Exp. 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 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 -Elicit-provide-elicit -Evoking change talk -Prioritizing

Assessing importance

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 dom

Demonstrating the technique for insulin self-injection

A nurse assisting a new mother in the act of breastfeeding represents which form of learning? a. Affective b. Psychomotor c. Cognitive d. Simplistic

psychomotor (Psychomotor refers to the muscular movements learned to perform new skills and procedures, such as breastfeeding. Affective learning involves engagement of the client's emotions. Cognitive learning involves engagement of the client's critical thinking and reason. Simplistic is not a formal type of learning, and assisting a new mother with breastfeeding is not simplistic.)

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? a. Are you worried about the pain? b. Why don't you want to do this? c. Most people are afraid of sticking themselves. d. Tell me what you know about these tests.

Tell me what you know about these tests (Saying something to encourage the client to openly discuss personal issues is the best option. Assessing worry about pain narrows the client's answer to only addressing pain. Asking "why" questions may be considered probing or accusatory and tends to block communication. Generalizing the client's fear is belittling. Assessing the client's perceptions about checking the INR opens up the discussion about the client's barrier to learning to perform this test.)

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 (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. Positive reinforcement is also known as positive feedback, which is what the nurse is providing in this case. Negative reinforcement or feedback would be attempting to change a client's behavior by pointing out and criticizing or even punishing mistakes or undesirable behaviors. Motivation refers to the client's desire to learn or make a change. Health promotion is a topic that may be covered in client teaching and that pertains to optimizing one's health through maintaining proper nutrition, exercise, and hygiene.)

A nurse is educating a client with a new diagnosis of diabetes. Which example demonstrates cognitive learning by the client? a. The client describes signs and symptoms of hypoglycemia. b. The client demonstrates proper technique for injecting insulin. c. The client expresses a desire to improve nutritional intake and lose weight. d. The client prepares the skin for the administration of an insulin injection.

- The client describes signs and symptoms of hypoglycemia. (Exp. 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).

Which nursing action is applicable to the psychomotor domain of learning when conducting a teaching session for breastfeeding mothers?

- observing a mother expressing the breast milk

Which documentation example best reflects the complexity of client teaching by the nurse? -"Told client to take antibiotic as ordered." -"Client return demonstrated how to use glucometer." -"Taught client about peak flows; client verbalized understanding." -"Client and spouse taught how to use phone app to count carbohydrates; client return demonstrated carb counting for a hypothetical meal."

"Client and spouse taught how to use phone app to count carbohydrates; client return demonstrated carb counting for a hypothetical meal." (The nurse should document who the teaching was provided to, what was taught, the teaching method, and the evidence of learning. The other answer choices are not as comprehensive and, therefore, are not the best examples of teaching.)

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? a. "Let me document that you can walk." b. "Those physical therapists work wonders. c. "You have made an amazing recovery." d. "Are you supposed to be out of the wheelchair?"

- "You have made an amazing recovery" (Reinforcement of learning shows that the nurse supports and wants to encourage the client. Giving credit where it is due communicates these values. Documenting is necessary, but stating this does not show interest in the client's progress. Crediting the therapists does not encourage the client. Asking about permission to ambulate negates the goal for improving wellness.)

When teaching a client, the nurse notices the client tends to lose focus easily. The nurse would adapt client teaching in which way? a. Request family members to serve as translators. b. Provide less health teaching because of the language barrier. c. Elongate the teaching session to be sure the client understands. d. Talk with animation and vocal inflection to stimulate the client aurally.

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

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? -Refer the client to internet resources on proper bowel health. -Have the client join a small group of other clients with the same problem and facilitate group discussions. -Begin the session with a reference to the client's actual experience. -Talk to the client's relatives and get a detailed account of the client's history.

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

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? a. Allow ample time for psychomotor skills. b. Keep the session at 2 to 3 hours. c. Allow for long-term memory loss. d. Provide information in a structured format.

Allow ample time for psychomotor skills. (Older adults need more time to learn psychomotor skills. Sessions of 2 to 3 hours are too long; short-term rather than long-term memory loss affects older adults; and information can be structured or nonstructured, depending on the content.)

The nurse has educated the client on the pathophysiology of osteoarthritis and degenerative joint disease. This type of teaching best illustrates which learning theory? -Adaptive learning theory -Behavioral learning theory -Cognitive learning theory -Developmental learning theory

Cognitive Learning theory (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. Developmental learning theory focuses on considering the patient's physical maturation and abilities, psychosocial development, and cognitive capacity when providing education. Behavioral learning theory focuses on how one learns and unlearns behaviors. Adaptive learning theory explains how learning is optimized when teaching is adapted to the particular learning style of the learner.)

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 states understanding and passes a written test. -The client organizes materials needed and gives return demonstration. -The client verbalizes items needed and how to perform the skill. -The client nods when asked about process and assists with cleanup.

The client organizes materials needed and gives return demonstration. (Confirmation that a client has learned a skill requires more than the client verbalizing understanding, passing a written test, nodding, or assisting with cleanup. Being able to gather all equipment needed for a skill and then perform it demonstrates proficiency.)

Which strategy should the nurse use when providing education to the older adult client? a. Remain calm and conduct the teaching session in a quiet environment. b. Avoid the use of colorful materials and keep the session short. c. Teach in a monotone voice in a quiet environment. d. Teach from books only and remain calm.

-Remain calm and conduct the teaching session in a quiet environment. (Exp. 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 nurse may attempt to help a client solve a situational crisis during what type of counseling session

- short- term counseling (Short-term counseling would help a client solve a situational crisis. A client 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 client. Professional counseling is a general term.)

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? a. "After I demonstrate it once, your mother will be able to do it." b. "When 15 minutes have passed, I will ask your mother to show me how to instill the drops." c. "We can never be completely sure that your mother understands instructions." d. "I will have you bring your mother back next week to see how things are going."

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

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 (Lecture/discussion is appropriate for this topic, audience, and group size. A lecture is a formal presentation of information by a teacher to a group of learners. This format is most effective when communicating facts. Role play would not be an appropriate teaching strategy for this topic, as key points cannot be acted out, or for this size of a group, as there are too many students for each one to be able to participate in role play. Demonstration would not be appropriate, either, as the topic does not focus on particular skills that can be demonstrated. Test taking is not appropriate for teaching but for evaluation of learning.)

Which statement describes the person who is likely the most motivated to learn? -A 29-year-old male whose significant other is insisting on the client receiving the education -A 52-year-old male who has been hired to drive the client home from the clinic -A 70-year-old female who is the client's spouse and is learning the care so the client can come home -A 25-year-old female who just completed a course of physical therapy

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

x 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. -Encourage the spouse to avoid online resources due to the unregulated nature of the Internet. -Direct the spouse to online databases such as the Cumulative Index to Nursing and Allied Health Literature. -Provide the spouse with print-based materials that are clearly referenced and reflect the spouse's learning style.

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

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 nurse is the expert in the teaching-learning environment. -The nurse must be able to handle criticism during the process. -The client and the nurse are equal participants. -Assimilation and application of psychomotor concepts is essential.

The client and the nurse are equal participants. (Effective learning occurs when clients and health care professionals are equal participants in the teaching-learning process, not when the nurse is viewed as the expert. Although it is important for the nurse to be able to handle criticism and to understand and apply psychomotor concepts when teaching, these are not as important as viewing the client and nurse as equal participants.

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? a. Blocking 30 minutes of time for skill teaching b. Using dolls to demonstrate psychomotor skills c. Ensuring the client's parents are present d. Giving stickers as a reward for task completion

-Blocking 30 minutes of time for skill teaching

The client is newly diagnosed with type 2 diabetes. After teaching the client about diabetes and how to self-administer insulin, the nurse identifies which client response as a need for additional education? a. The client gives a return demonstration of cleaning the side of the finger with alcohol before using a lancet. b. During the return demonstration, the client draws up insulin, leaving tiny bubbles in the syringe. c. Follow-up visit demonstrates a fasting blood glucose level of 89 mg/dl (4.94 mmol/l). d. The client reports being careful to rotate injection sites.

- During the return demonstration, the client draws up insulin, leaving tiny bubbles in the (Exp. Cleaning the side of the finger to check blood glucose, fasting blood glucose level of 89 mg/dl (4.94 mmol/l), and rotating injection sites are all appropriate actions. Drawing up insulin and leaving bubbles in the syringe indicates that the client does not understand that it could affect the blood glucose level by lowering the correct insulin amount in the syringe.)

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

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? a. Orthopedic surgical history b. Personal perception of health and aging c. Floor plan of the client's dwelling d. Formal religious beliefs

Personal perception of health and aging (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.)

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? a. Knowledge Deficit: child safety, related to inexperience with the active developmental stage of a toddler b. Risk for Injury, related to mother's lack of knowledge about child safety c. Potential for Enhanced Parenting, related to child safety knowledge deficit d. Non-compliance: child safety, related to mother's lack of experience and socioeconomic level

Risk for Injury, related to mother's lack of knowledge about child safety (The best answer would be "Toddler at High Risk for Injury, related to mother's lack of knowledge about child safety". The question states the woman has a knowledge deficit, and this is what the focus of the plan of care would be. However, the mother's lack of knowledge puts the toddler at high risk for injury, which is a critical component to include in the diagnosis and which is omitted in the other answer options.)

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 or two broad objectives rather than several specific objectives. -The nurse writes general statements for learner objectives that could be accomplished in any amount of time. -The nurse plans learner objectives with another nurse before obtaining input from the client and family. -The nurse writes one long-term objective for each diagnosis, followed by several specific objectives.

The nurse writes one long-term objective for each diagnosis, followed by several specific objectives.

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? A. "Use words that begin with 'f,' 's,' 'k,' and 'sh' to communicate." B. "Use flash cards and writing pads." C. "Limit communication to avoid frustration." D. "Encourage family members to increase their vocal pitch."

-USE FLASH CARDS AND WRITING PADS (EXP. Using flash cards and writing pads to communicate is a good substitute for verbal instructions for persons with hearing impairment. Speaking words that begin with "f," "s," "k," and "sh" typically requires forming high-pitched sounds, which are difficult for clients with hearing impairment to discriminate. Do not limit communication, because it will alienate the client from family and friends. Lowering (rather than increasing) the vocal pitch is better, as hearing loss is generally in the higher pitch ranges.)

The nurse has educated the client on the pathophysiology of osteoarthritis and degenerative joint disease. This type of teaching best illustrates which learning theory? a. Adaptive learning theory b. Behavioral learning theory c. Cognitive learning theory d. Developmental learning theory

-cognitive learning theory (Exp. 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. Developmental learning theory focuses on considering the patient's physical maturation and abilities, psychosocial development, and cognitive capacity when providing education. Behavioral learning theory focuses on how one learns and unlearns behaviors. Adaptive learning theory explains how learning is optimized when teaching is adapted to the particular learning style of the learner.)

The nurse is providing instructions to a client about performance of breast self-examination. What learning outcome would be most appropriate regarding this education? a. The client will demonstrate self-efficacy and improved body image. b.The client will have restoration of breast function. c. The client will be able to perform proper breast self-examination for breast cancer detection and prevention. d. The client will demonstrate improved coping skills.

The client will be able to perform proper breast self-examination for breast cancer detection and prevention. (Exp. This client education is focused on teaching the client a psychomotor skill for the purpose of early detection of breast cancer. Therefore, an appropriate learning outcome would be that the client is able to perform the skill properly. This client does not have any self-image problems, breast dysfunction, or poor coping skills, so outcomes related to these issues would not be appropriate

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? -Recall of the information being taught -Independent use of new learning -Involvement in the education in an active way -Repetition of information for memorization

- Independent use of new learning (The final learning stage for the client in this case is the independent use of the new learning. The client demonstrates the ability to recall the information being taught by describing it to others. Involvement of the client in the health education in an active way is required to maintain the attention and the concentration of the client. Repetition of information for memorization is a technique to teach illiterate clients.)

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? a. Intellectual development b. Motor development c. Emotional maturity d. Psychosocial development

- Intellectual development (Exp. Piaget's theory of intellectual development is a major learning theory. By understanding how children and adolescents develop learning abilities, the nurse can use this knowledge when teaching clients. School-age children are capable of logical reasoning and should be included in the teaching-learning process whenever possible. Teaching strategies that include clear explanations and reasons for procedures, stated in a simple and logical manner, are most successful. These children are open to new learning experiences but need learning to be reinforced by either a parent or health care personnel as they become more involved with their friends and school activities. Motor development would be focused on a hands-on skill for example, not the scientific explanation of the disease. Psychosocial development looks at stages of development and goals or tasks for different stages.

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 45-year-old female who is unsure of the benefit of psychiatric care, on a fixed income, and has good family support -A 51-year-old male who walks to most places because of a lack of transportation, has a low income, and works days -A 36-year-old male who uses public transportation, is unable to read, and wants to confer with a pastor -A 28-year-old female who works nights, is willing to try, and asks about insurance coverage of the appointment

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

When preparing client teaching materials, how does the nurse best assess a client's preferred learning style? -Observe the client's behaviors. -Provide teaching that works for the broadest base of clients. -Ask the client, "Do you learn best by observing, valuing, or doing?" -Determine client learning needs based on age and ability to hear effectively.

Ask the client, "Do you learn best by observing, valuing, or doing?" (One way to determine the client's preferred learning style is to ask the client about the client's personal learning preference--whether cognitive, affective, or psychomotor. Simply observing the client's behavior or considering the client's age and hearing ability would not provide as much information about the client's preferred learning style as would directly asking the client. Providing teaching using a broad-based approach would not help determine the client's preferred learning style and would not be as effective as providing teaching that is tailored to the client's preferred learning style.)

A nurse is working with a 15-year-old client with sickle cell anemia. The client was started on a new pain management plan today, and the nurse is evaluating the effectiveness of the plan. Which is not appropriate to include in the nursing care? A. Asking only the client's parents to be present at the education session B. Including a note about who was taught this new information in the client's chart C. Assuring the client that the conversation is confidential except under extreme circumstances D. Answering questions openly and honestly

Asking only the client's parents to be present at the education session (-Peers are often more influential than parents, nurses, or teachers at this age. It is often appropriate to include a close friend in on the education session. The other answers are developmentally appropriate for a 15-year-old.)

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 -Using dolls to demonstrate psychomotor skills -Ensuring the client's parents are present -Giving stickers as a reward for task completion

Blocking 30 minutes of time for skill teaching (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 other answers are developmentally appropriate for a 4-year-old.)

The nurse is completing documentation after an education session with a client. Which statement best demonstrates detailed documentation of an effective teaching plan? a. Demonstrated cord care to mother, who stated understanding and performed return demonstration using correct technique. b. Discussed wet-to-dry dressing changes, and client stated understanding. c. Spouse taught to flush feeding tube before and after medication. Denied further instruction needed. d. Lecture provided about infection, and client stated understanding what infection is.

Demonstrated cord care to mother, who stated understanding and performed return demonstration using correct technique. (Documentation of teaching must include who was taught, the topic taught, and some indication of the success of the learning plan beyond a simple verbal statement by the client. Only the answer with a mother being taught cord care and then performing return demonstration is complete.)