chapter 9 teaching

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.

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." Specific dosages and time intervals can be programmed into the machine to prevent overdose; medication is delivered when the patient pushes a control button. The medicine will help the client control pain. The client need not worry about pressing the button too often, as the machine has been programmed to not allow delivery of too much medication.

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 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 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

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

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

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 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.

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.

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.

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. When working with clients to change beliefs, values, and attitudes (i.e., affective learning), the nurse creates an atmosphere in which clients can honestly and freely discuss their feelings and emotions. Creating specific learning sessions for new information and creating an opportunity for rational thought and learning pertain more to cognitive learning, which involves the client's critical thinking and reason. In this scenario, the nurse has provided an educational opportunity in the present, not for the future.

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.

When caring for a diabetic client, the nurse notes that the client learns better when practicing the self-administration of the insulin injection alone. In which learning domain does this client's learning style fall?

psychomotor

A new client comes into the urgent care center with the spouse with a report of severe itchy rash with small blisters on the arms and hands. The nurse is documenting assessment data for the client. What is the nurse's best assessment action?

Make an open-ended statement to the client to elicit the history of the rash.

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

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 nurse is preparing to teach a 6-year-old client with a broken arm and the client's 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 the mother and the child.

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 The nurse is evaluating psychomotor skills; thus, a return demonstration, which is a method of testing skill performance, would be the most appropriate method for evaluating the client's learning. 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 the ability to perform the exercises.

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 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 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 has completed teaching. Which client behaviors demonstrate understanding within the cognitive domain? Select all that apply.

-Verbalizes key points of a brochure about diabetes that was read -Provides a description of what appropriate wound healing should look like

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

The nurse and the client

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."

The nurse is providing education to parents at a preschool regarding child safety and primary prevention. Which topic(s) would the nurse choose to discuss with the parents to represent primary prevention? Select all that apply.

Car seat restraints Bicycle helmets Immunizations

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

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

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.

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."

A client is meeting with the nurse to discuss options for smoking cessation. Which statement by the nurse is most appropriate for this client?

"What do you see as your biggest hurdle to stopping?"

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."

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

When deciding what information the client needs to meet the learner objectives successfully, the nurse is formulating which part of the teaching plan?

Content The nurse is planning the content when the nurse decides what information the client needs to meet the learner objectives successfully. To ensure the teaching was effective, the nurse would include teaching strategies. The learning activities would be designed by the nurse to meet the needs of the client. Learning domains—including cognitive, affective, psychomotor—are the different types of learning. Psychomotor is physical or kinesthetic based. Cognitive is knowledge based. Affective is feeling or emotion based.

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 most appropriate counseling for the situation at hand would be motivational counseling. With motivational counseling, the nurse would discuss feelings and incentives with the client. Short-term counseling focuses on the immediate problem or concern of the client or family. It can be a relatively minor concern or a major crisis, but in any case, it needs immediate attention. Long-term counseling extends over a prolonged period. A client might need the counsel of the nurse at daily, weekly, or monthly intervals. A client experiencing a developmental crisis, for example, might need long-term counseling. Professional counseling is a general term.

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 The precontemplation stage is the first stage change, in which the client does not indicate any intention to make a change within the next 6 months. During the precontemplation stage, the client is not even thinking about or considering making a change. During the contemplation stage, the client is considering making a change. During the preparation stage, the client has decided to make a change and is preparing for it. During the maintenance stage, the client attempts to maintain the change in lifestyle begun in an earlier stage.

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 This client is in the preparation stage, as the client is actively making changes to lose weight. During the precontemplation stage, the client is not even thinking about or considering making a change. During the contemplation stage, the client is considering making a change. During the preparation stage, the client has decided to make a change and is preparing for it. During the maintenance stage, the client attempts to maintain the change in lifestyle begun in an earlier stage.

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.

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

educational interventions.

Which topics would the nurse be most likely to explore with a client with the aim of restoring health? Select all that apply

-Education of a client about living with a suprapubic catheter -Postoperative teaching for the client after prostate surgery -Orientation to treatment center and staff -The medical and nursing regimens and how the client can participate in care

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 client states to the nurse, "I understand that I need a mastectomy for the treatment of my breast cancer, but I am fearful of learning about the drains I will need to empty." When responding to the client, the nurse will need to address which type of learning?

Affective This client is clearly expressing a negative feeling about the upcoming treatment: fear. Therefore, the nurse needs to provide teaching that addresses the client's emotional learning needs, or affective learning. Affective refers to emotions or feelings, and affective learning changes beliefs, attitudes, or values.

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 Andragogy is the art and science of helping adults learn. Pedagogy is the academic discipline that deals with the theory and practice of teaching and how these influence student learning. Psychomotor learning is demonstrated by physical skills such as movement. Affective learning is growth in feelings or emotional areas (attitude or self).

A nurse is teaching a 5-year-old boy who was recently diagnosed with type 1 diabetes. The client's mother, who is the primary caregiver, informs the nurse of having a fear of needles. What acttions are appropriate for the nurse to take to ensure a successful education session? Select all that apply.

Ensuring 20 minutes of uninterrupted teaching time Using a doll to demonstrate giving an insulin injection Providing the client's mother with an informational pamphlet about insulin injection

An older adult client who is recovering from a stroke is scheduled to be transferred to the rehabilitation unit in the morning. The client is tearful and reports feeling lonely and abandoned in the hospital unit. The family visits daily, and flowers and cards are 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.

Place the stages of learning in their order of progression.

-The client reports the first symptom that appears. -A family member reminds the older adult to take pain relief medication on alternate days. -The client is now eating three servings of vegetables per day. -An adolescent organizes a "safe sex" seminar. The client reporting the first symptom that appears is an example of an individual recognizing what has been taught. A family member reminding the older adult to take aspirin tablets on alternate days is an example of an individual's ability to explain or apply the information taught. An adolescent organizing a "safe sex" seminar is an example of an individual's ability to independently use the new learning. These are examples of the four progressive stages of learning in ascending order.

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.

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

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

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.

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

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.

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."

port this Question 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.

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

Client education focuses on identified home needs.

The parents of a school-age child are meeting with the nurse for health promotional education for their child. The child has the following assessment data: a 7-year-old male with diabetes mellitus type 1 with a hemoglobin A1C level of 8.3%, a body mass index (BMI) of 31.7, and a BMI percentile of 99. What are the most appropriate learning diagnoses for this first session?

Deficient Knowledge: Imbalanced nutrition: more than body requirements, and ineffective health maintenance.

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.

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 Limited hospitalization time demands that nurses begin teaching as soon as possible. The client should be educated during the process of admission regarding what to expect, patient rights, etc. The client should be educated prior to diagnostic testing. Waiting until immediately prior to discharge to begin teaching does not give the opportunity for return demonstration or to adequately determine whether the education was successful.

The nurse is documenting a teaching session with a client. Which nursing documentation is the most appropriate and detailed?

Family requested education on turning client. Explanation of use of draw sheet and body mechanics provided. Family coached through turning and repositioning client. Members state confidence and understanding.

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

Psychomotor

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.

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 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.

An adolescent client is being taught about changing an abdominal dressing as part of the education for care at home. On removing the dressing and seeing the surgical incision, the client becomes tearful. Which statement by the nurse is most appropriate to address the client's distress?

Your incision may look bad right now, but when it heals you will have a small scar about 3 in (7.5 cm) long that will fade over time.

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. Tools to determine literacy include reading tests such as the Wide Range Achievement Test (WRAT) and Rapid Estimate at Adult Literacy in Medicine (REALM), which ask a person to read a passage out loud. Such tests would provide a more accurate assessment of the spouse's literacy level than would reviewing the spouse's educational history or manner of speech. The spouse's motivation level would not indicate the spouse's literacy level.

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."

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.

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

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.

The nurse is preparing to educate a client newly diagnosed with diabetes about various aspects of home management techniques to maintain control of blood glucose levels. When performing education, what actions should the nurse take when assessing the learning needs of the client? Select all that apply.

-Ask the client what the client feels is the greatest learning need to manage diabetic care. -Determine whether the client has a support system in place to assist if necessary. -Determine whether the client is ready to learn about the care of diabetes. Four elements should be considered in each assessment of client learning needs. First, identify what the client considers of importance to learn, as well as new knowledge, attitudes, or skills necessary for the client and family to learn to manage the client's health care. Determine whether the client is prepared to learn and whether the client has a support system available if necessary. Readiness is distinguished from the client's actual ability to learn, which is the third element. The fourth element of assessment is of the client's strengths and not determination of weaknesses. Strengths are the personal resources that can be harnessed to facilitate the teaching-learning process

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.

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

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 teaching a client with diabetes how to inject daily insulin. Which method is most effective in evaluating the teaching?

Ask the client to demonstrate how to self-inject the morning insulin.

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?

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.

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

A client, eager to go home from an acute care facility, calls out to have discharge education completed. The nurse is not able to get to the client's room until an hour later, and finds the client asleep. The client's significant other states, "She will be out for a couple hours after that pain medication." Which of the following best describes what must happen with the education session?

The client is not demonstrating readiness to learn due to the effects of medication. The nurse knows the client's plan of care and should know what needs to be taught to this individual. The client is experiencing a side effect of pain medication and is not ready to be taught at this time. The nurse, not the significant other, is responsible for teaching the client about self-care. If the client cannot remain awake, then the client is not able to learn.

A nurse is forming an education plan for a client who is being discharged from the nursing unit after cardiac catheterization. Which diagnosis and intervention are most appropriate for this client?

Knowledge Deficient: Risk for altered perfusion secondary to re-occlusion Urinary output should not be changed from a cardiac catheterization. The incision for this procedure may require 8 hours of lying flat, but mobility returns to baseline before discharge home. The risk for ineffective breathing pattern would not be due to incisional pain, which would be in the groin or elbow. Educating the client to be aware for the safety issue of chest pain resulting from the newly opened coronary arteries becoming re-occluded and blocking blood flow to the heart is the highest priority focus.

The nurse is teaching a client newly diagnosed with diabetes about the disease, testing, diet, and how to self-administer insulin. The client does not speak the dominant language. What is the appropriate nursing action?

Obtain a medical interpreter.

A nurse is conducting a teaching session with a client about heart-healthy nutrition. Which teaching strategy would be appropriate to foster learning in the affective domain? Select all that apply.

Role playing Discussion Printed material Appropriate teaching strategies for affective learning include role playing, discussion, and printed materials. Demonstration is more appropriate for psychomotor learning. Discovery is appropriate for cognitive or psychomotor learning.

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

States, "I feel comfortable using my walker"

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 Gaining insight into the client's knowledge of obesity and family history of obesity may be helpful, but they do not address the client's statement of not knowing how to lose weight. Dietary intake for one day is not as helpful as a daily log, which gives a better overview of dietary habits. Assessing the client's past actions for weight loss addresses the client's immediate concern, takes advantage of a teachable moment, and helps establish a baseline of what the client understands about weight loss. With this understanding, the nurse has a starting point to begin educating the client.

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 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. Many adults are intimidated by learning a new skill, so encouragement and praise almost always improve performance. Comments such as, "Lots of people have that same concern" will help the client to feel less isolated. Positive corrective feedback such as, "You've just about figured out how to give yourself an injection; now, angle the syringe a little more this way," acknowledges and reinforces learning accomplishments, but at the same time provides significant correction to facilitate a better performance. Negative comments such as, "Why are you repeatedly holding the injection at the wrong angle?" or "It will be better if you ask someone responsible to administer the injection," will only make the client feel more nervous and intimidated.

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."