chapter 9 teaching test 3

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.

Promoting Compliance learning

•Be certain that instructions are understandable and support patient goals. •Include the patient and family as partners in the process. •Utilize interactive teaching strategies. •Develop interpersonal relationships with patients and their families.

Health Literacy - Ask Me 3 Questions- The questions patients should ask providers during every encounter:

•What is my main problem? •Pancreas can't keep up •What do I need to do? •Change eating habits, adhere to medication •Why is it important for me to do this? •Loose vision, limbs, life •Answer in plain language, incorporate visual models and have them teach-back •Newest Vital Sign Assessment

Learning Occurs If

the Patient Can Demonstrate What the Nurse Taught

Basic Learning Principles

-Motivation to learn -Addresses the patient's desire or willingness to learn -Ability to learn (factors affecting patient learning) -Depends on physical and cognitive abilities, -developmental level, physical wellness, thought processes -Learning environment -Allows a person to attend to instruction

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.

Infant teaching

is directed towards parents

Key Points to Effective Communication #1

•Be sincere and honest. •Avoid too much detail and stick to the basics. •Ask for questions. •Be a cheerleader for the patient. •Use simple vocabulary. •Vary the tone of voice. •Keep content clear and concise. •Listen and do not interrupt. •Be sensitive to the timing of teaching sessions •Consider the environment

•Motivational interviewing

•Discover barriers to patient learning •Establish relationships and explore perspectives

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?"

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."

Knowles Four Assumptions about Adult Learners

1.As a person matures, one's self-concept is likely to move from dependence to independence. 2.The previous experience of the adult is a rich resource for learning. 3.An adult's readiness to learn is often related to a developmental task or a social role. 4.Most adults' orientation to learning is that material should be useful immediately, rather than at some time in the future.

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

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 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

Domains of Learning

Cognitive Includes all intellectual behaviors and requires thinking: lecture, printed materials, audiovisual Affective Deals with expression of feelings and development of attitudes, opinions, or values: role playing, discussion, audiovisual, printed material Psychomotor Involves acquiring skills that require coordination and integration of mental and physical movements: demonstration, audiovisual, printed material

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

Cognitive learning theory

Domains of Learning: Psychomotor

Involves acquiring skills that require coordination and integration of mental and physical movements: demonstration, audiovisual, printed material

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-playing

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

Short-term counseling

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.

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.

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.

•School aged children teaching

should be included in teaching whenever possible- provide clear explanations and reasons that are reinforced by parent or health care provider.

•Toddlers/Preschoolers teaching

still mainly directed toward parents. Use toys to help provide simple facts and concrete demonstrations

The nurse is caring for a client who demonstrates a health literacy concern. The nurse adjusts client teaching in which way?

uses videos, diagrams, and pictures rather than focusing on verbal teaching

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.

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."

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

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

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

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.

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.

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.

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 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."

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

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

Newest Vital Sign

Health literacy test: being able to read food labels.

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 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

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

The nurse and the client

•Adolescents teaching

are similar to adults; peer group acceptance is critical for most teens, recognize the need for independence and the need to establish a trusting relationship that demonstrates respect for the adolescents opinions.

Purpose and Goals of Patient Education

•The basic purpose of teaching and counseling is to help patients and families develop the self-care abilities (knowledge, attitude, skills) they need to maximize their functioning and quality of life (or to have a dignified death). •Goals: •Maintain and Promote health •Prevent Illness •Restore Health •Facilitate Coping

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

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 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 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.

A nurse is using the teaching-learning process to teach new parents how to care for their infants. Which nursing actions reflect recommended steps of this process? Select all that apply.

The nurse assesses the learning needs and readiness of the parents. The nurse formulates a verbal or written contract with clients. The nurse relates new learning material to clients' past life experiences to help them to assimilate new knowledge.

The nurse is planning client education based on the developmental stage of the client. Which nursing actions best reflect this consideration? Select all that apply.

The nurse directs the health education for a 3-year-old to the parents. The nurse includes a school-age child in the teaching and learning process. The nurse determines the learning needs of the client. The nurse provides material that is useful immediately to adult clients.

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.

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.

•Teaching

•A planned method or series of methods used to help someone learn. The concept of imparting knowledge through a series of directed activities.

Domains of Learning: Affective

Deals with expression of feelings and development of attitudes, opinions, or values: role playing, discussion, audiovisual, printed material

Domains of Learning: Cognitive

Includes all intellectual behaviors and requires thinking: lecture, printed materials, audiovisual

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.

Adult Learner

•Adult learning •Self-directed •Patient-centered •Physical capability •Level of personal development •Physical health •Energy

Motivation and Health Belief Model

•Am I really susceptible? •Is this a serious threat? •What else can I do to reduce my risk? •Patient believes sacrifices/changes taken are not as great as the health problem itself, therefore, they are willing to try to change.

Evaluation of Learning

•Asking patient questions to clarify learning. •What do you think that means? •Analyze patient's comments •Tell me more about how you are going to make changes. •Observe patient's actions •Lunch order. •Return demonstration •Insulin injections •Reinforcing and celebrating learning •Great job on your weight loss! •Evaluating teaching •Feedback and self-evaluation •Revising the plan •Modify the weight loss plan

Steps of the Teaching-Learning Process

•Assess learning needs and learning readiness •Diagnose the patient's learning needs •Develop learning outcomes (set goals) •Develop a teaching plan •Implement teaching plan and strategies •Evaluate learning

Providing Culturally Competent Patient Education

•Develop an understanding of the patient's culture. •Work with multicultural team. •Be aware of personal assumptions, biases, and prejudices. •Understand the core cultural values of the patient or group. •Develop written material in patient's preferred language.

Factors Affecting Patient Learning

•Family support networks - COPE model •Financial resources •Cultural influences •Language deficits •Health literacy level •Age and developmental level

Older Adult Learners

•Identify learning barriers. •Allow extra time. •Plan short teaching sessions. •Accommodate for sensory deficits. •Reduce environmental distractions. •Relate new information to familiar activities or information.

Nurses Role in Counseling:Assist and Guide

•Improving coping abilities •Reinforcing healthy behaviors •Fostering positive interactions •Preventing illness and disability •NOT personal feelings related to situation or advice on what the patient should do

Child and Adolescent Learners

•Infant teaching is directed towards parents •Toddlers/Preschoolers still mainly directed toward parents. Use toys to help provide simple facts and concrete demonstrations •School aged children should be included in teaching whenever possible- provide clear explanations and reasons that are reinforced by parent or health care provider. •Adolescents are similar to adults; peer group acceptance is critical for most teens, recognize the need for independence and the need to establish a trusting relationship that demonstrates respect for the adolescents opinions. •Motor development must be considered too. The patient may have the cognitive development necessary to perform a skill but their manual dexterity and fine motor skills may not be fully developed.

Types of Counseling

•Short-term: for situational crisis •accident •Long-term: for developmental crisis •menopause •Motivational interviewing •Discover barriers to patient learning •Establish relationships and explore perspectives •Consider the patient cultural values

•Learning

•The process by which a person acquires or increases knowledge or changes behavior in a measurable way as a result of the experience.

Documentation teaching

•What & possibly Why •How did it go? •Most Importantly: document concrete evidence that demonstrates learning has occurred, if not update the plan. •