claywell ch 10 final

8. Assessment of patient learning is a required element of patient education. Shorter hospital stays make this step challenging, and we tend to evaluate learning immediately after teaching. What conclusion can be drawn from this? a. It takes time to truly incorporate what is learned, so immediate evaluation is not as accurate. b. The nurse will not have time to evaluate immediately after teaching. c. The patient will be too tired to participate in the evaluation. d. That would be too much information at one time.

ANS: A For learning to have occurred, the patient must incorporate the learned behavior into his or her life. In reality, an assessment done a day or two later may be a better indicator of the retention and incorporation of new information or behavior changes. For this reason, the other answer items are incorrect.

1. Which fact would you select to describe the mandate by The Joint Commission (TJC) regarding educating patients? The training and education must be: a. specific to the assessed needs, interdisciplinary, and evaluated for effectiveness. b. specific to the assessed needs, cost-effective, and focused. c. based on the patients ability to learn, cost-effective, and timely. d. specific to assessed needs, timely, and delivered by only one person for continuity.

ANS: A TJC standards state, The patient receives education and training specific to the patients assessed needs, abilities, learning preferences, and readiness to learn as appropriate to the care and services provided by the hospital. TJC requires patient education to be interdisciplinary, not delivered by only one person. Furthermore, health care facilities must audit patient education to ensure consistency of teaching and that the health care team members are evaluating the effectiveness of the patient education they give. Cost-effectiveness and timeliness are not requirements of TJC.

15. Which patient characteristic must a nurse consider when planning teaching? a. Literacy level b. Discharge instructions c. Good lighting d. Pain medication

ANS: A The correct answer is their literacy level. In many cases, institutions provide written instructions to patients in the hope that they will use them as references. Studies have shown that a lower-than-expected level of literacy may exist in patient populations seeking health care with the United States, as reported in a study by Fisher (1999). The implication for nursing of this and other studies is that the RN should recognize that patients may not have the comprehension of material needed to manage their own care. Discharge instructions, good lighting, and pain medications are not characteristics.

16. The nurse is assessing a patient who needs teaching about how to care for her wound at home. The nurse knows to be sensitive about asking questions that cause embarrassment. Which question is stated in the best manner? a. Would you like for me to write down how to change this dressing or is it better for you to see a demonstration? b. What is the highest grade you completed when you were in school? c. Do you read and write? d. I am going to give you a handout on how to perform your dressing change. Now dont worry if you do not read, Ill read it to you.

ANS: A Would you like me to write down how to change this dressing or is it better for you to see a demonstration? is correct. In many cases, institutions provide written instructions to patients in the hope that they will use them as references. Studies have shown that a lower-than-expected level of literacy may exist in patient populations seeking health care in the United States, as reported in a study by Fisher (1999). The implication for nursing of this and other studies is that the RN should recognize that patients may not have the comprehension of material needed to manage their own care. All the other answer choices are insensitive and condescending.

2. A nurse discusses home arrangements and safety factors related to emptying and changing the patients new colostomy bag. The patient has strong concerns about visibility of any stored colostomy supplies. Which teaching-learning principle does this example demonstrate? a. Using multiple teaching strategies to accommodate a variety of learning styles b. Increased effectiveness of teaching by involving the patient in the setting of objectives c. Paying attention to the timing during the hospitalization and planned discharge date when providing needed information d. Developing a strong nurse-patient relationship from the beginning of the contract with the patient

ANS: B An informed patient is better able to manage health care, is more compliant with the plan of care, and as a result, experiences more positive outcomes. Active learning facilitates the learning process. A patient who is educated regarding his or her condition and plan of care is less likely to refuse the plan of care in lieu of his or her own plan, less likely to complain more when the plan is revised, and less likely to demand explanation for each intervention. The other answer choices are also teaching-learning principles, but they are not reflected in the scenario.

5. The nurse recognizes that, for learning to be effective, the patient must first have his or her basic and most immediate needs met. Which statement best indicates that the nurse clearly understands this principle? a. The nurse administers pain medication to the new diabetic patient before she starts her teaching just in case the patient is in pain. b. Thirty minutes before the planned teaching, the nurse assesses the patient for comfort and ensures that the patient has eaten and had the opportunity to complete his bath routine. c. The nurse decides that conversation works best during a meal, so she plans to teach while the patient eats. d. The nurse asks the patients spouse to leave before beginning the teaching.

ANS: B Assessing the patient for comfort 30 minutes before the planned teaching and ensuring that the patient has eaten and had the opportunity to complete his bath routine validates that learning is best facilitated if the learner has had immediate needs met. Administering pain medication to the newly diabetic patient before teaching is incorrect because the nurse should delay (if advisable) medication that may cause distracting side effects. Deciding to teach while the patient eats is incorrect because eating a meal provides an unnecessary distraction. Making the spouse leave may be counterintuitive to the patients learning because family may reinforce the patients education, advocate for the patient, and seek clarification of the information taught.

17. An 85-year-old patient with chronic health problems is being considered for placement in a long-term care facility after discharge from the hospital. What purpose does the cost-effective nursing strategy of patient teaching help to achieve? a. Providing reasonable expectations from health care b. Giving the patient a sense of control over illness c. Preventing complications of chronic illness d. Increasing patient satisfaction with care

ANS: C As of late, the Centers for Medicare and Medicaid Services (CMS) has stated that reimbursement to hospitals will be limited for patients readmitted for the same conditions within a certain time period after admissions. Education is a critical part of transitional care, and nurses are key to providing adequate patient and family or caregiver education.

7. A 78-year-old patient has shortness of breath on very slight exertion. The physician has written an order for her to be taught about a 2-gram sodium diet. Based on these data, which factor would be likely to interfere with diet teaching? a. The patients age b. The patients shortness of breath c. The patients reluctance to change d. The chronic nature of the patients illness

ANS: B It is important to assess the patients readiness to learn. In reality the patient experiences little benefit from patient teaching often because of the stress from the medical problem as well as the environment, and the addition of a learning experience would add to the stress. The patient may be motivated to learn but not yet ready to learn. In this scenario, the patients shortness of breath is the medical problem interfering with the patients readiness to learn. The patients age and the chronic nature of the patients illness have nothing to do with readiness to learn. The patients reluctance to learn is an opinion.

14. Which item would most likely be a barrier to learning for a patient who must begin to wear an insulin pump? a. Curiosity about new experiences and equipment b. Tendency toward embarrassment about making mistakes and being seen with the pump c. Ability to prioritize diabetes management d. Understanding that the patient can promote his or her own well-being

ANS: B Patients are often embarrassed if they do not believe they can understand and perform the tasks of living with diabetes. When teaching patients about their illness and care required, it helps to consider their home situation, living arrangements, and usual activities. Myths and misconceptions about health, illness, and health care are often perpetuated by the experiences of the individual.

11. Which item would most likely be a barrier to learning for a patient who must begin to care for a large open wound at home? a. Curiosity about the new experience and equipment b. Tendency for uneasiness about making mistakes c. Ability to prioritize tasks d. Understanding that he can promote his own healing

ANS: B Patients values influence the willingness to accept the need to change and therefore the need to learn. Patients are often uneasy if they do not believe they can understand and perform the task of taking care of a wound. Patients may not live in the best environment and may feel embarrassed about their particular situation. When teaching patients about the care they require, it helps to reduce barriers to learning by considering their home situation, living arrangements, and usual activities. Curiosity about new experiences and new equipment, the ability to prioritize tasks, and understanding that the patient can promote his own healing are not barriers to learning.

10. A home health nurse is teaching a patient about a new medication he will be starting in the morning. The patient lives with his sons family, including two spirited children less than 6 years old. The patient replies, I just cant learn new information like I used to. The nurse will plan to: a. schedule the patient for daily visits for medication administration. b. provide privacy and minimize distractions and noise and try again. c. teach the patients family members to give the medications. d. tell the patient it is not safe to take the medication independently.

ANS: B The process of teaching new information requires the nurse to prepare the learning environment. Providing as much privacy as possible and minimizing distractions and noise can help ensure that the patient is comfortable discussing the treatment plan. Scheduling daily visits to administer medications defeats the purpose of teaching. Teaching the family to give the medication is unnecessary because the patient is able to care for himself. Telling the patient it is unsafe to take his medication is a false statement.

12. The nurse has just taught an adult patient with a new diagnosis of diabetes mellitus how to check blood glucose. The nurse should document: a. Demonstrated understanding of checking blood glucose. b. that the patient demonstrated the procedure properly and the time it took to complete the educational session. c. the steps of the procedure the patient was taught. d. that the nurse taught the patient how to check blood glucose.

ANS: B When documenting, the nurse can record that the patient was able to answer questions and demonstrate procedures correctly at the time of observation. The nurse also must record how much time it took to complete the educational sessions. To state that the patient demonstrated understanding as a result of one observation would be incorrect because many factors are present at the time of the observation that may influence the patients ability to understand. Documenting the steps of the procedure and noting that the nurse taught the procedure do nothing to communicate that learning took place.

1. The nurse recognizes that, to be an effective teacher, communication must be clear. In an educational session for a patient newly diagnosed with congestive heart failure, which statements by the nurse would demonstrate barriers to teaching? (Select all that apply.) a. Furosemide will increase urination, so you take it every morning. b. To help reduce the risk of pulmonary edema, your sodium intake must be monitored. c. Just remember, no sodium! d. Pulmonary edema can form if you have too much sodium. e. You will need to make sure you eat less salt to help prevent fluid from collecting in your lungs.

ANS: B, C, D To help reduce the risk of pulmonary edema, your sodium intake must be monitored and Pulmonary edema can form if you have too much sodium use medical jargon and little explanation. Just remember, no sodium! is a directive. Clear, precise communication skills are fundamental to teaching. The nurse must adjust his or her explanations such that patient education is delivered clearly, accurately, and in understandable terms. Examples of this include explaining the indication and administration of medication and the reason for diet changes.

6. Adult patients are adult learners. Knowing this, the nurse understands the assumptions about adult learners that will help the nurse plan and provide the appropriate education. Which statement provides proof that more instruction about adult learners is needed? a. Adults will learn as the need develops and the learning will fulfill that need. b. Adults use their lives as the point of reference for all learning. c. Adults are visual learners and learn best by taking notes. d. Adults prefer to have a say in their learning.

ANS: C Adults may represent different learning styles such as being a visual learner, auditory learner, or kinesthetic learner, so it is not a correct assumption that adults learn from taking notes. Adults will learn as the need arises and believe that the learning will fulfill the need. Adults use their lives as the point of reference for all learning and prefer to be self-directed in learning or at the very least have a say in it.

3. The nurse recognizes that new parents may be ready to learn about their newborn after the birth. What understanding leads the nurse to this conclusion? a. The baby will not be discharged until the parents have the training. b. The nurses on the mother-baby division do a better job of teaching baby care. c. The parents now have the motivation to learn because the baby has been born. d. The parents have no choice at this point.

ANS: C The motivation to learn often results from a life-changing event, such as childbirth or illness. The RN who recognizes the significance of the event can seize the opportunity to explore the patients motivation to learn. The babys not being discharged until the parents have training is untrue. That the nurses on the mother-baby division do a better job of teaching baby care is irrelevant. That the parents have no choice at this point is an opinion.

13. Persons seeking health care have increased autonomy and insist on taking an active role in their medical treatment decisions. What aspect of a nurses role does this fact affect? a. Use of professional communication when doing patient teaching and admitting patients to the unit b. Coordination of human and material resources that are directly used in the delivery of care at the bedside c. Evaluation of performance and skills of nursing staff members involved in direct patient care d. Patient collaboration with health care team members involved with the development of focused, quality care

ANS: D More people are seeking information before seeing physicians and researching options that physicians suggest before accepting and implementing these suggestions. Extensive information is available about illnesses and treatments, and with the advent of the Internet, this information is even more readily available. Including the patient in developing a health-promotion plan of care provides the best opportunity for effective teaching and long-term learning.

19. Which example demonstrates the principle that all adults learn best from and in relation to their experiences? a. Teaching the attitude of personal responsibility for health care b. Showing a patient newly diagnosed with diabetes the similarities between an insulin syringe and a 3-cc syringe c. Refraining from teaching two skills at one time d. Showing the patient how the current hand washing procedure he is now learning is like the hand washing he has always done

ANS: D Showing the patient how the current hand washing procedure he is now learning is like the hand washing he has always done is correct. Adults need new information to be related to something they already know. This creates a link so that the information can be readily recalled. For example, compliance with fluid restriction may be easier if you, as a nurse, create an analogy to a familiar frame of reference. Teaching personal responsibility has nothing to do with teaching principles. Showing the patient the difference between syringes may be of no significance if the patient has no information about syringes. Teaching one topic at a time facilitates learning but has no relation to learning best from experience.

18. An 18-year-old patient is scheduled for heart surgery tomorrow. To assess this patients level of knowledge, the nurse would say: a. Tell me the name of the surgery you are going to have. b. Do you understand what the doctor is going to do to you? c. Would you be willing to take a test for me? d. Tell me what you know about what is going to happen tomorrow.

ANS: D Tell me what you know about what is going to happen tomorrow is correct. Some patients are experts in regard to their ailment. To avoid or correct errors, determine the accuracy of information the patient provides about the condition. Not only are many reliable resources of medical information available but many unreliable, untested sources are as well. All other answer options are closed-ended questions and call for limited responses.

9. A 63-year-old patient is uncertain whether she can self-inject her medication. Which would be most likely to be an effective strategy at this time? a. Start with the details about her condition, why she has it, and the importance of her medication. b. In the first session, teach the patient how and why to rotate her abdominal injection sites. c. Start with information about avoiding rubbing or putting pressure on the site after an injection. d. In the first session let the patient handle a syringe while the nurse prepares and administers the next injection with another syringe.

ANS: D The nurse should consider the learning style of the individual patient. For example, some people learn best by practice or hands-on experience. The nurse should also have appropriate teaching aids. In the first session, giving the patient a syringe to handle while the nurse administers the next injection helps the patients readiness to learn. Starting a new teaching session with details, teaching the patient how and why to rotate injection sites, and sharing information about care of the injection site after the medication administration may overwhelm the patient and create a barrier to learning.

4. A patient has been newly diagnosed with type 2 diabetes. The teaching begins in the hospital with an interdisciplinary approach and continues with outpatient classes. However, the patient continues to state, I know I do not need to spend my time doing all this because I will be fine once I get out from under all this stress. The barrier to learning that the nurse recognizes and must deal with is the: a. patient already knows all she needs to know, so more education is not necessary. b. patient doesnt know what she doesnt know, so the circle will continue. c. patients blood sugar is keeping her from thinking clearly, so it is too soon to try to teach her. d. patient is in denial and that will need to be dealt with before she will accept the diagnosis and thus the education related to it.

ANS: D The patient is in denial of her new diagnosis. The RN must use rational thought and convey that logic in the presentation of the facts. The patient must decide that the change is necessary. The RN must understand the patients decision and show acceptance of it. The patients already knowing all she needs to know so more education is unnecessary is incorrect based on the patients statement. The patients not knowing what she does not know so the circle will continue is irrelevant. That the patients blood sugar is keeping her from thinking clearly is a presumption.