Intro to nursing exam 4

The nurse makes a late entry in a client's record. Which of the following is the best example of how to document this type of situation?

"2:45 PM—ASA gr X given for temperature of 38.1° C."

Which of the following statement best reflects the nurse's appropriate attention to a client's need for self-efficacy? 1. "What can I do to help you lose the weight?" 2. "Are you really ready to start a regular exercise regimen?" 3. "After you watch me demonstrate this inhaler, you will have no problems using it at all." 4. "Come on; with all the self-help products out there, you will be able to stop smoking."

"After you watch me demonstrate this inhaler, you will have no problems using it at all."

Which of the following nursing notations shows the best understanding regarding the need to document only objective client assessment data?

"Client expressed pain as an 8 out of 10, was diaphoretic, guarding her abdomen and clenching her fists."

Which of the following nursing notations shows the greatest need for instruction regarding the need to document only objective client assessment data?

"Client is depressed; was observed crying while alone in room."

Which statement best reflects the major limitation of the team nursing model?

"Getting our two new admissions stabilized took up all of my time today."

Related to Problem Oriented Medical Record (POMR) documentation, which of the following statements made by a nurse reflects the greatest need for additional instruction on the proper management of a resolved client problem?

"He doesn't experience any dizziness now that we have his medication regulated, so I've erased that from his problem list."

Which of the following statements best reflects the nurse's understanding of team nursing?

"I delegate the care of the clients to the appropriate team members & I am responsible for coordinating & directing that care."

Which of the following statements made by a nurse most reflects a need for additional instruction on areas of client care requiring nursing documentation?

"I provided a detailed description of the dressing change in the client's chart in order to show it was done as prescribed."

Which of the following statements made by a nurse related to the organization of client care requires follow- up by the mentor?

"I was taking vitals on one client, dangling a second client while I had the third expelling an enema."

Which of the following statements best reflects the autocratic style of leadership?

"I'll consider each of your requests, & then I'll give you the guidelines for establishing new acuity ratings for our clients."

What is the correct response for the licensed practical nurse that answers the phone to respond within the following scenario? The physician calls to leave orders late at night for one of his clients.

"Let me get the Registered Nurse on the phone."

The client developed a slight hematoma on his left forearm. The nurse labels the problem as an infiltrated intravenous (IV) line. The nurse elevates the forearm. The client states, "My arm feels better." What is documented as the "R" in FOCUS charting?

"My arm feels better"

Which of the following nursing statements regarding the release of a client's medical record to another institution requires immediate follow-up by the nurse's manager?

"The client agreed to the consultation, so I'll have the chart sent over."

Which of the following nursing statements reflects the best understanding of the role of documentation and the Medicare reimbursement policy?

"The hospital is reimbursed for the nursing care documented in the client chart."

The nurse evaluates which of the following statements as an indication that the client is not ready to learn at this time? 1. "I need to understand more about the reason for the colostomy." 2. "I will find out more about that when the support group meets." 3. "There's no sense in showing me that now. I'm too sick right now." 4. "Please be sure to tell me if I am completing all the steps correctly."

"There's no sense in showing me that now. I'm too sick right now."

Which of the following is evaluated as a legally appropriate notation?

"Verbalized sharp, stabbing pain along the left side of chest."

Races for Low Health Literacy

*Hispanic - lowest* African/Native American/Alaska Native White and Asian Pacific Islander - highest

Reinforcement can be... (3 types and examples of reinforcement..)

*Positive* or Negative 1. Social (ex. smiles, compliments, words of encouragement) 2. Material: works well with children (ex. food, toys, music) 3. Activity (ex. acquiring more *freedom*)

Affective Learning

*feelings, attitude, opinions* *receiving (simplest) *responding *valuing *organizing *characterizing (most complex)

Patient Education (promotes ___) (reduces ___)

-Promotes optimal levels of health -Reduce health care costs and hardships

Learner characteristics that may be barriers to the teaching/learning process

-acute Illness: all energy concentrate to cope illness -pain: decrease ability to concentrate -prognosis: client focused in getting better -emotions: fear, anger, depression -age: special needs, shorter attention span -language: foreing language, education level -culture/religion: different beliefs, restrictions -physical disability: impairments (hearing, vision, etc) -mental disability

Nursing diagnoses that address the learning needs of clients

-deficient knowledge -health seeking behaviors -ineffective therapeutic regimens -noncompliance

Which is the most appropriate notation for a use to use according to the guidelines that should be followed when documenting client care?

0830—Increased IV fluid rate to 100 mL/hr according to protocol.

To achieve Magnet status, the nursing staff of a hospital must exhibit: (Select all that apply.)

1. A "client first" mentality 2. Autonomy of personal practice 3. Strong involvement in life-long learning 4. Ability to use "state of the art" technology 5. Strong nurse-health care provider collaboration 6. Clinical competence through earned certifications

Nursing documentation should fulfill which of the following criteria? (Select all that apply.)

1. Accurate 2. Inclusive 3. Well organized 4. Show continuity of care 5. Record nursing opinion 6. Identify client outcomes

Problem Oriented Medical Record (POMR) method of documentation includes which of the following sections? (Select all that apply.)

1. Database 2. Care plan 3. Problem list 4. Progress notes

Self-Efficacy (4 sources and examples of self-efficacy are..)

1. Enactive *Mastery Experiences* (pt completes skill) 2. Vicarious *(Demonstrative) Experiences* (demonstration) 3. *Verbal Persuasion* (express belief in pt's ability) 4. *Physiological State* (positive effects from skill promote repeated use)

The advantages of team nursing include: (Select all that apply)

1. Fosters team cooperation 2. Facilitates decision making at the clinical level 3. Encourages collaboration between team members 4. Provides management experience for team leaders

Purpose of Patient Education 1. Maintainence ______ 2. Restoration _____ 3. Coping with _____

1. Maintainence & Promotion of Health and Illness Program 2. Restoration of Health (get back to baseline) 3. Coping with Impaired Functions

Factors that affect Ability to Learn include.. (6 types [1 big one])

1. Physical Strength 2. Sensory Deficit 3. Reading Level 4. Developmental Level 5. Cognitive Function 6. Pain, Fatigue, *Anxiety*

The nurse realizes that effective nursing documentation encourages: (Select all that apply.)

1. Safe nursing practice 2. Continuity of client care 3. Efficient time management

Importance of Quality Patient Education: 1. 2. 3. 4.

1. Shorter hospital stays 2. increase # of ill patients 3. increase demand on nurses' time 4. give patients good info

Which of the following are recognized competencies for an entry-level nurse? (Select all that apply.)

1. Views clients holistically 2. Utilizes the nursing process 3. Participates in life-long learning 4. Exhibits nursing professionalism 5. Delegates client care appropriately

Restoration of Health

1. pt needs inormation & skills 2. identify willigness & motivation to learn. 3. Include famlily but don't expect the to do it.

Good teaching plans: 1. 2. 3.

1. reduce health care costs 2. improve quality of care 3. change behaviors to improve pt outcomes

The Ideal Teaching Duration is..

10-15 minutes

While teaching the client about management of his heart disease, a nurse might use a strategy that is implemented to promote learning in the affective domain such as: 1. Asking the client what he believes he needs to know about the diagnosis 2. Providing brochures both on current exercises and on nutrition guidelines 3. Encouraging the client to personally discuss his feelings about his health status 4. Having the client return-demonstrate self-measurement of his own blood pressure

3. Encouraging the client to personally discuss his feelings about his health status (Affective means to ask/discuss - verbalize)

Different topics are presented in the information sessions that are held in the outpatient clinic. In planning for a session on health maintenance/illness prevention, the nurse should select a topic on: 1. Use of assistive devices, such as canes 2. Self-help devices for post-CVA clients 3. Stress management techniques for working parents 4. Environmental alterations for clients in wheelchairs

3. Stress management techniques for working parents

A client whose neck is swollen with cellulitis refuses to have visitors or look in the mirror and is not sleeping well or eating healthy foods. You would most expect this client to have which of the following nursing diagnoses? 1. defensive coping 2. ineffective denial 3.situational low self-esteem 4. disturbed body image

4. Disturbed body image The client who has a body-image disturbance may hide or not look at or touch a body part that is significantly changed in structure by illness or trauma. A person who has an unhealthy body image will likely be overly concerned about minor illness and neglect sleep and a healthy diet. The other defense mechanisms are not as likely in this client.

Which of the following clients would most benefit from the case manager model of nursing care?

A client diagnosed with end-stage renal failure

A nurse is teaching a 27-year-old gentleman how to adjust his insulin dosages based on his blood sugar results. What type of learning is this? A) Cognitive B) Affective C) Adaptation D) Psychomotor

A) Cognitive Cognitive learning requires thinking; learning how to adjust insulin requires analysis, synthesis, and evaluation, which are all types of cognitive learning.

A nurse needs to teach a young woman newly diagnosed with asthma how to manage her disease. Which of the following topics does the nurse teach first? A) How to use an inhaler during an asthma attack B) The need to avoid people who smoke to prevent asthma attacks C) Where to purchase a medical alert bracelet that says she has asthma D) The importance of maintaining a healthy diet and exercising regularly

A) How to use an inhaler during an asthma attack It is important to start with essential life-saving information when teaching people because they usually remember what you tell them first.

A patient with chest pain is having an emergency cardiac catheterization. Which teaching approach does the nurse use in this situation A. Telling approach B. Selling approach C. Entrusting appraoch D. Participating approach Answer

A. Telling approach Rationale: Telling approach is most appropriate when preparing a patient for an emergency procedure

2. The nurse is in the process of conducting an admission interview with the client. At one point in the discussion, the client has provided information that the nurse would like to clarify. The nurse employs the technique of clarification as indicated by the response: 1. "I'm not sure that I understand what you mean by that statement." 2. "The ECG records information about your heart's electrical activity." 3. "Let's look at the problem you have had with your medication when you were home." 4. "What's your biggest concern related to your hospitalization at the moment?"

ANS: 1 "I'm not sure that I understand what you mean by that statement" is correct. Clarifying is when the nurse checks whether understanding is accurate by restating an unclear message to clarify the sender's meaning, or by asking the other person to restate the message, explain further, or give an example of what the person means. This response indicates the nurse wants to clarify what the client is saying so he or she can have an accurate understanding of what the client means. "The ECG records information about your heart's electrical activity" is an example of providing information, not clarification. "Let's look at the problem you have had with your medication when you were home" is an example of focusing, not clarification. "What's your biggest concern related to your hospitalization at the moment" is an example of sharing empathy.

18. Which of the following clients would most benefit from the case manager model of nursing care? 1. A client diagnosed with end-stage renal failure 2. A client who has a chronic wound on the left foot 3. A client newly diagnosed with type 2 diabetes mellitus 4. A postoperative client who had a cholecystectomy (gallbladder removal)

ANS: 1 A case manager follows up with the client after discharge home. Case managers do not always provide direct care, but instead they work with and supervise the care delivered by other staff members. Case managers actively coordinate client discharge planning by identifying health care needs, determining the availability of services and resources, and assisting the client in choosing cost-efficient health care options. The client dealing with end-stage renal failure would most benefit from this model of care because the client's case is the most complex and will require extension discharge support.

20. Which of the following actions best reflects accountability for the client's care outcomes? 1. Reassessing a client's BP when the reported value is higher than usual 2. Assisting a team member in providing a client with a complete bed bath 3. Reevaluating a client's pain 30 minutes after administering pain medication 4. Asking a client's daughter to bring her father's non-skid slippers to the hospital

ANS: 1 Accountability refers to individuals being responsible for their actions. It means that a nurse accepts the commitment to provide excellent client care and the responsibility for the outcomes of the actions in providing that care. Reassessing an abnormally high BP is the best example of nursing accountability because it shows the nurse being responsible for the accuracy of the assessment. The remaining options better reflect nursing responsibility.

5. Communication involves both active listening and body language working together. The nurse actively listens to the client and: 1. Sits facing the client 2. Keeps the arms and legs crossed 3. Leans back in the chair away from the client 4. Avoids eye contact as much as is physically possible

ANS: 1 Active listening means to be attentive to what the client is saying both verbally and nonverbally. A nonverbal skill to facilitate attentive listening is to sit facing the client. This posture gives the message that the nurse is there to listen and is interested in what the client is saying. For active listening, the arms and legs should be uncrossed. This posture suggests that the nurse is "open" to what the client says. For active listening, the nurse should lean toward the client. This posture conveys that the nurse is involved and interested in the interaction. For active listening, the nurse should establish and maintain intermittent eye contact. This conveys the nurse's involvement in and willingness to listen to what the client is saying.

6. During the assessment phase of the nursing process, the nurse may uncover data that help to identify communication problems. An example of this information is: 1. Extreme dyspnea or shortness of breath 2. Urinary frequency and pain 3. Chronic stomach pain 4. Lack of appetite

ANS: 1 An extremely breathless person must use oxygen to breathe rather than speak. Urinary frequency may interrupt conversation but is not a communication problem. Chronic stomach pain would not be a communication problem. The patient with chronic pain is, to some degree, used to the pain. A lack of appetite is not a communication problem.

13. The nurse on the unit is determining which activities may be delegated to assistive personnel. Assuming that the nurse assistant is competent, which one of the following activities may be safely delegated by the registered nurse? 1. Vital signs on a stable client 2. An admission history on a new client 3. Initial transfer of a postoperative client 4. Administration of medications prepared by the nurse

ANS: 1 An institution's policies and procedures and job description for assistive personnel provide specific guidelines in regard to which tasks or activities can be delegated. The nurse should match tasks to the delegate's skills, such as delegating vital signs to a nurse assistant. It would not be appropriate to delegate an admission history on a new client to a nurse assistant. The RN should perform this task. Initial transfer of a postoperative client should not be delegated to a nurse assistant, as the client would be considered unstable. The RN should perform this task. The nurse should not delegate medication administration to a nurse assistant, even if the nurse prepared it. The nurse assistant is not licensed to administer medication.

24. A nurse who performs a skin assessment while bathing an immobile client would be displaying: 1. Efficiency 2. Leadership 3. Organization 4. Effectiveness

ANS: 1 Effective use of time means doing the right things, whereas efficient use of time means doing things right. The nurse is showing efficiency by combining various nursing activities—in other words, doing more than one thing at a time. Organization is a general term that may include efficiency, while leadership is the ability to manage people and resources.

42. Which of the following statements made by a nurse reflects a need for further instruction regarding communicating with the older adult client? 1. "Children and the elderly have the same communication barriers." 2. "If I tell him why he needs to know something, he'll usually listen." 3. "Hearing deficits can certainly make communication a challenge." 4. "I always try to have family around when I talk with an elderly client."

ANS: 1 Even though some older adults have communication barriers, you need to communicate with them on an adult level and avoid patronizing or speaking in a condescending manner. Older adults do not necessarily have the same barriers as children. The remaining options reflect interventions and/or statements that are not inappropriate and so do not require further instructions.

10. In working with a client who is newly diagnosed with diabetes mellitus, the nurse provides feedback to the client on her progress in learning the treatment regimen. Of the following, the nurse demonstrates the use of therapeutic communication by stating: 1. "I believe that you have come a long way in learning how to manage your care." 2. "It didn't look like you were ever going to be able to get the injection technique." 3. "Check your blood sugar unless you really want to come back to the hospital again." 4. "You don't appear to have any real interest in managing your daily dietary intake."

ANS: 1 In stating, "I believe that you have come a long way in learning how to manage your care" the nurse is demonstrating the use of therapeutic communication by sharing hope. The nurse is pointing out that personal growth can come from illness experiences. "It didn't look like you were ever going to be able to get the injection technique" is a negative statement. The nurse should not state observations that might embarrass or anger the client. "Check your blood sugar unless you really want to come back to the hospital again" does not demonstrate the use of therapeutic communication. It implies disapproval and is an aggressive, threatening type of response. "You don't appear to have any real interest in managing your daily dietary intake" is not a therapeutic statement. It is negative and aggressive in nature. If it is a true observation, it is one the nurse should not state as it could anger the client.

10. In anticipation of a nursing shortage, the nursing management in a facility are investigating a nursing care delivery model that involves staff members working under the direction of a registered nurse leader. This model is called: 1. Team nursing 2. Primary nursing 3. Functional nursing 4. Total patient care nursing

ANS: 1 In team nursing a registered nurse leads a team that is composed of other RNs, LPNs or LVNs, and nurse assistants or technicians. The team members provide direct client care to groups of clients, under the direction of the RN team leader. Nurse assistants are given client assignments rather than being assigned particular tasks. Primary nursing is a model of care delivery whereby an RN assumes responsibility for a caseload of clients over time. Typically the RN selects the clients for his or her caseload and cares for the same clients during their hospitalization or stay in the health care setting. Functional nursing is task-focused, not client focused. In this model, tasks are divided, with one nurse assuming responsibility for specific tasks. Total patient care is a model of care where an RN is responsible for all aspects of care for one or more clients. The RN may delegate aspects of care but retains accountability for care of all assigned clients.

15. There are a number of variables that may influence the client's communication with the health care team. Which of the following is an example of an interpersonal variable? 1. Postoperative discomfort 2. An extremely warm room 3. A talkative roommate 4. A loud television

ANS: 1 Interpersonal variables are factors within both the sender and receiver that influence communication. An example of an interpersonal variable is postoperative discomfort. An extremely warm room is an example of an environmental variable that may affect communication. A talkative roommate is an example of an environmental variable that may affect communication because of the lack of privacy and distraction. Noise, such as a loud television, is an example of an environmental variable that may affect communication.

33. The nurse sits on a chair alongside a client's bed to discuss the postoperative nursing care the client will receive. The therapeutic outcome of sitting beside the client is that: 1. The nurse-client relationship will be strengthened 2. The client will feel less threatened by the nurse's presence 3. The nurse can appear more relaxed during the conversation 4. The nurse and client will be equal participants in the conversation

ANS: 1 Looking down on a person establishes authority, whereas interacting at the same eye level indicates equality in the relationship. While the remaining options may be correct in some situations, the primary benefit of the nurse sitting is to convey to the client that both are equal contributors to the conversation.

31. An older client who appears confused after discussing his new diagnosis of Parkinson's disease shares with the nurse that, "I didn't understand much of what you said." The nurse determines that the most likely cause of the client's failure to understand is that: 1. The conversation included unfamiliar medical terminology 2. The client is in denial concerning the diagnosis of Parkinson's disease 3. The nurse's choice of timing for the client education was poor 4. The etiology of the condition is too complicated for this client to understand

ANS: 1 Medical jargon (technical terminology used by health care providers) sounds like a foreign language to clients unfamiliar with the health care setting. Limiting use of medical jargon to conversations with other health team members will improve communication. The remaining options may have contributed to the problem, but the more common problem deals with inappropriate use of jargon.

23. The best communicator is the nurse who: 1. Thinks critically 2. Is a good listener 3. Is comfortable talking 4. Empathizes with the client

ANS: 1 Nurses who develop good critical thinking skills make the best communicators. The remaining options identify components of good communication.

24. Which of the following statements shows the best attempt by a nurse to overcome personal biases? 1. "So how does that make you feel?" 2. "Most people really like Dr. Jones." 3. "I know how that must frighten you." 4. "How much did the medication help your pain?"

ANS: 1 People often assume that others think, feel, act, react, and behave as they would in similar circumstances. They tend to distort or ignore information that goes against their expectations, preconceptions, or stereotypes. This statement clearly shows the nurse attempting to assist the client in expressing his or her personal feelings. The remaining options all make a presumption about the client's feelings or attitudes.

14. The most important responsibility of a nurse manager is to: 1. Foster an environment that enables staff to provide quality nursing care 2. Provide leadership and role modeling for nursing and ancillary staff 3. Evaluate the delivery of nursing care in regard to its effect on client outcomes 4. Create a unit attitude of cooperative engagement directed toward positive client outcomes

ANS: 1 Perhaps the most important responsibility of the nurse executive is to establish a vision for nursing that enables managers and staff to provide quality nursing care. The remaining options are means by which the manager can affect the proper environment.

12. The student nurse is seeking to learn skills associated with priority setting. In discussing different priorities of care, an example of a second-order priority is: 1. The need to urinate 2. An obstructed airway 3. The side effects of a medication 4. Activities of daily living in the home environment

ANS: 1 Second-order priority needs are actual problems for which the client or family has requested immediate help, such as a full bladder. An obstructed airway is a first-order priority need because it is an immediate threat to a client's survival or safety. Side effects of a medication is an example of a third-order priority need. It is a relatively urgent actual or potential problem that the client or family does not recognize. Activities of daily living in the home environment is a fourth-order priority need. It is an actual or potential problem with which the client or family may need help in the future.

41. The nurse identifies the nursing diagnosis risk for injury for a client who is unable to verbally communicate effectively. The primary risk for injury occurs because the client: 1. Lacks the ability to tell the staff what he or she needs 2. Cannot notify the staff when he or she has fallen 3. Is not able to effectively use the call bell to communicate 4. Displays impatience when needs are not met effectively

ANS: 1 The client who cannot communicate effectively will often have difficulty expressing needs and responding appropriately to the environment. A client who is unable to speak is at risk for injury unless the nurse identifies an alternate communication method. The remaining options relate to potential outcomes of ineffective verbal communication but not to the risk for injury.

19. When working with a client with aphasia, the nurse may attempt to enhance communication by: 1. Using visual cues 2. Speaking loudly 3. Using open-ended questions 4. Communicating through a speech therapist

ANS: 1 The nurse may enhance communication for a client with aphasia by using visual cues (e.g., words, pictures, and objects) when possible. The nurse should not shout or speak too loudly to enhance communication with a person who has aphasia. The nurse should ask simple questions that require "yes" or "no" answers to enhance communication with the client who has aphasia. Using a speech therapist is not the primary way to enhance communication with a client who has aphasia. The nurse can use communication techniques to facilitate communication and to develop a helping relationship with the client. The speech therapist may help the client to learn new ways or to relearn how to communicate.

13. The nurse is aware of the client's zones of personal space when planning interactions. The zone of personal space and touch that extends the greatest amount from an individual is the: 1. Social zone 2. Personal zone 3. Consent zone 4. Vulnerable zone

ANS: 1 The social zone extends the greatest amount from an individual in personal space and touch. It is a distance of 4 to 12 feet. Permission is not needed for touch in the social zone. The personal zone is 18 inches to 4 feet. The consent zone of touch requires permission. The vulnerable zone is in the consent zone of touch. Because the vulnerable zone implies special care is needed, permission is required.

23. A client has reported all of the following which should be given priority by the nurse? 1. Pain 2. Hunger 3. Anxiety 4. Constipation

ANS: 1 When a client has diverse priority needs, it helps to focus on the client's basic needs pain will exacerbate the client's anxiety and interfere with eating and thus should be attended to first. While a concern, constipation is the lowest priority problem.

1. Which of the following are recognized competencies for an entry-level nurse? (Select all that apply.) 1. Views clients holistically 2. Utilizes the nursing process 3. Participates in life-long learning 4. Exhibits nursing professionalism 5. Delegates client care appropriately 6. Exhibits expert nursing knowledge

ANS: 1, 2, 3, 4, 5 All provided options are recognized competencies for entry-level nurses except the ability to practice with expert nursing knowledge. This will be acquired with time and experience.

2. To achieve Magnet status, the nursing staff of a hospital must exhibit: (Select all that apply.) 1. A "client first" mentality 2. Autonomy of personal practice 3. Strong involvement in life-long learning 4. Ability to use "state of the art" technology 5. Strong nurse-health care provider collaboration 6. Clinical competence through earned certifications

ANS: 1, 2, 3, 5, 6 All provided options are characteristics required of the nursing staff for recognition as a Magnet hospital except for expertise with state of the art technology.

4. Which of the following are reasons for communication during the assessment phase of the nursing process? (Select all that apply.) 1. Providing information to the client 2. Obtaining information from the client 3. Establishment of the nurse-client relationship 4. Identification of the client's physical health needs 5. Mutual goal setting regarding client health needs 6. Identification of client's emotional health

ANS: 1, 2, 4, 5, 6 The reasons for communication include information exchange, goal achievement, problem resolution, and expression of feelings. The initiation of the nurse-client relationship is not considered a facet of assessment communication.

1. Which of the following critical thinking attitudes contributes to an effective nurse-client relationship? (Select all that apply.) 1. Fairness 2. Guarded 3. Curiosity 4. Creativity 5. Perseverance 6. Self-confidence

ANS: 1, 3, 4, 5, 6 Curiosity motivates the nurse to communicate and know more about a person. Perseverance and creativity are also attitudes conducive to communication because they motivate the nurse to communicate and identify innovative solutions. A self-confident attitude is important because the nurse who conveys confidence and comfort while communicating more readily establishes an interpersonal, helping-trust relationship. Risk-taking rather than a guarded attitude is important because colleagues sometimes question the suggested nursing interventions. At the same time, an attitude of fairness goes a long way in the ability to listen to both sides of any discussion.

2. The nurse realizes that the cancer support group for breast cancer clients will be most effective if the group: (Select all that apply.) 1. Is not too large 2. Is similar in age 3. Members feel valued 4. Communicates freely 5. Shares a common culture 6. Meets in a comfortable place

ANS: 1, 3, 4, 6 Small groups are more effective when they are a workable size and have an appropriate meeting place, suitable seating arrangements, and cohesiveness and commitment among group members. Group participants need to feel accepted, feel able to communicate openly and honestly, and actively listen to others in the group. Similarity in age and similarity in culture are not necessary criteria for a successful group interaction.

3. The advantages of team nursing include: (Select all that apply) 1. Fosters team cooperation 2. Allows for ancillary staff autonomy 3. Strengthens the RN-client relationship 4. Facilitates decision making at the clinical level 5. Encourages collaboration between team members 6. Provides management experience for team leaders

ANS: 1, 4, 5, 6 An advantage of team nursing is the collaborative style that encourages each member of the team to help the other members. This model has a high level of autonomy for the team leader and is an example of decision making occurring at a clinical level. Team nursing can limit the actual time the RN spends with the clients ancillary staff are not afforded autonomy regardless of the nursing care model because their work must be supervised by the RN.

9. The nurse will often display empathy in communication with clients. Of the following responses by the nurse, which one best conveys empathy? 1. "Good morning. How did you sleep last night?" 2. "I can understand your concern about learning to inject yourself." 3. "Do you mean you would like to talk to the new family nurse practitioner?" 4. "Can you describe to me what the pain in your abdomen feels like right now?"

ANS: 2 "I can understand your concern about learning to inject yourself" is correct. Empathy is the ability to understand and accept another person's reality, to accurately perceive feelings, and to communicate this understanding to others. "Good morning. How did you sleep last night?" is asking a question. It does not convey empathy. "Do you mean you would like to talk to the new family nurse practitioner?" is asking a question to clarify the client's meaning. It does not convey empathy. "Can you describe to me what the pain in your abdomen feels like right now?" is asking a relevant question that may focus on a particular topic. It is not an example of empathy.

15. The primary benefit of achieving Magnet status is the nursing staff is empowered to make innovative changes that: 1. Promote nursing autonomy 2. Positively affect client care outcomes 3. Enhance the perception of the nursing profession 4. Strengthen the collaborative RN/MD relationship

ANS: 2 A Magnet hospital empowers the nursing team to make changes and be innovative. This culture and empowerment combine to produce a strong collaborative relationship among team members and so ultimately improves client quality outcomes. The remaining options are outcomes of the Magnet status but not the primary benefit.

26. The primary reason the nurse asks for help when changing a client's complicated dressing is to: 1. Foster efficient client-oriented interventions 2. Facilitate a comfortable, safe dressing change 3. Minimize the amount of time spent on a specific task 4. Engage in collaborative learning with other health care professionals

ANS: 2 A nurse should never hesitate to have staff assist, especially when there is an opportunity to make a procedure or activity more comfortable and safer for the client. While it is possible that having help with a task can be a learning experience as well as making the task more efficient and less time-consuming, it is not always the case and not the primary reason for asking for assistance.

35. Supporting a client by holding onto her elbow while accompanying her as she ambulates around the nursing unit is considered social touching and so would typically: 1. Be considered nonthreatening by the client 2. Not require the client's permission 3. Be viewed as therapeutic by the nurse 4. Not be needed unless the client was ataxic

ANS: 2 A person's hands, arms, shoulders, and back are considered social zones and typically do not cause a client emotional discomfort if touched, and so permission to do so is not generally required. Nurses frequently move into clients' personal space because of the nature of caregiving. You need to convey confidence, gentleness, and respect for privacy, especially when your actions require intimate contact or involve a client's vulnerable zone. The remaining options do not necessarily deal with a client's social touching zone.

26. Mentally reviewing the steps of a complicated nursing procedure before entering the client's room is an example of: 1. Nonverbal communication 2. Interpersonal communication 3. Intrapersonal communication 4. Transpersonal communication

ANS: 2 A type of intrapersonal communication, self-instructions, provides a mental rehearsal for difficult tasks or situations so individuals are able to deal with them more effectively. Interpersonal communication is one-to-one interaction between the nurse and another person that often occurs face to face while transpersonal communication is interaction that occurs within a person's spiritual domain. Nonverbal communication includes all five senses and everything that does not involve the spoken or written word.

18. When dealing with toddlers or preschoolers what communication technique may be used most effectively? 1. Using analogies to explain health-related ideas 2. Allowing manipulation of equipment to be used 3. Moving quickly and minimizing contact to avoid distress 4. Focusing on what other children on the unit may have been doing

ANS: 2 Allowing toddlers and preschoolers to touch and examine objects that will come in contact with them is an effective communication technique. Toddlers and preschoolers are unable to understand analogies. Sudden movements can be frightening. Children often prefer to make the first move in interpersonal contacts. Focusing on what other children have done is not an effective communication technique for toddlers or preschoolers. Communication should be focused on the child.

21. When the oncology unit's interdisciplinary team meets every Monday morning at 0830 to discuss the unit's individual clients, the group is best displaying: 1. Staff education 2. Collaborative practice 3. Team communication 4. Nursing shared governance

ANS: 2 Collaboration of health care team members is required to help meet the complex needs of clients in health care settings. Such collaborative interaction may strengthen individual members' knowledge and communication skills. Nursing shared governance is a process directed towards the standard of nursing care among a particular groups of professional nurses.

6. In anticipation of a nursing shortage, the nursing management in a facility is investigating a nursing care delivery model that involves the division of tasks, with one nurse assuming the responsibility for particular tasks. This model is called: 1. Total patient care 2. Functional nursing 3. Team nursing 4. Primary nursing

ANS: 2 Functional nursing is task-focused, not client-focused. In this model, tasks are divided, with one nurse assuming responsibility for specific tasks. Total patient care is a model of care where an RN is responsible for all aspects of care for one or more clients. The RN may delegate aspects of care, but retains accountability for care of all assigned clients. In team nursing a registered nurse leads a team that is composed of other RNs, LPNs or LVNs, and nurse assistants or technicians. The team members provide direct client care to groups of clients, under the direction of the RN team leader. Nurse assistants are given client assignments rather than being assigned particular tasks. Primary nursing is a model of care delivery whereby an RN assumes responsibility for a caseload of clients over time. Typically the RN selects the clients for his or her caseload and cares for the same clients during their hospitalization or stay in the health care setting.

29. The nurse is discussing discharge instructions with a client who was recently diagnosed with type 1 diabetes mellitus and is now taking insulin. The nurse recognizes this as an example of: 1. Nonverbal communication 2. Interpersonal communication 3. Intrapersonal communication 4. Transpersonal communication

ANS: 2 Interpersonal communication is one-to-one interaction between the nurse and another person that often occurs face to face. Transpersonal communication is interaction that occurs within a person's spiritual domain whileintrapersonal communication, self-talk or self-instruction provides a mental rehearsal for difficult tasks or situations so individuals are able to deal with them more effectively. Nonverbal communication includes all five senses and everything that does not involve the spoken or written word.

34. The nurse enters a client's room and finds her crying softly. The most therapeutic statement the nurse can make at this time is to ask: 1. "Are you alright?" 2. "Why are you crying?" 3. "What can I do to help you?" 4. "Is being hospitalized upsetting you?"

ANS: 2 Sounds have several interpretations: crying may communicate happiness, sadness, or anger. The nurse needs to validate such nonverbal messages with the client to interpret them accurately. Although the other options may elicit information regarding the client's tears, they make assumptions or attempt to provide generalized comfort without first establishing the cause of the tears.

25. A close, effective nurse-client relationship impacts interpersonal communication most by facilitating: 1. Client education regarding health-related issues 2. The accurate interpretation of shared information 3. A free exchange of information between client and nurse 4. The client's expression of physical and emotional needs

ANS: 2 The more the sender and receiver have in common and the closer the relationship, the more likely they will accurately perceive one another's meaning and respond accordingly. The remaining options are outcomes of an effective nurse-client relationship but they do not impact communication as directly.

17. In using communication skills with clients, the nurse evaluates which response as being the most therapeutic? 1. "Why don't you stick to the special diet?" 2. "I noticed that you didn't eat lunch. Is something wrong?" 3. "I think you need to find another physician that's better than this one." 4. "We can't continue talking about your problems it's time for your bath.

ANS: 2 The nurse who is sharing an observation, "I noticed that you didn't eat lunch. Is something wrong?" is using the most therapeutic response. Sharing observations often helps the client communicate without the need for extensive questioning, focusing, or clarification. "Why don't you stick to the special diet?" is an example of a nontherapeutic response. It is asking for an explanation. "Why" questions can cause resentment, insecurity, and mistrust. "I think you need to find another physician that's better than this one." is not a therapeutic response. It is giving a personal opinion. Changing the subject, "We can't continue talking about your problems it's time for your bath," is not therapeutic.

25. When the nurse gathers all the equipment needed for a particular procedure and arranges the client's room for proficient implementation of the procedure, the nurse is displaying: 1. Multitasking 2. Organization 3. Effectiveness 4. Professionalism

ANS: 2 The well-organized nurse approaches any planned procedures by having all of the necessary equipment available and making sure the client is prepared. It always is wise to have the work area organized and preliminary steps completed before asking co-workers for assistance. Multitasking is dealing with more than one task at a time while being effective means doing the right things correctly. Being professional means showing the characteristics of performing the expected tasks of the profession.

11. "I've never told anyone this information about my son," is an example of a parent: 1. Identifying problems 2. Building trust 3. Clarifying roles 4. Revealing

ANS: 2 This response is an example of trust. Trusting another person involves risk and vulnerability, but it also fosters open, therapeutic communication and enhances the expression of feelings, thoughts, and needs. This statement is not an example of revealing. Although the parent may have provided information that was never before revealed, in this statement the parent is indicating there is trust between himself or herself and the nurse practitioner. This statement is not clarifying roles of the nurse and client. This statement is not an example of identifying problems and goals.

As the nurse starts to perform a procedure, a peer says, "I've done that before. Would you like me to help?" The peer's leadership style is described as: 1. Directing 2. Coaching 3. Democratic 4. Laissez-faire

ANS: 2 This situational leadership style is described as coaching. The peer is willing to explain the procedure and provide the opportunity for clarification. Directing is a highly directive style of leadership where leaders provide specific instructions and close supervision. A laissez-faire style of leadership is where the leader intervenes as little as possible in the direction of others. The laissez-faire style of leadership is described as nondirective, permissive, ultraliberal. A democratic leadership style encourages group discussion and decision making. The democratic leadership style is described as participative and consultative.

30. A nurse provides a brief but concise orientation to the use of the room's telephone and television to a newly admitted older client experiencing abdominal pain. The client's daughter later reports that her father attempted to call her but was never shown how to use the telephone. The most likely cause for the client's apparent lack of knowledge retention is: 1. Admission to the hospital has caused mild confusion that is not atypical in older clients 2. The pain was distracting him from focusing on the information when it was provided 3. He is experiencing forgetfulness regarding newly introduced nonessential information 4. The nurse did not take adequate time to explain the use of either the telephone or the television

ANS: 2 Timing is critical in communication. Even though a message is clear, poor timing prevents it from being effective. Do not begin routine teaching when a client is in severe pain or emotional distress. Although the other options may affect client retention of information, the scenario did not provide reason to believe that any of the options rather than poor timing was the primary factor.

39. Which of the following statements made by a nurse most reflects a poor understanding of trustworthiness regarding nurse-client communication in response to a client's report that, "I don't like the night shift nurse"? 1. "How can I meet your needs and expectations on dayshift?" 2. "Tell me more about why you dislike the night shift nurse." 3. "Can you give me an example of why you are dissatisfied?" 4. "The nurse on night shift has your well being in mind always."

ANS: 2 To foster trust, the nurse communicates warmth and demonstrates consistency, reliability, honesty, competence, and respect. Sharing personal information or gossiping about others sends the message you cannot be trusted and damages interpersonal relationships. The nurse appears to be gossiping by the way the client is encouraged to discuss what the night shift nurse is doing. The remaining options show varying degrees of addressing the client's statement.

5. To meet the needs of assigned clients and the responsibilities associated with the position, nurses need to be aware of time management techniques. The time management skills for the nurse include: 1. Meeting all of the client's needs in the early morning hours 2. Anticipating possible interruptions by therapists and visitors 3. Leaving each day unplanned to allow for adaptations in treatments 4. Completing client assessments and treatments individually at separate times

ANS: 2 To manage time, the nurse must anticipate when care will be interrupted for medication administration and any diagnostic testing, and the nurse should also determine the best time for planned therapies such as dressing changes, client education, and client ambulation. Meeting all the needs in the early morning hours would be unrealistic. Some activities have specific time limits in terms of addressing client needs and some activities follow scheduled routines according to hospital policy. The nurse may also have to work around other schedules, such as if the client had a test ordered for the morning. Therefore, the nurse cannot expect to meet all of the client's needs at a specified time of day. Because the nurse has a limited amount of time with clients, it is essential to remain goal-oriented and make a plan for using time wisely. Time management involves using client goals as a way to identify priorities. The nurse in reviewing the care requirements organizes his or her time so the activities of care and client goals can be achieved. A nurse should complete the activities started with one client before moving on to another.

22. Clinical nursing decisions are best made using: 1. Clinical pathways 2. Accurate assessment data 3. Previous nursing knowledge 4. Interdisciplinary collaboration

ANS: 2 When beginning an assignment with a client, the first nursing activity involves a focused but complete assessment of the client's condition. This information enables the nurse to make an accurate clinical decision as to the client's health problems and required nursing therapies. The remaining options support the clinical decision-making process.

36. When meeting for the first time, the home health nurse smiles warmly and shakes the client's hand. The nurse-client relationship is in the: 1. Working phase 2. Orientation phase 3. Termination phase 4. Preinteraction phase

ANS: 2 When the nurse and client meet and get to know one another, they are engaged in the orientation phase of the nurse-client relationship. The remaining options are phases that occur either before or after the orientation phase.

27. The nurse can best detect that a client needs clarification of the information provided on a special diet by: 1. Asking the client frequently if they have any questions 2. Assessing the client's nonverbal cues that suggest confusion 3. Providing the client with written supportive materials on the diet 4. Requesting that the client rephrase the information in his or her own words

ANS: 2 You determine the need for clarification by watching the listener for nonverbal cues that suggest confusion or misunderstanding. The remaining options are means of reinforcing or evaluating the listener's understanding of the information.

8. Indicators in a quality improvement program that evaluates the manner in which care is delivered are: 1. Structure indicators 2. Team indicators 3. Process indicators 4. Client indicators

ANS: 3 A quality indicator for evaluating the manner in which care is delivered is a process indicator. Structure indicators evaluate the structure or systems for delivering care an example is adherence to checking if emergency carts are adequately stocked. There is no team indicator. Client indicators would actually be outcome indicators. Outcome indicators evaluate the end result of care delivered.

11. Accountability is a critical aspect of nursing care. An example of a specific decision-making process of accountability is demonstrated by: 1. Selecting the medication schedule for the client 2. Implementing discharge teaching plans that meet individual needs 3. Evaluating the client's outcomes following implementation of care 4. Promoting participation of all staff members in regular unit meetings

ANS: 3 Accountability refers to individuals being responsible for their actions. It involves follow-up and a reflective analysis of one's decisions to evaluate their effectiveness. Selecting the medication schedule for the client is an example of taking responsibility. Implementing discharge teaching plans that meet individual needs is an example of autonomy. Promoting participation of all staff members in unit meetings is an example of decentralized management and of promoting authority.

40. Which of the following statements made by a nurse most reflects the best understanding of the effect assertiveness has on interpersonal communication? 1. "Can anyone help overwhelmed today?" 2. "I think we need to tell the doctors to write more legibly." 3. "I will need some help with that complicated dressing change." 4. "You will need to do the admission assessments today because I'm so busy."

ANS: 3 Assertiveness conveys a sense of self-assurance while also communicating respect for the other person. Assertive responses often contain "I" messages, such as "I want," "I need," "I think," or "I feel," but in a fashion that is not demeaning or demanding. The remaining options are not the best examples because some lack an explanation of the nurse's actual needs while others are not respectfully stated.

3. A unit manager on a busy multi-service medical nursing unit decides to take responsibility for the direct client care of one of the many new admissions. Later the manager decides she is too busy to give adequate client care. Which of the following situational leadership styles does the nurse manager need to apply? 1. Coaching 2. Supporting 3. Delegating 4. Directing

ANS: 3 Delegation is transferring responsibility for the performance of an activity or task while retaining accountability for the outcome. To be more efficient in providing adequate client care, the manager needs to use delegation. Coaching would not be the situational leadership style to apply. The manager does not have time to explain decisions and provide the opportunity for clarification. Supporting would not be the situational leadership style of choice. The manager does not need to share ideas and facilitate decision making of other employees at this time. Directing is a highly directive style of leadership. The manager needs to delegate, not provide specific instructions and close supervision.

12. Discussing the client's follow-up dietary needs immediately after the surgery when the client is experiencing discomfort is an error in: 1. Pacing 2. Intonation 3. Timing and relevance 4. Denotative meaning

ANS: 3 Discussing follow-up dietary needs immediately after surgery when the client is experiencing discomfort is an error in timing and relevance. The client is less likely to be able to pay attention and comprehend instruction when in pain, and immediately after surgery, discussing follow-up dietary needs would seem irrelevant. Pacing has to do with the speed of conversation. This is not an example of an error in pacing. Intonation is the tone of voice used. This is not an example of an error in intonation. Denotative meaning is when a single word can have several meanings. This is not an example of an error in denotative meaning.

28. Which of the following statements made by a nurse related to the organization of client care requires follow-up by the mentor? 1. "I had my LPN bring the Foley catheterization supplies into the room so they'd be there when I got there." 2. "I delegated all the stable vital signs to my nursing assistant and the treatments to the LPN." 3. "I was taking vitals on one client, dangling a second client while I had the third expelling an enema." 4. "Organization was never a strength of mine, but I believe I'm getting better at completing all my client's care."

ANS: 3 Good time management involves completing one task before starting another. If possible, complete the activities started with one client before moving on to the next. Care will then become less fragmented, and the nurse will be better able to focus on what is being done for each client. As a result, it is less likely that errors will be made. The remaining options are not reflective of poor management and so do not need follow-up.

32. The nurse shares with a client diagnosed with bipolar disorder who is in the manic phase that, "The CNA will be in 20 minutes to complete your ADLs." This nurse-initiated communication will likely result in client confusion or noncompliance because: 1. The timing of the conversation was poorly chosen 2. The client was not actively involved in the decision-making process 3. The conversation relied on terms familiar only to health care providers 4. The nurse assumed that the client would accept the nursing assistant's help

ANS: 3 Medical jargon (technical terminology used by health care providers) sounds like a foreign language to clients unfamiliar with the health care setting. Limiting use of medical jargon to conversations with other health team members will improve communication. The remaining options may contribute to client confusion and/or noncompliance, but the heavy reliance on unfamiliar terms is the most likely primary cause in this situation.

17. Which statement best reflects the major limitation of the team nursing model? 1. "The team really needed an extra pair of hands today." 2. "It complicates things when you have a different team each day." 3. "Getting our two new admissions stabilized took up all of my time today." 4. "My nursing assistants need to be in-serviced on how to do a bladder scan."

ANS: 3 One of the limitations to the model is that the team leader does not spend a large amount of time with clients. Depending on the mix of staff members, this sometimes means that clients see an RN infrequently. Risks exist if an RN is unable to make necessary client assessments and be involved in important clinical decision making. The remaining options refer to less frequent problems inherent to the team nursing model.

38. Which of the following statements made by a nurse best reflects an understanding of the therapeutic value of perceived client control? 1. "The client was very interested in the information about support groups." 2. "The client fell right to sleep when I told her the procedure was canceled." 3. "Research has shown that clients are less stressed when told what to expect." 4. "I always include the client in on any decisions regarding their nursing care."

ANS: 3 Research has shown that personal control over a situation contributes to emotional comfort. By informing the client of expectations, the client's personal sense of control is increased and emotional stress should then be decreased. The remaining options show an understanding of emotional comfort but do not express an understanding of the origin of that comfort.

8. A client is admitted for a CAT scan (diagnostic test) of the cranium. As the nurse explains this diagnostic test, the client moves away from the nurse. This is an example of what influencing factor in communication? 1. Gender 2. Environment 3. Space and territoriality 4. Sociocultural background

ANS: 3 Territoriality is the need to gain, maintain, and defend one's right to space. The client who moves away from the nurse during a conversation is demonstrating the influence of space and territoriality on communication. This not an example of gender influencing communication. This is not an example of environment influencing communication. Noise, temperature extremes, distractions, and lack of privacy are examples of environmental factors that may influence communication. Although people do maintain varying distances between each other depending on their culture, this is not an example of sociocultural background influencing communication, as cultural orientation is not mentioned in this situation.

27. The nurse is prioritizing care for two postoperative abdominal surgery clients the first is 15 hours postoperative and the second is ready for discharge. Which of the interventions should be accomplished first? 1. Discharge pain control 2. First day dangling and ambulation 3. First day post op coughing and deep breathing 4. Discharge teaching regarding the dressing change

ANS: 3 The first client's goals center on restoring physiological function impaired as a result of the stress of surgery. The second client's goals center on adequate preparation to assume self-care at home. Physiological interventions, particularly those affecting breathing, should receive priority. Dangling and ambulation may be addressed after the second client is readied for discharge.

14. Throughout the nursing process communication is used. During the evaluation phase, communication is specifically used by the nurse to: 1. Delegate activities to other staff members 2. Validate the client's health and wellness needs 3. Acquire both verbal and nonverbal client feedback 4. Document expected outcomes and planned interventions

ANS: 3 The nurse and client determine whether the plan of care has been successful by evaluating the client communication outcomes established during planning. This process involves acquiring verbal and nonverbal feedback. Delegation is not the purpose of communication in the evaluation phase of the nursing process. Delegation is more likely to be used in the implementation phase of the nursing process. Validation of the client's needs is not why the nurse specifically uses communication in the evaluation phase of the nursing process. Validation of the client's needs is often determined when data are gathered during the assessment phase of the nursing process. Documenting expected outcomes and planned interventions is part of the planning phase of the nursing process, not the evaluation phase.

3. The nurse is preparing a community outreach program on stress management. The nurse realizes that speaking in public requires some specific adaptations regarding: (Select all that apply.) 1. Makeup 2. Clothing attire 3. Vocal inflection 4. Voice projection 5. Physical gesturing 6. Making eye contact

ANS: 3, 4, 5, 6 Public communication requires special adaptations in eye contact, gestures, voice inflection, and use of media materials to communicate messages effectively. Makeup and clothing need to be appropriate but do not require specific adaptations.

4. Which of the following statements best reflects the autocratic style of leadership? 1. "Let's discuss this case study thoroughly and decide on a plan of action as a group." 2. "I'll try to pair you in comparable work teams, and let's evaluate the success of this approach in 2 weeks." 3. "Everyone knows their work assignment, so let's not meet together unless we have an unexpected crisis." 4. "I'll consider each of your requests, and then I'll give you the guidelines for establishing new acuity ratings for our clients."

ANS: 4 "I'll consider each of your requests, and then I'll give you the guidelines for establishing new acuity ratings for our clients" reflects the autocratic style of leadership. The leader is making the decision. "Let's discuss this case study thoroughly and decide on a plan of action as a group" reflects the democratic style of leadership. The leader encourages group discussion and decision making. "I'll try to pair you in comparable work teams, and let's evaluate the success of this approach in 2 weeks" reflects the delegating style of leadership. Responsibility and implementation are being turned over to the group, but the leader remains accountable. "Everyone knows their work assignment, so let's not meet together unless we have an unexpected crisis" reflects the laissez-faire style of leadership. There is much freedom, and the leader assumes a "hands off" approach.

3. The faculty member is reviewing a process recording with the student nurse. The student has been working with a client who has had an amputation of the lower left leg and is emotionally fragile. The student receives positive feedback from the faculty member for the following response made to the client: 1. "Why are you so upset today?" 2. "I'm sure that everything will be all right." 3. "You shouldn't cry. The wound will heal soon." 4. "It must be very difficult to have this happen to you."

ANS: 4 "It must be very difficult to have this happen to you" is an example of using the therapeutic communication technique of sharing empathy. "Why are you so upset today?" is an example of a nontherapeutic communication technique of asking for explanations. "I'm sure that everything will be all right" is an example of a nontherapeutic communication technique of giving false reassurance. "You shouldn't cry. The wound will heal soon" is an example of a nontherapeutic communication technique of giving disapproval.

19. Which of the following actions is the best example of a nurse exercising nursing authority? 1. Assigning team responsibilities to individual team members 2. Evaluating a team member's ability to perform a bladder scan 3. Readjusting a client's turning schedule to provide hourly repositioning 4. Determining that a client will not be ambulated based on assessment findings

ANS: 4 Authority refers to legitimate power to give commands and make final decisions specific to a given position. Canceling a client's ambulation is the best example because it shows critical thinking in determining the appropriateness of an intervention. The remaining options are better examples of nursing responsibility.

22. Which of the following is the single most negative factor affecting a nurse's credibility? 1. Deficient technical skills 2. Unethical or illegal behavior 3. Lack of caring and empathy 4. Poor nurse-client communication

ANS: 4 Breakdown in communication is a top contributor to errors in the workplace and threatens professional credibility. The remaining options affect credibility but not to the extent that poor communication does.

16. A helping relationship is being established between nurse and client. In addressing the client, the nurse should: 1. Use the client's first name 2. Touch the client right away to establish contact 3. Sit far enough away from the client's personal space 4. Always knock and pause before entering the client's room

ANS: 4 Common courtesy is part of professional communication. To practice courtesy, the nurse says hello and goodbye, knocks on doors before entering, and uses self-introduction. Knocking on doors is important in addressing the client. Because using last names is respectful in most cultures, nurses usually use the client's last name in the initial interaction, and then use the first name if the client requests it. Touching the client right away would not be an appropriate action in establishing a helping relationship. It would more likely be interpreted as invading the client's personal space. Sitting far enough away from the client is important in that the nurse should not enter the client's personal space when establishing a helping relationship. However, leaning toward the client conveys that the nurse is involved and interested in the client. Knocking on the door before entering the client's room would be the first step in addressing the client properly.

20. Which of the following statements best reflects the client's positive feedback to the nurse's question, "Do you understand how to check your blood sugar?" 1. Nodding affirmatively 2. "I test it 4 times a day." 3. "Yes, I understand how to do it." 4. Demonstrating a fingerstick to the nurse

ANS: 4 Feedback is the message the receiver returns. It indicates whether the receiver understood the meaning of the sender's message. Demonstrating the technique is the best way to show the nurse an understanding of the process. The other options either nonverbally or verbally indicate understanding they are not as conclusive as showing understanding.

7. One advantage of a decentralized management structure for nursing units over a centralized structure is that: 1. Communication pathways are simplified 2. Staff are not responsible for defining their roles 3. Managers handle all of the difficult decision making 4. Each staff member is accountable for evaluating the plan of care

ANS: 4 In decentralized management, decision making is moved down to the level of staff. It requires workers to be empowered to accept greater responsibility for the quality of client care provided. This means that each staff member is accountable for evaluating the plan of care. Communication pathways are not simplified. If decentralized decision making is in place, professional staff have a voice in identifying the RN role. Each RN on the work team is responsible for knowing his or her role and how it is to be implemented on the nursing unit. In decentralized management, there is autonomy. In other words, there is freedom to decide and act. The nurse manager does not necessarily handle the difficult decisions. Those staff members who are best informed about a problem or issue make decisions on the basis of knowledge.

16. Which of the following statements best reflects the nurse's understanding of team nursing? 1. "The team provides the client care and I provide the leadership and decision making." 2. "I will manage the complex care and delegate the remaining care to my LPN and ancillary assistants." 3. "Everyone on the team has responsibilities and is accountable to me regarding the effective execution of that care." 4. "I delegate the care of the clients to the appropriate team members and I am responsible for coordinating and directing that care."

ANS: 4 In team nursing a registered nurse (RN) leads a team that is made up of other RNs, licensed practical nurses (LPNs) or licensed vocational nurses (LVNs), and nurse assistants or technicians. The team members provide direct client care to groups of clients under the direction of the RN team leader. In this model, nurse assistants have client assignments rather than being assigned particular nursing tasks. The remaining options fail to provide an inclusive definition of team nursing.

4. When reaching over the side rails to take a client's blood pressure, he draws back. To promote effective communication, the nurse should first: 1. Tell the client that the blood pressure can be taken at a later time 2. Rotate the nurses who are assigned to take the client's blood pressure 3. Continue to perform the blood pressure assessment quickly and quietly 4. Apologize for startling the client and explain the need for touching the client

ANS: 4 Nurses often have to enter a client's personal space to provide care. The nurse should convey confidence, gentleness, and respect for privacy. This response demonstrates respect and provides information so the client can understand the need for personal contact. Telling the client that the blood pressure can be taken at a later time does not promote effective communication. Rotating the nurses who are assigned to take the client's blood pressure impedes the nurse's ability to form a therapeutic, helping relationship. Continuing to perform the procedure quickly and quietly may send a negative nonverbal message. It also does not promote effective communication.

37. The nurse recognizes that a client's sense of personal control is most therapeutically impacted when: 1. The client attends a self-help/support group 2. The nurse encourages the client to make menu selections 3. The client views a video on the use of a personal glucose monitor 4. The nurse provides instructions on a patient-controlled analgesic (PCA) pump

ANS: 4 Personal control over the situation contributes to emotional comfort. Pain control is a very basic need, and by providing the client with the power to control that pain, the need has been therapeutic. The remaining options contribute to personal control but not on the same elemental level as pain control.

7. When a nurse tells an advanced nurse practitioner that her client is "slipping a little" in reference to hemodynamic pressures, The nurse is using: 1. Brevity 2. Relevance 3. Pacing and control. 4. Connotative meaning

ANS: 4 The connotative meaning is the shade or interpretation of a word's meaning influenced by the thoughts, feelings, or ideas people have about the word. "Slipping a little" in reference to hemodynamic pressures is an example of using connotative meaning. Brevity means that communication is simple, brief, and direct. This is not an example of using brevity. Relevance means the message is relevant or important to the situation at hand. This is not an example of using relevance. Pacing and control mean speaking slowly enough to enunciate clearly and not changing subjects rapidly. This is not an example of using pacing and control.

1. The client tells the nurse that he understands most of the information but still has questions concerning the medication after the nurse has provided the client with information regarding the treatment plan for the diagnosis the. This response is an example of: 1. Referent 2. Receiver 3. Channel 4. Feedback

ANS: 4 This response is an example of feedback. Feedback is the message returned by the receiver. The referent motivates one person to communicate with another, such as a time schedule. This is not an example of a referent. The receiver is the person who receives and decodes the message. This question is not asking about the receiver, but rather the response. Channels are means of conveying and receiving messages through visual, auditory, and tactile senses. This response is not an example of a channel.

21. Which of the following nursing statements is the best example of the communication tool of clarification? 1. "Please say that again." 2. "I don't think I understand." 3. "What did you mean by that?" 4. "Can you give me an example?"

ANS: 4 To check whether understanding is accurate, ask the other person to rephrase it, explain further, or give an example of what the person means. By asking for an example, the nurse is best able to determine the meaning of the client's statement. The other options either simply ask the client to repeat the statement or state that the nurse needs further information.

28. The nurse observes a client with head bowed and hands folded seemingly in prayer. The nurse recognizes this as an example of: 1. Nonverbal communication 2. Interpersonal communication 3. Intrapersonal communication 4. Transpersonal communication

ANS: 4 Transpersonal communication is interaction that occurs within a person's spiritual domain. Many persons use prayer, meditation, guided reflection, religious rituals, or other means to communicate with their "higher power." Intrapersonal communication, self-talk or self-instruction provides a mental rehearsal for difficult tasks or situations so individuals are able to deal with them more effectively. Interpersonal communication is one-to-one interaction between the nurse and another person that often occurs face to face while nonverbal communication includes all five senses and everything that does not involve the spoken or written word.

1. It is necessary for the nurse manager to delegate tasks to the staff. Which of the following is a requirement of the delegation process? 1. Working alongside the staff to evaluate their care 2. Functioning from a laissez-faire style of leadership 3. Obtaining the employee's voluntary acceptance of the task 4. Communicating the work assignment in understandable terms

ANS: 4 When delegating, the nurse should always provide unambiguous and clear directions by describing a task, the desired outcome, and the time period within which the task should be completed. The nurse manager does not necessarily have to work alongside staff to evaluate their care. The nurse manager can often evaluate staff performance in client outcomes. A laissez-faire style of leadership is not a requirement for delegation. Tasks should be delegated to those who are capable, not necessarily to those who are willing.

9. A threshold of 90% is identified for an outcome indicator in the quality improvement program. Which of the following situations indicates a need for further review of the quality improvement plan? 1. The waiting time for clinic appointments has decreased 96%. 2. Clients with renal dialysis expressed a 95% satisfaction with their care. 3. In 93% of clients, subjective expressions of postoperative pain have decreased. 4. Wound infections are evident in 92% of clients after care of their IV access ports.

ANS: 4 Wound infections are exceeding the designated threshold, indicating a need for further review of the quality improvement plan. Waiting time for clinic appointments has decreased, meeting the threshold. Satisfaction with care meets the threshold. Expressions of pain have decreased, meeting the threshold.

Clinical nursing decisions are best made using:

Accurate assessment data

The nurse has completed an assessment on the client and identified the following nursing diagnoses. Which one of the following nursing diagnoses indicates a need to postpone teaching that was planned? 1. Activity intolerance related to pain 2. Ineffective management of treatment regimen 3. Noncompliance with prescribed exercise plan 4. Knowledge deficit regarding impending surgery

Activity intolerance related to pain

Which Domain? Role playing how the client can respond to friends when they *ask* about her situation

Affective Domain

Learning Environment (3/3 of Basic Learning Principles) (importance) *(6 requirements)* (when using groups...)

Allows a person to focus on the learning task *Lighting, Ventilation, Furniture, Temperature, Noise, Privacy* Position groups so everyone is facing each other

Which domain? Explaining blood pressure by comparing it to the flow of water in a hose

Analogy

A client has been recently told that the primary cancer has metastasized and the cancer is considered terminal. When the nurse offers to discuss palliative care options the client replies, "I can't understand why you all want to upset me by bringing the topic up. Now please just leave me alone." The nurse recognizes this response as: 1. Anger 2. Disbelief 3. Bargaining 4. Acceptance

Anger

The nurse is planning to teach a patient about the importance of exercise. When is the best time for teaching to occur? (Select all that apply.) A. When there are visitors in the room B. When the patients pain medications are working. C. Just before lunch when the patient is most awake and alert D. When the patient is talking about current stressors in his or her life

Answer: B. When the patients pain medications are working. C. Just before lunch when the patient is most awake and alert

To meet the needs of assigned clients & the responsibilities associated with the position, nurses need to be aware of time management techniques. The time management skills for the nurse include:

Anticipating possible interruptions by therapists & visitors

A client, after being taught of the clinical manifestations of inflammation to enable early detection of a complication of a surgical wound states, "I will look at the wound four times a day and tell my surgeon if it looks red or swollen." Her statement is an example of: 1. Attitudes 2. Application 3. Analysis 4. Evaluation

Application

The nurse is preparing the discharge teaching materials on newly prescribed drugs to a client diagnosed to be in the early stage of Alzheimer's disease. The nurse best deals with the client's cognitive deficits by: 1. Providing written material to supplement the discussion 2. Arranging for family to be present during the discussion 3. Presenting the material in two short but focused sessions 4. Requiring the client to restate the information in her own words

Arranging for family to be present during the discussion

Nursing Process: Assessment (identify ___)

Ask questions to *identify motivation to learn*

When a nurse is teaching a patient about how to administer an epinephrine injection in case of a severe allergic reaction, he or she tells the patient to hold the injection like a dart. Which of the following instructional methods did the nurse use? A. Telling B. Analogy C. Demonstration D. Simulation

B. Analogy Rationale: Again really? its an analogy

A patient who is hospitalized has just been diagnosed with diabetes. He is going to need to learn how to give himself injections. Which teaching method does the nurse use? A. Simulation B. Demonstration C. Group instruction D. One-on-one

B. Demonstration Rationale: Demonstration is used to teach patients psychomotor skills

A patient needs to learn how to administer a subcutaneous injection. Which of the following reflects that the patient is ready to learn? A. Describing difficulties a family member has had in taking insulin B. Expressing the importance of learning the skill correctly C. Being able to see and understand the markings on the syringe D. Having the dexterity needed to prepare and inject the medication.

B. Expressing the importance of learning the skill correctly Rationale: Patients are ready to learn when they understand the importance of learning and are motivated to learn

A patient needs to learn how to administer a subcutaneous injection. Which of the following reflects that the patient is ready to learn? A. Describing difficulties a family member has had in taking insulin B. Expressing the importance of learning the skill correctly C. Being able to see and understand the markings on the syringe D. Having the dexterity needed to prepare and inject the medication

B. Expressing the importance of learning the skill correctly Rationale: Patients are ready to learn when they understand the importance of learning and are motivated to learn.

A nurse is planning a teaching session about healthy nutrition with a group of children who are in first grade. The nurse determines that after the teaching session the children will be able to name three examples of foods that are fruits. This is an example of: A. A teaching plan B. Learning objective C. Reinforcement of content D. Enhancing the children's self efficacy

B. Learning objective Rationale: A learning objective describes what the learner will do after the teaching session

When is the best time for teaching to occur? (Select all that apply.) A. When there are visitors in the room B. When the patients pain medications are working. C. Just before lunch when the patient is most awake D. When the patient is talking about current stressors in his or her life

B. When the patients pain medications are working. C. Just before lunch when the patient is most awake

The nurse is preparing to present a teaching session on skin protection for a group of older adults at a senior center. A principle that has been found to be most effective in teaching older adults is: 1. Moving the group along at a predetermined pace 2. Providing information in longer teaching sessions 3. Speaking very slowly and in a louder tone of voice 4. Beginning and ending each session with important information

Beginning and ending each session with important information

A nurse is going to teach a patient how to perform breast self-examination. Which behavioral objective does the nurse set to best measure the patient's ability to perform the examination? A) The patient will verbalize the steps involved in breast self-examination within 1 week. B) The nurse will explain the importance of performing breast self-examination once a month. C) The patient will perform breast self-examination correctly on herself before the end of the teaching session. D) The nurse will demonstrate breast self-examination on a breast model provided by the American Cancer Society.

C) The patient will perform breast self-examination correctly on herself before the end of the teaching session. Return demonstration provides an excellent source of feedback and reinforcement to evaluate learning.

The school nurse is about to teach a freshman-level high school health class about nutrition. What is the best instructional approach to ensure that the students meet the learning outcomes? A. Provide information in a lecture B. Use simple words to promote understanding C. Develop topics for discussion that require problem solving D. Complete an extensive literature search focusing on eating disorders

C. Develop topics for discussion that require problem solving Rationale: Adolescents learn best when they are able to use problem solving to help them make choices

A patient newly diagnosed with cervical cancer is going home. The patient is avoiding discussion of her illness and postoperative orders. What is the nurse's best plan in teaching this patient? A. Teach the patient's spouse B. Focus on the knowledge that the patient will need in a few weeks C. Provide only the information that the patient needs to go home D. convince the patient that learning about her health is necessary

C. Provide only the information that the patient needs to go home Rationale: patient is in denial only give her information that is needed immediately

A nurse is going to teach a patient how to perform breast self-examination. Which behavioral objective does the nurse set to best measure the patient's ability to perform the examination? A. The patient will verbalize the steps involved in breast self-examination within 1 week. B. The nurse will explain the importance of performing breast self examination once a month. C. The patient will perform breast self-examination correctly on herself before the end of the teaching session. D. The nurse will demonstrate breast self-examination on a breast model provided by the American Cancer Society. Answer

C. The patient will perform breast self-examination correctly on herself before the end of the teaching session. Rationale: Return demonstration provides an excellent source of feedback and reinforcement to evaluate teaching.

A nurse is going to teach a patient how to perform breast self-examination. Which behavioral objective does the nurse set to best measure the patient's ability to perform the examination? A. The patient will verbalize the steps involved in breast self-examination within 1 week. B. The nurse will explain the importance of performing breast self examination once a month. C. The patient will perform breast self-examination correctly on herself before the end of the teaching session. D. The nurse will demonstrate breast self-examination on a breast model provided by the American Cancer Society.

C. The patient will perform breast self-examination correctly on herself before the end of the teaching session. Rationale: Return demonstration provides an excellent source of feedback and reinforcement to evaluate teaching.

Clients give various responses to teaching sessions. For the nurse, an example of an evaluation of a psychomotor skill is: 1. Client states side effects of a medication 2. Client responds appropriately to eye contact 3. Client independently plans an exercise program 4. Client demonstrates the proper use of a walking cane

Client demonstrates the proper use of a walking cane

The nurse is evaluating the responses of clients to teaching sessions. An example of an evaluation of a client's attainment of a cognitive skill is: 1. Client explains that the medication should be taken with meals 2. Client looks at the surgical incision without requiring prompting 3. Client uses crutches appropriately to move both up and down stairs 4. Client independently capable of dressing self after eating breakfast

Client explains that the medication should be taken with meals

As the nurse starts to perform a procedure, a peer says, "I've done that before. Would you like me to help?" The peer's leadership style is described as:

Coaching

3 Types of Learning *Domains*

Cognitive Affective Psychomotor

Which Domain? Asking a client what he *thinks* might happen at home and how he might respond

Cognitive Domain

When a client newly diagnosed with type 2 diabetes mellitus selects a lunch menu that correlates with the number of carbohydrates he is allowed for that meal, this is an example of: 1. Cognitive learning 2. Affective learning 3. Impaired learning 4. Psychomotor learning

Cognitive learning

When the oncology unit's interdisciplinary team meets every Monday morning at 0830 to discuss the unit's individual clients, the group is best displaying:

Collaborative practice

It is necessary for the nurse manager to delegate tasks to the staff. Which of the following is a requirement of the delegation process?

Communicating the work assignment in understandable terms

There are a variety of teaching methodologies that may be utilized to meet the client's needs. Which teaching method is best applied to a cognitive learning need? 1. Modeling of behavior 2. Discussion of feelings 3. Computer-assisted instruction 4. Demonstration of a procedure

Computer-assisted instruction

The professional nurse realizes there is both a legal and an ethical obligation to keep client information obtained through examination, observation, conversation, or treatment:

Confidential

The nurse realizes that the incorrect spelling of terms in the medical record most importantly:

Contributes to serious treatment errors

A patient needs to learn to use a walker. Which domain is required for learning this skill? A. Affective domain B. Cognitive domain C. Attentional domain D. Psychomotor domain

D. Psychomotor domain Rationale: Using a walker requires the integration of mental and muscular activity.

An older adult is being started on a new antihypertensive medication. In teaching the patient about the medication, the nurse: A. Speaks loudly B. Presents the information once C. Expects patient to understand information quickly D. allows the patient time to express himself/herself and ask questions

D. allows the patient time to express himself/herself and ask questions Rationale: In older patients its important to establish rapport, involve them in their care, and allow them to progress at their own pace

The new staff nurse is having her documentation evaluated by the charge nurse. On review of her charting, the charge nurse notes that there is evidence of appropriate documentation when the new staff nurse:

Dates and signs all of the entries made in the record

A unit manager on a busy multi-service medical nursing unit decides to take responsibility for the direct client care of one of the many new admissions. Later the manager decides she is too busy to give adequate client care. Which of the following situational leadership styles does the nurse manager need to apply?

Delegating

Which of the following actions is the best example of a nurse exercising nursing authority?

Determining that a client will not be ambulated based on assessment findings

A client has been recently told that the primary cancer has metastasized, and the cancer is considered terminal. When the nurse offers to discuss palliative care options, the client replies, "I'm going to have the reports reevaluated by another doctor; I feel fine and I think a mistake has been made." The nurse recognizes this response as: 1. Anger 2. Disbelief 3. Bargaining 4. Acceptance

Disbelief

To locate the recording of a nurse's description of the teaching provided to the client on performance of self- medication administration, one would look in a(n):

Discharge summary form

The nurse has made an error and is documenting such on the client's record and notes. The action that the nurse should take is to:

Draw a straight line through the error and initial it.

The nurse established the following objective for the client who was unable to void: The client's intake will be at least 1000 mL between 7 AM and 3:30 PM. Feedback showing success is indicated by the client: 1. Voiding at least 1000 mL during the shift 2. Verbalizing abdominal comfort without pressure 3. Having adequate fluid intake and urinary output 4. Drinking 240 mL of fluid five or six times during the shift

Drinking 240 mL of fluid five or six times during the shift

Appropriate Time to Implement Teaching is when..

During a similar activity (ex. teach proper skin care techniques when performing skin care)

One advantage of a decentralized management structure for nursing units over a centralized structure is that:

Each staff member is accountable for evaluating the plan of care

Which of the following is an example of an intervention used in the Problem-Intervention-Evaluation documentation method?

Educated to the purpose of dangling on the bedside before standing

A nurse who performs a skin assessment while bathing an immobile client would be displaying

Efficiency

Accountability is a critical aspect of nursing care. An example of a specific decision-making process of accountability is demonstrated by

Evaluating the client's outcomes following implementation of care

The primary reason the nurse asks for help when changing a client's complicated dressing is to:

Facilitate a comfortable, safe dressing change

The nurse is prioritizing care for two postoperative abdominal surgery clients; the first is 15 hours postoperative & the second is ready for discharge. Which of the interventions should be accomplished first?

First day post op coughing & deep breathing

The most important responsibility of a nurse manager is to:

Foster an environment that enables staff to provide quality nursing care

In anticipation of a nursing shortage, the nursing management in a facility is investigating a nursing care delivery model that involves the division of tasks, with one nurse assuming the responsibility for particular tasks. This model is called:

Functional nursing

teaching process: Assessment

Gather data about clients learning needs, motivation, ability to learn

The client continues to ask questions about a surgical wound. The client states, "I think I would like help the first time I look at my wound." This is an example of: 1. Adaptation 2. Perception 3. Organizing 4. Guided response

Guided response

A nurse is teaching a group of young college-age women the importance of using sunscreen when going out in the sun. What type of content is the nurse providing? A) Simulation B) Restoring health C) Coping with impaired function D) Health promotion and illness prevention

Health promotion and illness prevention

Nursing process: Evaluation

Identify success in meeting desired outcomes and goals of nursing care.

Teaching process: Plan

Identify type of teaching method to use

For a functionally illiterate client, the nurse particularly focuses on: 1. Using intricate analogies and examples 2. Avoiding lengthy return demonstrations 3. Incorporating familiar nonmedical terminology 4. Providing longer learning sessions with the client

Incorporating familiar nonmedical terminology

The nurse is preparing the information that will be provided to the staff on the next shift. Which of the following should the nurse include in the inter-shift report to nursing colleagues?

Instructions given to the client in a teaching plan

In preparing a teaching plan for adult clients in a cancer support group, the nurse incorporates evidence-based information. The nurse recognizes that evidence obtained about adult learners has identified that this group prefers: 1. Computer-assisted instruction 2. Traditional classroom settings 3. Long sessions with plenty of technical information 4. Interesting personal communication techniques

Interesting personal communication techniques

In planning to teach an older adult client, the nurse should incorporate which teaching method or principle into the plan? 1. Keep teaching sessions short. 2. Teach in the early morning or late evening. 3. Put as much as possible into each teaching session. 4. Focus on teaching a family member or caregiver instead.

Keep teaching sessions short.

Teaching tools appropriate for use in the pediatric patient

Let kids play dress-up and play with equipment (stethoscope, tongue blade). Use simple language.

The nursing faculty recognizes the correct way to instruct the nursing students to acknowledge their charting in a client's medical record is:

Linda Mozden, SN, Fairmont State University

3 Types of Basic Learning *Principles*

Motivation Ability Environment

Which of the following nursing actions is most directly aimed at affording a client confidential treatment of his or her medical information while minimizing delay in accessing needed medical and nursing care?

Notifying the client of the institution's privacy policy

When the nurse gathers all the equipment needed for a particular procedure & arranges the client's room for proficient implementation of the procedure, the nurse is displaying:

Organization

A client has reported all of the following; which should be given priority by the nurse?

Pain

In order for therapy to have an effect the patient must.. (example)

Patient must believe the tissue is important enough to change. (ex. patient with lung disease who continues to smoke)

Motivation to Learn (requires these three things..)

Patient's desire or willingness to learn 1. *Self-Efficacy* 2. Attentional Set 3. Motivation

To avoid legal risks and possible lack of confidentiality associated with computerized documentation, many programs currently have:

Periodic changes in staff passwords

The primary benefit of achieving Magnet status is the nursing staff is empowered to make innovative changes that:

Positively affect client care outcomes

Indicators in a quality improvement program that evaluates the manner in which care is delivered are:

Process indicators

Which of the following actions is the primary nursing responsibility regarding client education? 1. Providing accurate, current, relevant information 2. Answering the client's questions regarding health-related issues 3. Assessing the individual client's readiness and motivation to learn 4. Identifying areas where clients are in need of educational information

Providing accurate, current, relevant information

Which Domain? Demonstrating and *practicing* how to perform a procedure

Psychomotor

When a client newly diagnosed with type 2 diabetes mellitus assumes responsibility for checking her blood glucose level four times a day, this is an example of: 1. Cognitive learning 2. Affective learning 3. Impaired learning 4. Psychomotor learning

Psychomotor learning

Which of the following actions best reflects accountability for the client's care outcomes?

Reassessing a client's BP when the reported value is higher than usual

When another health care professional is asked to assess a client for the purpose of suggesting treatment to the primary health care provider, this is called a:

Referral

Nurse must establish ___ before teaching

Report with patient/learner

Which of the following is an example of a problem statement used in the Problem-Intervention-Evaluation documentation method?

Risk for injury related to falling due to dizziness

The nurse is teaching a parenting class to a group of pregnant adolescents. The nurse pretends to be the baby's father, and the adolescent mother is asked to show how she would respond to the father if he gave her a can of beer. Which teaching approach did the nurse use? A) Role play B) Discovery C) An analogy D) A demonstration

Role play

Regarding access to client records, the nursing faculty informs the nursing students to be prepared to:

Show the unit staff proper student identification

There are a variety of teaching methodologies fro a nurse to choose from to use with clients. For a toddler, the nurse should use: 1. Role-playing 2. Problem-solving 3. Independent learning 4. Simple explanations and pictures

Simple explanations and pictures

The client has been informed that he can be discharged once he can irrigate his colostomy independently. The client requests the nurse to observe his irrigation technique. Which of the following learning motives is the client displaying? 1. Physical need 2. Social activity 3. Task mastery 4. Evaluation stance

Task mastery

Differences between teaching and learning

Teaching produces learning. Learning is a change in behavior.

In anticipation of a nursing shortage, the nursing management in a facility are investigating a nursing care delivery model that involves staff members working under the direction of a registered nurse leader. This model is called:

Team nursing

The nurse has important information to share with a parent who has brought his child to the emergency department. The nurse discovers that the parent, who appears very anxious, has just learned his son will require surgery. The most effective teaching approach in this situation is: 1. Telling 2. Trusting 3. Participating 4. Group teaching

Telling

The following statement: "Upon exertion, the client is wheezing and experiencing some dyspnea," is an example of:

The "P" of PIE

The nurse recognizes that the client's teaching plan is most directly driven by: 1. The client's identified learning needs 2. The complexity of the client's health needs 3. The client's readiness and motivation to learn 4. The presence of cultural or physical barriers

The client's identified learning needs

The student nurse is seeking to learn skills associated with priority setting. In discussing different priorities of care, an example of a second-order priority is:

The need to urinate

An incident report is to be completed because the client climbed over the side rails and fell to the floor. The correct reporting of an incident involves which of the following?

The witnessing nurse completes the report.

The nurse recognizes that the primary goal of a client's teaching plan is to: 1. Facilitate a knowledge-based client decision-making process 2. Provide information that brings about informed client consent 3. Enhance the client's sense of personal control regarding his or her health care 4. Therapeutically affect the client's health, wellness, and independence

Therapeutically affect the client's health, wellness, and independence

The nurse is demonstrating to the client how to put on anti-embolitic stockings. In the middle of the lesson the client asks, "Why have my feet been swelling?" The nurse stops and responds to the client. Which of the following is the teaching principle that the nurse should follow? 1. Timing 2. Setting priorities 3. Building on existing knowledge 4. Organizing the teaching materials

Timing

An industrial nurse is planning to give an informative talk on hypertension to employees in honor of "heart month." He plans to teach individuals how to take their blood pressure measurements. Which information is important for him to ask the planning committee before this presentation? 1. Ages of all employees involved 2. Names of employees who are married 3. Number of employees with high blood pressure 4. Type of room available and number of participants

Type of room available and number of participants

The nurse on the unit is determining which activities may be delegated to assistive personnel. Assuming that the nurse assistant is competent, which one of the following activities may be safely delegated by the registered nurse?

Vital signs on a stable client

Which of the following teaching topics is an example of restoration of health? 1. Glucose monitoring at home 2. Living with rheumatoid arthritis 3. Stress management's impact on depression 4. What to expect after hip replacement surgery

What to expect after hip replacement surgery

There are many factors are assessed before teaching the client to learn insulin injection sites, but the most important factor for the nurse to assess first is the: 1. Previous knowledge level of the client 2. Willingness of the client to want to learn the injection sites 3. Financial resources available to the client for the equipment 4. Intelligence and developmental level of the individual client

Willingness of the client to want to learn the injection sites

A threshold of 90% is identified for an outcome indicator in the quality improvement program. Which of the following situations indicates a need for further review of the quality improvement plan?

Wound infections are evident in 92% of clients after care of their IV access ports.

Which statements by the nurse indicate a good understanding of patient education/teaching? (Select all that apply.) a. "Patient education is a standard for professional nursing practice." b. "Patient teaching falls within the scope of nursing practice." c. "Patient education is an essential component of safe, patient-centered care." d. "Patient education is not effective with children." e. "Patient teaching can increase health care costs." f. "Patient teaching should be documented in the chart."

a. "Patient education is a standard for professional nursing practice." b. "Patient teaching falls within the scope of nursing practice." c. "Patient education is an essential component of safe, patient-centered care." f. "Patient teaching should be documented in the chart."

While preparing a teaching plan, the nurse described what the learner will be able to accomplish after the teaching session. Which action did the nurse complete? a. Developed learning objectives b. Provided positive reinforcement c. Implemented interpersonal communication d. Presented facts and knowledge

a. Developed learning objectives Learning objectives describe what the learner will be able to do after successful instruction. Positive reinforcement follows feedback and involves the use of praise and acknowledgment of new attitudes, behaviors, or knowledge. Interpersonal communication is necessary for the teaching/learning process, but describing what the learner will be able to do after successful instruction constitutes learning objectives. Facts and knowledge will be presented in the teaching session.

Which factors should the nurse assess to determine a patient's ability to learn? a. Developmental capabilities and physical capabilities b. Sociocultural background and motivation c. Psychosocial adaptation to illness and active participation d. Stage of grieving and overall physical health

a. Developmental capabilities and physical capabilities Developmental and physical capabilities reflect one's ability to learn. Sociocultural background and motivation are factors in readiness to learn. Psychosocial adaptation to illness and active participation are factors in readiness to learn. Readiness to learn is related to the stage of grieving. Overall physical health does reflect ability to learn; however, because it is paired here with stage of grieving (which is a readiness to learn factor), this is a wrong answer.

The nurse is developing a teaching plan on self-injection of insulin for a group of diabetic clients. The plan includes information about injections and types of insulin, and demonstrations of injection technique. What affective component is important for the nurse to plan to include in educating these clients? a. Helping clients accept the need for daily injections b. Having clients demonstrate injection procedures on themselves c. Asking clients to describe the injection procedure d. Giving a test on the types of insulin and duration of action

a. Helping clients accept the need for daily injections Rationale: The affective domain of learning is the feeling domain, and involves emotions, attitudes, interests, and appreciations. The cognitive domain is the thinking domain, and involves intellectual abilities. The psychomotor domain is the skill domain, and involves motor skills. All three domains should be included in planning client education.

A nurse is preparing to teach a kinesthetic learner about exercise. Which technique should the nurse use? a. Let the patient touch and use the exercise equipment. b. Provide the patient with pictures of the exercise equipment. c. Let the patient listen to a podcast about the exercise equipment. d. Provide the patient with a case study about the exercise equipment.

a. Let the patient touch and use the exercise equipment. Kinesthetic learners learn best while they are moving and participating in hands-on activities.

A patient has been taught how to cough and deep breathe. Which evaluation method is most appropriate? a. Return demonstration b. Computer instruction c. Verbalization of steps d. Cloze test

a. Return demonstration To demonstrate mastery of the skill, have the patient perform a return demonstration under the same conditions that will be experienced at home or in the place where the skill is to be performed.

When the nurse describes a patient's perceived ability to successfully complete a task, which term should the nurse use? a. Self-efficacy b. Motivation c. Attentional set d. Active participation

a. Self-efficacy Self-efficacy, a concept included in social learning theory, refers to a person's perceived ability to successfully complete a task. Motivation is a force that acts on or within a person (e.g., an idea, an emotion, a physical need) to cause the person to behave in a particular way. An attentional set is the mental state that allows the learner to focus on and comprehend a learning activity. Learning occurs when the patient is actively involved in the educational session

A nurse provides teaching about coping with long-term impaired functions. Which situation serves as the best example? a. Teaching a family member to give medications through the patient's permanent gastric tube b. Teaching a woman who recently had a hysterectomy about her pathology reports c. Teaching expectant parents about physical and psychological changes in childbearing women d. Teaching a teenager with a broken leg how to use crutches

a. Teaching a family member to give medications through the patient's permanent gastric tube New knowledge and skills are often necessary for patients and/or family members to continue activities of daily living. Teaching family members to help the patient with health care management (e.g., giving medications through gastric tubes, doing passive range-of-motion exercises) is an example of coping with long-term impaired functions.

A client from a homeless shelter who has had minor surgery and has been given an instruction sheet in preparation for discharge is noted to be noncompliant with instructions when dressing for discharge. When asked by the nurse if the instructions were clear, the client said, "I'll read them later, when I have my glasses; besides, I know all that stuff." Based on these behaviors, the nurse may suspect that: a. The client may be unable to read the instructions b. The client is noncompliant c. The client doesn't understand the instructions d. The client is confused

a. The client may be unable to read the instructions Rationale: Clients who can't read may be noncompliant, insist that they know information, or have excuses for not reading the instructions. Behaviors such as these should alert the nurse to the need to further assess literacy.

Which learning objective/outcome has the highest priority for a patient with life-threatening, severe food allergies that require an EpiPen (epinephrine)? a. The patient will administer epinephrine. b. The patient will identify the main ingredients in several foods. c. The patient will list the side effects of epinephrine. d. The patient will learn about food labels.

a. The patient will administer epinephrine. Once you assist in meeting patient needs related to basic survival (how to give epinephrine), you can discuss other topics, such as nutritional needs and side effects of medications. For example, a patient recently diagnosed with coronary artery disease has deficient knowledge related to the illness and its implications. The patient benefits most by first learning about the correct way to take nitroglycerin and how long to wait before calling for help when chest pain occurs. Thus, in this situation, the patient benefits most by first learning about the correct way to take epinephrine. "The patient will learn about food labels" is not objective and measurable and is not correctly written.

A patient had a stroke and must use a cane for support. A nurse is preparing to teach the patient about the cane. Which learning objective/outcome is most appropriate? a. The patient will walk to the bathroom and back to bed using a cane. b. The patient will understand the importance of using a cane. c. The patient will learn how to use a cane. d. The patient will know the correct use of a cane.

a. The patient will walk to the bathroom and back to bed using a cane. Outcomes often describe a behavior that identifies the patient's ability to do something on completion of teaching such as will empty colostomy bag, or will administer an injection. Understand, learn, and know are not behaviors that can be observed or evaluated.

Learning

acquire new knowledge, attitudes, behaviors and skills.

Which action best indicates that learning has occurred? a. A nurse presents information about diabetes. b. A patient demonstrates how to inject insulin. c. A family member listens to a lecture on diabetes. d. A primary care provider hands a diabetes pamphlet to the patient.

b. A patient demonstrates how to inject insulin. Learning is the purposeful acquisition of new knowledge, attitudes, behaviors, and skills. Complex patterns are required if the patient is to learn new skills, change existing attitudes, transfer learning to new situations, or solve problems.

A nurse is preparing to teach a patient about heart failure. Which environment is best for patient learning? a. A darkened, quiet room b. A well-lit, ventilated room c. A private room at 85 F temperature d. A group room for 10 to 12 patients with heart failure

b. A well-lit, ventilated room The ideal environment for learning is a room that is well lit and has good ventilation, appropriate furniture, and a comfortable temperature. Although quiet is appropriate, a darkened room interferes with the patient's ability to watch your actions, especially when you are demonstrating a skill or using visual aids such as posters or pamphlets.

A nurse is asked about the goal of patient education. What is the nurse's best response? The goal of educating others is to help people a. Meet standards of the Nurse Practice Act. b. Achieve optimal levels of health. c. Become dependent on the health care team. d. Provide self-care only in the hospital.

b. Achieve optimal levels of health. The goal of educating others about their health is to help individuals, families, or communities achieve optimal levels of health. Although all state Nurse Practice Acts acknowledge that patient teaching falls within the scope of nursing practice, this is the nurse's standard, not the goal of education. Patient education helps patients make informed decisions about their care and become healthier and more independent, not dependent. Nurses provide patients with information needed for self-care to ensure continuity of care from the hospital to the home.

Which nursing action is most appropriate for assessing a patient's learning needs? a. Assess the patient's total health care needs. b. Assess the patient's health literacy. c. Assess all sources of patient data. d. Assess the goals of patient care.

b. Assess the patient's health literacy. Because health literacy influences how you deliver teaching strategies, it is critical for you to assess a patient's health literacy before providing instruction. The nursing process requires assessment of all sources of data to determine a patient's total health care needs. Evaluation of the teaching process involves determining outcomes of the teaching/learning process and the achievement of learning objectives, not patient care. Assessing the goal of meeting patient care is the evaluation component of the nursing process.

A patient with heart failure is learning to reduce salt in the diet. When would be the best time for the nurse to address this topic? a. At bedtime, when the patient is relaxed b. At lunchtime while the nurse is preparing the food tray c. At bath time, when the nurse is cleaning the patient d. At medication time, when the nurse is administering patient medication

b. At lunchtime while the nurse is preparing the food tray Appropriate times to talk about food/diet changes during routine nursing care are at breakfast, lunch, and dinner times or when the patient is completing the menu. Many nurses find that they are able to teach more effectively while delivering nursing care. For example, while hanging blood, you explain to the patient why the blood is necessary and the symptoms of a transfusion reaction that need to be reported immediately. In this situation, because the teaching is about food, coordinating it with routine nursing care that involves food can be effective. At bedtime would be a good time to discuss routines that enhance sleep. At bath time would be a good time to describe skin care and how to prevent pressure ulcers. At medication time would be a good time to explain the purposes and side effects of the medication.

A student nurse learns that a normal adult heartbeat is 60 to 100 beats/minute. In which domain did learning take place? a. Kinesthetic b. Cognitive c. Affective d. Psychomotor

b. Cognitive Cognitive learning includes all intellectual behaviors and requires thinking. In the hierarchy of cognitive behaviors, the simplest behavior is acquiring knowledge. The student nurse acquired knowledge, which is cognitive. Kinesthetic is a type of learner who learns best with a hands-on approach. Affective learning deals with expression of feelings and acceptance of attitudes, opinions, or values. Psychomotor learning involves acquiring skills that require integration of mental and muscular activities, such as the ability to walk or to use an eating utensil.

A nurse who is applying behaviorist learning theory offers a block of information on risk factors for heart disease in a straightforward, non-distracting way. What teaching strategies are appropriate for the nurse applying this learning theory to use next? a. Encourage positive teacher-learner relationships, and select multisensory delivery methods b. Give a short test, and provide positive feedback c. Assess clients' developmental and individual learning readiness, and adapt teaching strategies accordingly d. Encourage clients to establish goals, and promote self-directed learning

b. Give a short test, and provide positive feedback Rationale: Nurses applying behaviorist theory should include: careful identification of material to be taught; strategies that avoid distracting information; immediate and repeat testing; positive feedback; and role modeling. Strategies in choice "1" and "3" are consistent with cognitive theory. Strategies in choice "4" are consistent with humanism.

A nurse is teaching a patient about the Speak Up Initiatives. Which information should the nurse include? a. The nurse is the center of the health care team. b. If you still do not understand, ask again. c. Ask a nurse to be your advocate or supporter. d. Inappropriate medical tests are the most common mistakes.

b. If you still do not understand, ask again. If you still do not understand, ask again is part of the S portion of the Speak Up Initiatives. Speak up if you have questions or concerns. You (the patient) are the center of the health care team, not the nurse. Ask a trusted family member or friend to be your advocate (advisor or supporter), not a nurse. Medication errors are the most common health care mistakes, not inappropriate medical tests.

A patient has been taught how to change a colostomy bag but is having trouble measuring and manipulating the equipment and has many questions. What is the nurse's next action? a. Refer to a mental health specialist. b. Refer to an ostomy specialist. c. Refer to a dietitian. d. Refer to a wound care specialist.

b. Refer to an ostomy specialist. Resources that specialize in a particular health need (e.g., wound care or ostomy specialists) are integral to successful patient education. A mental health specialist is helpful for emotional issues rather than for physical problems. A dietitian is a resource for nutritional needs. A wound care specialist provides complex wound care.

The nurse is teaching a client about reducing blood cholesterol levels through dietary management. The most appropriate learning outcome for the teaching would be: a. The client will understand benefits of a low-fat diet for cholesterol reduction b. The client will accurately select low-fat foods from a list of common foods c. The nurse will teach the client about low-fat foods and cholesterol reduction d. The client will list some common low-fat foods

b. The client will accurately select low-fat foods from a list of common foods Rationale: Learning outcomes should state expected client behavior; should reflect an observable, measurable activity; and may have conditions or modifiers stating conditions of performance. Words such as know, understand, feel, and believes are not measurable.

Which situation will cause the nurse to postpone a teaching session? (Select all that apply.) a. The patient is mildly anxious. b. The patient is fatigued. c. The patient is asking questions. d. The patient is hurting. e. The patient is febrile (high fever). f. The patient is in the acceptance phase.

b. The patient is fatigued. d. The patient is hurting. e. The patient is febrile (high fever).

Which situation indicates to the nurse that the patient is ready to learn? a. A patient has sufficient upper body strength to move from a bed to a wheelchair. b. A patient has the ability to grasp and apply the elastic bandage. c. A patient with a below-the-knee amputation is motivated about how to walk with assistive devices. d. A patient has normal eyesight to identify the markings on a syringe and coordination to handle a syringe.

c. A patient with a below-the-knee amputation is motivated about how to walk with assistive devices.

A toddler is going to have surgery on the right ear. Which teaching method is most appropriate for this developmental stage? a. Encourage independent learning. b. Use discussion throughout the teaching session. c. Apply a bandage to a doll's ear. d. Develop a problem-solving scenario.

c. Apply a bandage to a doll's ear. Use play to teach a procedure or activity (e.g., handling examination equipment, applying a bandage to a doll) to toddlers. Encouraging independent learning is for the middle-aged adult. Use of discussion is for older children, adolescents, and adults, not for toddlers. Use problem solving to help adolescents make choices. Problem solving is too advanced for a toddler.

A nurse is going to teach a patient about hypertension. Which action should the nurse implement first? a. Set mutual goals for knowledge of hypertension. b. Teach what the patient wants to know about hypertension. c. Assess what the patient already knows about hypertension. d. Evaluate the outcomes of patient education for hypertension.

c. Assess what the patient already knows about hypertension. Assessment is the first step of any teaching session, then diagnosing, planning, implementation, and evaluation. An effective assessment provides the basis for individualized patient teaching. Assessing what the adult patient currently knows improves the outcomes of patient education.

The nurse is planning an educational program on cancer detection for a community group. What should be included in the plan to assure that the program will address various learning styles of clients? a. Multicolored posters with bright colors b. Lecture to the group, using many examples c. Audiovisuals, examples, group discussions, and activities d. A game board, with clients matching terms

c. Audiovisuals, examples, group discussions, and activities Rationale: When teaching a group, utilize strategies to address visual, auditory, manipulative, group, and problem-solving types of learners. Using varying techniques and varying activities is a good way to match the varying learning styles of group participants.

A nurse is teaching an older adult patient about strokes. Which teaching technique is most appropriate for the nurse to use? a. Use a pamphlet about strokes with large font in blues and greens. b. Speak in a high tone of voice to describe strokes. c. Begin and end each teaching session with the most important information about strokes. d. Provide specific information about strokes in frequent, large amounts.

c. Begin and end each teaching session with the most important information about strokes.

Prior to beginning a teaching session on self-care of a colostomy, the nurse will assess the client's readiness to learn by assessing: a. Client's recognition of a need to learn, and belief that learning will lead to self-care ability b. Client's knowledge and previous experience with colostomies c. Client's pain and comfort levels, and willingness to learn d. Client's cognitive and sensory abilities

c. Client's pain and comfort levels, and willingness to learn Rationale: Readiness involves both willingness to learn and ability to learn at a specific time. Pain or discomfort may make it difficult for a client to learn, and must be addressed prior to teaching. The other factors should be assessed as well, but are not indicative of readiness.

A nurse is teaching a culturally diverse patient about nutritional needs. What must the nurse do first before starting the teaching session? a. Obtain pictures of food. b. Get an interpreter. c. Establish a rapport. d. Refer to a dietitian.

c. Establish a rapport. Establishing a rapport is important for all patients, especially culturally diverse patients, before starting teaching sessions. Obtaining pictures of food, getting an interpreter, and referring to a dietitian all occur after rapport is established.

A nurse wants the patient to begin to accept the chronic nature of diabetes. Which teaching technique should the nurse use to enhance learning? a. Lecture b. Demonstration c. Role play d. Question and answer session

c. Role play Affective learning deals with expression of feelings and acceptance of attitudes, opinions, or values. Role play and discussion (one-on-one and group) are effective teaching methods for the affective domain. Lecture and question and answer sessions are effective teaching methods for the cognitive domain. Demonstration is an effective teaching method for the psychomotor domain.

After a teaching session on taking blood pressures, the nurse tells the patient, "You took that blood pressure like an experienced nurse." What type of reinforcement did the nurse use? a. Material b. Activity c. Social d. Entrusting

c. Social Three types of reinforcers are social, material, and activity. When a nurse works with a patient, most reinforcers are social and are used to acknowledge a learned behavior (e.g., smiles, compliments, words of encouragement). Examples of material reinforcers include food, toys, and music. Activity reinforcers rely on the principle that a person is motivated to engage in an activity if he or she has the opportunity to engage in a more desirable activity after completion of the task. The entrusting approach is a teaching approach that provides the patient the opportunity to manage self-care. It is not a type of reinforcement.

The nurse has offered a diabetic education program. What is the best indication of client compliance with a diabetic treatment plan? a. The client expresses a desire to learn about diabetes treatment. b. The client can list foods that are not allowed on a diabetic diet. c. The client willingly learns about diabetes treatment and follows the treatment plan. d. The client is able to discuss diabetes treatment and passes a test on program content with a score of 90%.

c. The client willingly learns about diabetes treatment and follows the treatment plan. Rationale: Evaluation of compliance involves evaluating the extent to which the client recognizes and accepts the need to learn, and then follows through with appropriate behavior. Clients may learn the educational material and still not be compliant.

As the nurse starts to perform a procedure, a peer says, "I've done that before. Would you like me to help?" The peer's leadership style is described as:

coaching

A nurse is assessing the ability to learn of a patient who has recently experienced a stroke. Which question/statement will best assess the patient's ability to learn? a. "What do you want to know about strokes?" b. "On a scale from 1 to 10, tell me where you rank your desire to learn." c. "Do you feel strong enough to perform the tasks I will teach you?" d. "Please read this handout and tell me what it means."

d. "Please read this handout and tell me what it means." A patient's reading level affects ability to learn. Reading level is often difficult to assess because patients who are functionally illiterate are often able to conceal it by using excuses such as not having the time or not being able to see. One way to assess a patient's reading level and level of understanding is to ask the patient to read instructions from an educational handout and then explain their meaning. Asking patients what they want to know identifies previous learning and learning needs and preferences; it does not assess ability to learn. Motivation is related to readiness to learn, not ability to learn. Just asking a patient if they feel strong is not as effective as actually assessing the patient's strength

Which statement indicates that the nurse has a good understanding of teaching/learning? a. "Teaching and learning can be separated." b. "Learning is an interactive process that promotes teaching." c. "Learning consists of a conscious, deliberate set of actions designed to help the teacher." d. "Teaching is most effective when it responds to the learner's needs."

d. "Teaching is most effective when it responds to the learner's needs." Teaching is most effective when it responds to the learner's needs. It is impossible to separate teaching from learning. Teaching is an interactive process that promotes learning. Teaching consists of a conscious, deliberate set of actions that help individuals gain new knowledge, change attitudes, adopt new behaviors, or perform new skills.

A client presents with the following: recent medical diagnosis of congestive heart failure, four new medications, and reduced activity levels due to shortness of breath. The most appropriate nursing diagnosis based upon this information is: a. Health-Seeking Behavior (exercise and activity) related to desire to improve health status b. Noncompliance with medical treatment plan related to lack of energy for activity c. Risk for ineffective coping related to deficient knowledge d. Deficient Knowledge (medication) related to inexperience with newly ordered therapy

d. Deficient Knowledge (medication) related to inexperience with newly ordered therapy Rationale: Deficient Knowledge is used as a diagnostic label when the client is seeking health information or the nurse has identified a learning need. The area of deficiency should be included in the diagnosis.

A nurse is teaching the staff about nursing and teaching processes. Which information should the nurse include regarding the teaching process? During the teaching process, what should the nurse do? a. Assess all sources of data. b. Identify that it is the same as the nursing process. c. Perform nursing care therapies. d. Focus on a patient's learning needs.

d. Focus on a patient's learning needs. The teaching process focuses on the patient's learning needs and willingness and capability to learn. Nursing and teaching processes are not the same. All the rest are components of the nursing process: Assess all sources of data and perform nursing care therapies.

A client who is doing a return demonstration of how to change a wound dressing to the leg contaminates the dressing after appropriately cleansing the wound. The best nursing response is to: a. Say, "You have done this all wrong! Let me show you again." b. Remove the dressing, cleanse the wound again, and apply a new dressing c. Say and do nothing to avoid upsetting the client d. Say, "You did a good job of cleansing the wound. Let's look at ways to best put the dressing on."

d. Say, "You did a good job of cleansing the wound. Let's look at ways to best put the dressing on." Rationale: Clients need positive feedback on performance to enhance learning. Positive feedback can include praise, positively worded corrections, and suggestions of alternate methods. Negative feedback is often viewed as punishment, and may cause the client to avoid the nurse or refuse to participate further.

A nurse teaches a patient with heart failure healthy food choices. The patient states that eating yogurt is better than eating cake. In this situation, which element represents feedback? a. The nurse b. The patient c. The nurse teaching about healthy food choices d. The patient stating that eating yogurt is better than eating cake

d. The patient stating that eating yogurt is better than eating cake Feedback should show the success of the learner in achieving objectives (i.e., the learner verbalizes information or provides a return demonstration of skills learned). The nurse is the sender. The patient is the receiver. The teaching is the message.

Risk for Low Health Literacy

elderly minority immigrant low income chronic mental/physical health conditions

Motivation 1. 2. 3.

force that acts within person to cause the person to behave in a particular way: 1. social motive - need to connect, approval or self-esteem 2. task mastery motive - based on achievement and competence 3. physical motive - return to level of normalcy *none have an effect unless the person believes health is important

Functional Illiteracy

inability to read above 5th grade level

Cognitive Learning

includes all intellectual behaviors, requires *thinking*: *knowledge (easiest) *comprehension *application *analysis *synthesis - break down create something new *evaluation - (hardest)

Teaching Process requires ____ communication

interpersonal

Implementation Teaching Process

involve pt in learning activities, include family caregiver

Teaching is an _____

is an interactive process that *promotes* learning.

Teaching process: Diagnosis

learning needs on basis of three domains of learning

Lower Health Literacy Scores

older adults men no English before entering school below poverty level no h.s. education

Teaching Process focuses on..

patient's learning needs and ability to learn

Nursing Process focuses on..

patient's total health care needs

Social Learning Theory

people attempt to control events that affect their lives

Teaching process: Implementation

use teaching methods. involve client and family participation as appropriate.