PrepU Chapter 09: Teaching and Counseling

A nurse is educating a client with a new diagnosis of diabetes. Which example demonstrates cognitive learning by the client?

*** The client describes signs and symptoms of hypoglycemia. - The client demonstrates proper technique for injecting insulin. - The client expresses a desire to improve nutritional intake and lose weight. - The client prepares the skin for the administration of an insulin injection.

When caring for a client at the health care facility, the nurse observes that the client is having difficulty understanding the health education. Which action is most appropriate?

**Assess for cultural differences. - Boost the morale of the client. - Delegate the health education to a colleague. - Replace one-on-one teaching with written materials.

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

- Role playing - Discussion - Printed materials

A client informs the nurse about being committed to quitting smoking to improve health. During discussion, the nurse asks the client "on a scale of 0 to 10, how likely are you to attend a support group?" Which strategy of motivational interviewing is the nurse using with the client?

**Assessing importance - Elicit-provide-elicit - Evoking change talk - Prioritizing

A client diagnosed with type 2 diabetes has been prescribed insulin therapy in conjunction with an oral agent because the client has been experiencing difficulty controlling blood sugar levels with an oral agent alone. The nurse is preparing a teaching plan for this client. Which intervention would the nurse include in the teaching plan to address the psychomotor domain?

**Demonstrating the technique for insulin self-injection - Describing the signs and symptoms of low blood sugar - Explaining what to do if hypoglycemia occurs - Reviewing with the client appropriate foods to eat

While the nurse is caring for a hearing impaired client, and a family member of the client states, "What do you think is the best way to communicate?" What is the best response by the nurse? -"Use words that begin with 'f,' 's,' 'k,' and 'sh' to communicate." -"Use flash cards and writing pads." -"Limit communication to avoid frustration." -"Encourage family members to increase their vocal pitch."

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

A 46-year-old obese client has been diagnosed with hypertension and type 2 diabetes. The client acknowledges the need to lose weight. The client recently visited a local fitness club, obtained a membership, and has signed up for their next water aerobics class. According to the Transtheoretical Model of Change, what stage of change is this client in related to her weight loss?

** Preparation - Maintenance - Precontemplation - Contemplation

The nurse has provided education to a client about home care for an open surgical wound on the lower left extremity. When evaluating learning through the cognitive domain, what statement by the nurse would be appropriate?

**"Tell me about what signs of infection you will report to the health care provider." - "I would like you to demonstrate how to change the dressing on your leg." - "Let's see how you irrigate the wound with saline." - "I notice that you do not have the dressing secured. Place a piece of tape on the wrap."

A pediatric nurse provides education to numerous clients. Which group of children benefits most from being involved in the teaching-learning process?

**School-age children - Infants - Toddlers - Preschoolers

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

- Adaptive learning theory - Behavioral learning theory **Cognitive learning theory - Developmental learning theory

Which learning domain is the focus for instruction when the nurse educates a new mother about the breast and its role in milk production for feeding the newborn?

- Affective - Psychomotor **Cognitive - Behavioral

A client is reluctant to learn to do finger sticks for home international normalized ratio (INR) monitoring. What is the best statement by the nurse?

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

A nurse is preparing to teach a client about the importance of contraception and safe-sex practices. Which factors can most affect the nurse's teaching strategies for this client? Select all that apply.

- Available resources - Learning style preferences - Literacy level

A nurse is providing teaching to clients in a short-term rehabilitation facility. Which examples are common teaching mistakes made by health care professionals? Select all that apply.

- The nurse fails to accept that clients have the right to change their minds. - The nurse uses medical jargon frequently when discussing the teaching plan. - The nurse ignores the restrictions of the client's environment.

A nurse is writing learner objectives for a client who was recently diagnosed with type 2 diabetes. Which statement best describes the proper method for writing objectives?

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

When a client says, "I don't care if I get better; I have nothing to live for, anyway," which type of counseling would be appropriate?

Long-term counseling ***Motivational counseling Short-term counseling Professional counseling

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

Long-term counseling Motivational counseling ** Short-term counseling Professional counseling

A client reads the nutritional chart and follows it accurately. The nurse also notes that the client understands the need for a balanced diet and its relationship with a quick recovery. In which domain is the client demonstrating successful learning?

**Cognitive Affective Psychomotor Interpersonal

The nurse will be caring for a client with a new diagnosis of hypertension. The client will be arriving for laboratory testing. When should the nurse begin client teaching? -during the admission process -after testing is completed -when results are available -immediately prior to discharge

during the admission process Explanation: Limited hospitalization time demands that nurses begin teaching as soon as possible. The client should be educated during the process of admission regarding what to expect, client rights, etc. The client should be educated prior to diagnostic testing. Although the client may require additional education when the test results become available, education should begin earlier. Waiting until immediately prior to discharge to begin teaching does not give the opportunity for return demonstration or to adequately determine whether the education was successful.

When a client says, "I don't care if I get better; I have nothing to live for, anyway," which type of counseling would be appropriate? -Long-term counseling -Motivational counseling -Short-term counseling -Professional counseling

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

When preparing client teaching materials, how does the nurse best assess a client's preferred learning style?

- Observe the client's behaviors. - Provide teaching that works for the broadest base of clients. **Ask the client, "Do you learn best by observing, valuing, or doing?" - Determine client learning needs based on age and ability to hear effectively.

The nurse is providing instructions to a client about performance of breast self-examination. What learning outcome would be most appropriate regarding this education?

- The client will demonstrate self-efficacy and improved body image. - The client will have restoration of breast function. **The client will be able to perform proper breast self-examination for breast cancer detection and prevention. - The client will demonstrate improved coping skills.

A nurse is assessing a client who has come to the clinic for a follow-up appointment. The client was diagnosed with asthma several months ago and has missed several appointments since that time. The client also has not been following the medication plan and has not kept the appointment for allergy testing. The nurse suspects that the client may be experiencing problems with health literacy. The nurse teaches the client about the condition and prescribed treatment. Which question from the nurse would help to assess the client's health literacy about the condition? -"Do you understand what asthma is?" -"How are you supposed to take your medication?" -"Are you having trouble getting your medications filled?" -"Do you have any questions about what you are supposed to do?"

"How are you supposed to take your medication?" Explanation: The teach-back method assesses health literacy, seeking to confirm that the learner understands the health information received from the health professional. The question about how to take the medication reflects this method. Clients and caregivers have the opportunity to repeat back to the health care provider the key points they understand from a teaching session. Asking whether the client understands, has questions, or is having trouble getting the medications are "yes" or "no" type questions, which do not allow the nurse to determine the client's ability to obtain, read, understand, and act on health information.

A nurse is preparing to teach a 6-year-old client with a broken arm and the client's mother about caring for the child's cast. Which statement reflects the best education plan for these clients?

*** Include the child in the education; ask questions of both the mother and the child. - Focus mainly on the mother; ask the child a couple of simple questions. - Provide the mother with written materials; teach the child about keeping the cast dry. - Separate the mother and the child; teach the mother and then let the mother teach the child.

A nurse is working with a 15-year-old client with sickle cell anemia. The client was started on a new pain management plan today, and the nurse is evaluating the effectiveness of the plan. Which is not appropriate to include in the nursing care?

**Asking only the client's parents to be present at the education session - Including a note about who was taught this new information in the client's chart - Assuring the client that the conversation is confidential except under extreme circumstances - Answering questions openly and honestly

A nurse is discussing the benefits of smoking cessation with a client. The nurse informs the client that smoking cessation will reduce the client's risk for cancer, improve respiratory status, and enhance the quality of life. The nurse also shares a personal story of smoking cessation, provides information on other individuals who have successfully quit, and encourages the client to attend a support group for smoking cessation. The client discusses feelings on smoking cessation and verbalizes a desire to quit smoking. What type of counseling did the nurse provide to this client?

**Motivational Long-term Developmental Situational

The nurse is conducting a community health promotion class and has developed scenarios that will involve active participation by the class attendees. What type of education strategy is the nurse incorporating into this class?

**Role-playing - Role modeling - Programmed instruction - Panel discussion

A parish nurse is preparing to provide a health promotion class to a group of adults in the parish. In preparing to meet the learning needs of this group, the nurse recognizes which as a characteristic of an adult learner?

**Their readiness to learn is often related to a developmental task or social role. - Peer group acceptance is a critical issue for this age group. - The material presented should focus on future application. - Previous experiences have little impact on learning.

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

- "There are many options available. Which options have you previously tried?" ** "What do you see as your biggest hurdle to stopping?" - "Some people find that reducing cigarette consumption slowly over time is an effective option." - "Most clients are successful when they use over-the-counter nicotine patches or gum."

Which documentation example best reflects the complexity of client teaching by the nurse?

- "Told client to take antibiotic as ordered." - "Client return demonstrated how to use glucometer." - "Taught client about peak flows; client verbalized understanding." **"Client and spouse taught how to use phone app to count carbohydrates; client return demonstrated carb counting for a hypothetical meal."

A 56-year-old client meets with the nurse for education about a recently diagnosed atrial fibrillation. The client verbalizes concerns about being away from work too long and doubts about the necessity of having blood tests every week, as the client has no symptoms. Which is the best motivational statement by the nurse for this client?

- "Your doctor wants you to take your warfarin every day, go to the clinic every week to have blood drawn, and then wait for any dosage change. Do you understand?" - "You have to take your warfarin and go to the clinic every week for a blood draw. It's not the most convenient way to live, but you have to do it." ***"The medicine and blood work can help prevent blood clots, which can lead to strokes. What do you know about warfarin therapy?" - "Atrial fibrillation is when your upper heart beats ineffectively and blood clots can go to your brain. Would you like some printed information about this?"

Which statement describes the person who is likely the most motivated to learn?

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

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

- Deficient Knowledge: Readiness for enhanced nutrition, and risk for disturbed body image. - Deficient Knowledge: Risk for chronic low self esteem, and risk for unstable blood glucose level. - Deficient Knowledge: Risk for imbalanced nutrition: more than body requirements, and sedentary lifestyle. **Deficient Knowledge: Imbalanced nutrition: more than body requirements, and ineffective health maintenance.

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

- Discussion - Role playing - Printed materials

An active, otherwise healthy, older adult client presents to the clinic with severe osteoarthritis in both knees. The nurse knows this client does not want to be a burden on the family, and the client remains stoic despite reporting the pain as severe. The client avoids the topic of surgery and attends church weekly. The client's family is supportive of any decisions the client makes regarding health. Which of the assessment data is most important to forming an individualized education plan for this client concerning treatment for osteoarthritis?

- Orthopedic surgical history **Personal perception of health and aging - Floor plan of the client's dwelling - Formal religious beliefs

The nurse is preparing to teach a client from Generation X about hypertension. Which teaching approach should the nurse plan to implement?

- Provide brochures about low-sodium foods. - Ask a family member to do meal planning to alleviate the burden for the client. **Demonstrate the MyFoodPyramid phone app, to show the best food choices on a lunch tray. - Have the client repetitively choose appropriate foods from various menus.

As the nurse enters the room to teach the client about self-care at home, the client states, "I am glad you are here. I need some pain medicine. I can't stand it anymore." What is the best action of the nurse?

- Redirect the client to learning about self-care and begin education. - Give written materials to the client and administer pain medication. **Have the client rate pain level, and reschedule the teaching session. - Assess the client's understanding of self-care and administer medication

A home health nurse states to her client, "I am very proud of you. You gave your first insulin injection without a problem. You have done wonderfully and are learning fast." What technique is the nurse using to compliment the client's progress?

- Reinforcement - Motivation - Health promotion **Positive feedback

When teaching a client, the nurse notices the client tends to lose focus easily. The nurse would adapt client teaching in which way?

- Request family members to serve as translators. - Provide less health teaching because of the language barrier. - Elongate the teaching session to be sure the client understands. **Talk with animation and vocal inflection to stimulate the client aurally.

What is the most appropriate teaching strategy for the nurse to use for a 1-hour presentation on the prevention of osteoporosis to a group of 30 college-age women?

- Role play **Lecture/discussion - Demonstration - Test taking

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

- Telling the mothers to avoid taking over-the-counter drugs while breastfeeding - Showing charts to the mothers that illustrate the types of breast milk **Observing a mother expressing the breast milk - Advising the mothers to drink plenty of water

The nurse is preparing discharge teaching for a client with diabetes. Which information should the nurse include? Select all that apply. -Meal planning -Community resources -Appropriate use of a glucometer -Instructions to follow up with the health care provider -Ways to pay for hospitalization and outpatient care charges

-Appropriate use of a glucometer -Community resources -Instructions to follow up with the health care provider -Meal planning Explanation: The nurse should teach the client with diabetes about meal planning, community resources, appropriate use of a glucometer, and instructions for follow-up care. The social worker will work with the client on methods of payment, if necessary.

When caring for a client at the health care facility, the nurse observes that the client is having difficulty understanding the health education. Which action is most appropriate? -Assess for cultural differences. -Boost the morale of the client. -Delegate the health education to a colleague. -Replace one-on-one teaching with written materials.

Assess for cultural differences. Explanation: When the client is having difficulty learning, it may be possible that the client does not understand the language that the nurse speaks. In such a case, the nurse should take the necessary steps to break the cultural barrier and then proceed with the education. Written materials can enhance many clients' learning, but will not necessarily overcome many of the common barriers to understanding, including cultural and linguistic factors. The nurse should take action to overcome any barriers to the learning process before delegating to a colleague. The client's morale is not pertinent to the client's difficulty understanding the teaching.

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

Car seat restraints Bicycle helmets Immunizations

Which learning domain is the focus for instruction when the nurse educates a new mother about the breast and its role in milk production for feeding the newborn? -Affective -Psychomotor -Cognitive -Behavioral

Cognitive Explanation: Educating a new mother about the physiology of the breast and its role in milk production is an example of cognitive learning, which involves the client's critical thinking and reason. Affective learning involves the client's beliefs, emotions, and values. Psychomotor learning involves physically performing a task--learning by doing. Behavioral learning involves learning new behaviors and unlearning others.

The parents of a school-age child are meeting with the nurse for health promotional education for their child. The child has the following assessment data: a 7-year-old male with diabetes mellitus type 1 with a hemoglobin A1C level of 8.3%, a body mass index (BMI) of 31.7, and a BMI percentile of 99. What are the most appropriate learning diagnoses for this first session? -Deficient Knowledge: Readiness for enhanced nutrition, and risk for disturbed body image. -Deficient Knowledge: Risk for chronic low self esteem, and risk for unstable blood glucose level. -Deficient Knowledge: Risk for imbalanced nutrition: more than body requirements, and sedentary lifestyle. -Deficient Knowledge: Imbalanced nutrition: more than body requirements, and ineffective health maintenance.

Deficient Knowledge: Imbalanced nutrition: more than body requirements, and ineffective health maintenance. Explanation: The data present for the nurse to use for planning the educational session do not give enough information to determine the parents' concepts of their child's health. Before making judgments on their readiness to learn, the nurse must assess them. There are not enough data to support sedentary lifestyle. When making a diagnosis, do not address actual problems as risks. With the hemoglobin A1C level of 8.3%, the nurse knows that the client's glucose control is an actual problem, as is a BMI of 31.7 and a BMI percentile of 99. The assessment data on the client do reflect enough data to make the learning diagnoses of imbalanced nutrition and ineffective health maintenance.

When teaching an adult client how to control stress through relaxation techniques, the nurse should proceed on the basis of which assumption concerning adult learners? -As an adult matures, self-concept becomes more dependent; therefore, this client must be made aware of the importance of reducing stress. -The adult learner is not as concerned with the immediate usefulness of the material being taught as with the quality of the material. -As clients, adults are the least likely to resist learning because of preconceived ideas about the teaching-learning process. -The nurse should be able to draw from the previous experience of the client to emphasize the importance of stress reduction.

The nurse should be able to draw from the previous experience of the client to emphasize the importance of stress reduction. Explanation: Knowles (1990) listed the following four assumptions about adult learners: (1) As people mature, their self-concept is likely to move from dependence to independence. (2) The previous experience of the adult is a rich resource for learning. (3) An adult's readiness to learn is often related to a developmental task or a social role. (4) Most adults' orientation to learning is that material should be useful immediately, rather than at some time in the future. With this in mind, adult learners would appreciate the nurse being able to draw from previous experiences of the client to emphasize the importance of stress reduction. The other options do not apply to Knowles's assumptions about adult learners.

A client shares with the nurse how much the client appreciates understanding the physiology of breastfeeding. The client states, "I felt very comfortable with what you explained to me, and I feel I will be successful at breastfeeding." In affective learning, this represents the nurse: -creating an educational opportunity for the future. -creating an atmosphere for discussion of feelings. -creating specific learning sessions for new information. -creating an opportunity for rational thought and learning.

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