VNSG 1304: Chapter 8 Prep U Questions

A client has been newly diagnosed with type 2 diabetes mellitus. The diabetes educator on staff recognizes which potential client learning need?

Desire to acquire new information Explanation: Learning needs are those skills and concepts that the client and family should acquire to restore, maintain, or promote health. In this client's case, learning how to control blood glucose through dietary and treatment practices is instrumental to successful independence - despite the chronic condition.

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

Family requested education on turning client. Explanation of use of draw sheet and body mechanics provided. Family coached through turning and repositioning client. Members state confidence and understanding. Explanation: Complete documentation must always include the topic taught and who was present during the teaching session. Documentation of the teaching-learning process includes a summary of the learning need, the plan, the implementation of the plan, and the evaluation results. The evaluative statement is crucial and must show concrete evidence that demonstrates that learning has occurred.

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

"Client and spouse taught how to use phone app to count carbohydrates; client return demonstrated carb counting for a hypothetical meal." Explanation: The nurse should document who the teaching was provided to, what was taught, the teaching method, and the evidence of learning. The other answer choices are not as comprehensive and, therefore, are not the best examples of teaching.

A nurse is working with a client and suspects the client might have a literacy problem. What question would the nurse ask initially to get a better sense of the situation?

"How do you learn best?" Explanation: Those who are illiterate and functionally illiterate usually develop elaborate mechanisms to disguise or compensate for their learning deficits. To protect the client's self-esteem, the nurse can ask, "How do you learn best?" and plan accordingly.

The nurse is discussing the use of the patient-controlled analgesia pump with the postoperative patient. Which of the following statements by the patient indicate a need for additional education?

"I should not press the button more often than every 3-4 hours." Explanation: Specific dosages and time intervals can be programmed into the machine to prevent overdose; medication is delivered when the patient pushes a control button.

A male client age 61 years has been admitted to a medical unit with a diagnosis of pancreatitis secondary to alcohol use. Which statement by the client suggests that nurses' education has resulted in affective learning?

"I'm starting to see how my lifestyle has caused me to end up here." Explanation: The client's understanding of his contribution to his problem demonstrates a shift in attitude and feelings that is characteristic of affective learning. Understanding the treatment, course, and prognosis of his illness are aspects of cognitive learning.

The nurse determines that which client has accomplished the learning level of remembering according to Bloom's taxonomy?

30-year old who recalls the name of a medication the provider prescribed Explanation: Remembering is the lowest level of cognition and requires recalling information from prior memorization. Therefore, the client who recalls the name of a medication demonstrates remembering. The other clients demonstrate higher levels of learning.

Which developmental considerations is a nurse assessing when the nurse determines that an 8-year-old is not equipped to understand the scientific explanation of a disease?

Intellectual development Explanation: For the person to receive, remember, analyze, and apply new information, the person must have a certain amount of intellectual ability.

The parents of an infant suffering from apnea need to be educated on the apnea monitor and cardiopulmonary resuscitation. What should the nurse assess first regarding the parents?

Baseline knowledge of these concepts Explanation: Before educating parents on the apnea monitor and cardiopulmonary resuscitation, the nurse should determine the parents' baseline knowledge so that the nurse knows where to begin. Educational level would be the next assessment in order to plan the appropriate teaching delivery method.

Which observation during the nursing assessment of a client supports the documentation of low health literacy?

The client avoids health care screenings and seeks care in the local Emergency Department. Explanation: Lack of follow up on test and referrals, missing appointments, being unable to provide a coherent health history, having incomplete health forms, and exhibiting noncompliance with medication regime are indications that the client has low health literacy. Relatives reporting the client to the nurse, the client's inability to read, and being too sick to care about self are less significant, but may help to assess the client's readiness to learn.

Before clients can learn, they must believe that they need to learn the information. The nurse recognizes that this is an example of which learning principle?

Relevance Explanation: Clients are more receptive and ready to learn if they believe that information being presented is real and relevant to them.

A client is experiencing difficulty in adjusting to a new prosthesis despite conscientious client education by numerous members of the health care team. How should the team respond to the client's lack of learning to this point?

Revise the education plan that has guided education. Explanation: If evaluation of client education indicates that client learning has not met outcomes, it is appropriate to revise the education plan. This does not necessarily entail reducing the detail or referring the client to outside information sources. Exploring alternatives to prosthesis does not address the client's learning needs.

An elderly client is advised to undergo a 12-lead ECG assessment. The client seems to be anxious because this is the first time he is undergoing such a procedure. What explanation should the nurse provide to the client?

"The ECG electrodes are painless and will record electrical activity of the heart." Explanation: The nurse should explain to the client that ECG electrodes are painless, and it will take less than 5 minutes to complete the procedure. The client should lie still while the ECG is recorded. The statements that the client needs to lie still to avoid the recording being wrong, and that the ECG gives information about the client's heart to the doctor to guide treatment are both informative but do not reduce anxiety. The statement that the procedure would finish in 45 minutes is incorrect.

Advocacy and support are activities associated with which learning style?

Affective Explanation:T he affective learner learns best when presented with information that appeals to his or her feelings, beliefs, and values. Cognitive learners process information best by listening to or reading facts and descriptions. The psychomotor learner prefers to learn by doing. There is no learning style classified as cultural.

The nurse is providing education to a group of clients with diabetes about the benefits of healthy food choices. What type of learning is the nurse using with this client group?

Affective learning Explanation: The education that the nurse provided has influenced the value some of her clients place on their food choices. This is the definition of affective learning.

A nurse is assessing a client's readiness to learn. What would be most important for the nurse to assess? Select all that apply.

Motivation Compliance Literacy level Physical state Explanation: Assessing a client's readiness to learn involves assessing the following: motivation, compliance, sensory and physical state, literacy level and health literacy. Baseline knowledge and cultural needs are areas addressed when assessing the client's learning needs.

A client with a new diagnosis of type 2 diabetes mellitus is being discharged after being admitted for acute hyperglycemia. The nurse prepares a discharge teaching plan for the client. In order to enhance the nurse-client partnership, what should the nurse include as a priority?

Provide meaningful options for the client. Explanation: When it comes to treatment decisions, the nurse avoids giving advice, reserving the right of each person to make their own choices on matters affecting health and illness care. The nurse shares information on potential alternatives, promotes the client's freedom to choose, and supports the client's ultimate decision. Emphasizing negative consequences, performing physical assessments, and assessing motivation do not usually enhance nurse-client partnership.

A client is visually impaired. Which measures would the nurse take to optimize a teaching session with this client? (Select all that apply.)

Speak in a normal tone of voice. Avoid standing in front of a window through which bright sunlight is shining. Provide a magnifying glass for reading. Avoid using materials printed on glossy paper. Explanation: Guidelines for teaching a visually impaired client include speaking in a normal tone of voice. Clients with visual impairment do not necessarily also have hearing impairment. Increased volume does not compensate for reduced vision. Use at least a 75- to 100-watt light source, preferably in a lamp that shines over the client's shoulder. Ceiling lights tend to diffuse light rather than concentrate it on a small area where the client needs to focus. Avoid standing in front of a window through which bright sunlight is shining. It is difficult to look into bright light. Provide a magnifying glass for reading. Magnification enlarges standard or small print to a comfortable size. Obtain pamphlets in large (12- to 16-point) print and serif lettering, which has horizontal lines at the bottom and top of each letter. Letters and words are usually more distinct when set in large print with a style that promotes visual discrimination. Avoid using materials printed on glossy paper. Glossy paper reflects light, causing a glare that makes reading uncomfortable. Select black print on white paper. This combination provides maximum contrast and makes letters more legible.

During a meeting, the nursing staff was reminded that learning takes place in four progressive stages. Place the stages of learning in their order of progression.

The client reported the first symptom that appeared. A family member reminded the older adult to take pain relief medication on alternate days. The client is now eating three servings of vegetables per day. An adolescent organizes a "Safe Sex" seminar. Explanation: The client reporting first symptom that appears is an example of an individual recognizing what has been taught. A family member reminding the older adult to take Aspirin tablet on alternate days as an example of an individual's ability to explain or apply the information taught. An adolescent organizing a "Safe Sex" seminar is an example of an individual's ability to independently use the new learning. These are examples of the four progressive stage of learning in ascending order.

When teaching an older adult how to control stress through relaxation techniques, the nurse should consider which assumption concerning such learners?

The nurse should be able to draw from the previous experience of the client to emphasize the importance of stress reduction Explanation: Gerogogic learners are practical thinkers and use experience in the teaching/learning process.

The nurse is providing care to a hospitalized client who is not sure what the health problem is nor what will be done. The nurse teaches the client "Ask Me 3" questions and tells the client to ask these questions when the primary care provider visits. What are the "Ask Me 3" questions? Select all that apply.

What is my main problem? What do I need to do? Why is it important for me to do this? Explanation: The "Ask Me 3" tool is intended to improve communication between the client and the health care provider. The three questions are: What is my main problem? What do I need to do? and Why is it important for me to do this? These three questions will provide the client with the most information. The other questions listed provide limited information.

Which strategy should the nurse use when providing education to the older adult client?

Remain calm and conduct the teaching session in a quiet environment. Explanation: Remaining calm and conducting the teaching session in a quiet environment would decrease anxiety or distractions that interfere with learning for the older adult. Keeping the session short will increase concentration, but is not unique to older adults. The nurse is to use colorful materials in a variety of ways and the nurse's tone and pitch should vary.

A nurse is showing an older adult client with severe diabetes the correct method of self-administering an insulin injection. What should be the nurse's comment if the client continues making mistakes when learning how to self-administer an insulin injection? Select all that apply.

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

A nurse is conducting an education session with a client prior to the client's discharge. At the beginning of the session, the client was engaged with the material and had several questions. However, the client has stopped asking questions and is now rarely making eye contact with the nurse. How should the nurse best respond?

Bring the education session to a close and continue at a later time. Explanation: If the client has stopped engaging with the nurse, it is likely necessary to continue the education at a later time. Increasing emphasis is unlikely to compensate for the fact that the client's temporary threshold for learning has been reached. Temporary loss of interest does not denote a lack of caring and it would be ineffective to involve another nurse.

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: 7-year-old male, diabetes mellitus type 1 with a hemoglobin A1C of 8.3%, BMI of 31.7, BMI percentile of 99. What are the most appropriate learning diagnoses for this first session?

Deficient Knowledge: Imbalanced nutrition: more than body requirements, and ineffective health maintenance. Explanation: The data present for the nurse to use for planning the educational session do not give enough information to determine the parents' concepts on 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 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.

The nurse is conducting a teaching session regarding HIV/AIDS for hotel workers in the community. Which nursing actions are appropriate for the adult learning? (Select all that apply.)

Identifying the length of the session beginning with basic concepts about HIV/AIDS providing adequate lighting and comfortable temperature identifying the time, place, and content for the next teaching session Explanation: Identifying the length of the session is correct, because it prepares the participants for the demand on their time and attention. Beginning with basic concepts about HIV/AIDS is correct, as this allows for the participants to learn from the simple to the complex. Providing adequate lighting and comfortable temperature is correct, as these will promote an environment for learning. Identifying the time, place, and content for the next teaching session is correct, because it helps to plan and provide a time frame for which the participants can review the material taught. There is a need for the nurse to explain medical jargons, as this will allow the nurse to accept some accountability for the participants' comprehension.

A nurse is educating an older adult client with diabetes and family members about the importance of a nutritious diet. What outcomes does the nurse hope to achieve in the process of educating the client and family? Select all that apply.

The client will achieve optimal health. The client will cope with alterations in health status. Explanation: Nurses are involved in client education to promote wellness (primary prevention), prevent or diagnose illness early (secondary prevention), restore optimal health and function if illness has occurred (tertiary prevention), and assist clients and families to cope with alterations in health status. Simply being knowledgeable about the client's health status and care is not enough. Nurses must know the education and learning process and know how best to include the client in the process.

A nurse is preparing to teach a client with a hearing impairment. Which measures would the nurse employ to optimize the teaching experience? (Select all that apply.)

Use a magic slate, chalkboard, flash cards, or writing pads to communicate. Try to select words that do not begin with "f," "s," "k," and "sh." Insert a stethoscope into the client's ears and speak into the bell with a low voice. Explanation: Measures to teach a client with a hearing impairment include using a magic slate, chalkboard, flash cards, or writing pads to communicate. Writing can substitute for verbal instructions. Lower the voice pitch. Hearing loss is generally in the higher pitch ranges. Try to select words that do not begin with "f," "s," "k," and "sh." These letters are formed with high-pitched sounds and are therefore difficult for clients with hearing impairment to discriminate. Rephrase rather than repeat when the client does not understand. Rephrasing may provide additional visual or auditory clues to facilitate the client's understanding. Insert a stethoscope into the client's ears and speak into the bell with a low voice. The stethoscope acts as a primitive hearing aid. It projects sounds directly to the ears and reduces background noise.