Ch. 9: Teaching and Counseling
A couple has just learned that their newborn infant has a congenital cardiac anomaly that will require many lifestyle modifications, surgical corrections, and hospital stays. Place the following aspects of the couple's client education in the correct order that nurses should conduct them.
Correct Response: Determine their emotional readiness to learn. Draft learning outcomes. Select educational strategies. Implement various educational techniques. Revise the learning plan if needed. Explanation: The education process parallels the learning process. It begins with assessment of variables such as readiness to learn, and learning needs that lead to a determination of learning outcomes. Teaching strategies are selected, implemented, evaluated, and then revised if necessary.
The nurse is providing education for a client that will be providing self-care at home. The client states, "I just don't think I can do all of this. It's too much to learn." What is the best response by the nurse? a) "I understand that you feel overwhelmed with all of the information. Tell me what I can do to help." b) "It's not difficult information, you just need to listen carefully to the instructions." c) "If you don't learn how to do it, who will take care of you?" d) "You will be just fine."
Correct Response: a) "I understand that you feel overwhelmed with all of the information. Tell me what I can do to help." Explanation: Letting the client know that the nurse is aware the information is overwhelming and placing some of the control with the client is a therapeutic approach to the statement. The other responses are non-therapeutic. Informing the client that "You will be just fine" is offering false reassurance. Informing the client that the information is not difficult is demeaning. Instilling fear into the client by asking who will take care of them is non-therapeutic.
A client states to the nurse, "I understand that I need a mastectomy for the treatment of my breast cancer, but I am fearful of learning about the drains I will need to empty." This is an example of what kind of learning? a) Affective learning b) Behavioral learning c) Psychomotor learning d) Cognitive learning
Correct Response: a) Affective learning Explanation: Affective refers to emotions or feelings. Affective learning changes beliefs, attitudes, or values.
A female adolescent is being taught about changing her abdominal dressing as part of the education for her care at home. When she removes the dressing, she becomes tearful when she sees her surgical incision. What knowledge deficit is best to address for this client at this moment? a) Altered body image related to surgical incision b) Infection related to surgical incision c) Pain related to surgical incision d) Self-care deficit secondary to surgical incision
Correct Response: a) Altered body image related to surgical incision Explanation: There are few data to support infection, lack of self-care, or pain at this time. The client is attempting to learn about her dressing change and the nurse observes that she becomes emotional at the sight of her surgical incision. By opening the discussion about altered body image, the nurse can teach about the healing process. This may help alleviate some of the fears about physical changes
A nurse is documenting assessment data for a new client. What is the best source of assessment information for the nurse? a) Client b) Family and friends c) Nursing plan of care d) Physician
Correct Response: a) Client Explanation: The best source of assessment information for the nurse is the client. Nursing care is individualized to the needs of the client. In emergency situations, other sources might be used, such as family and friends. The physician would not be a source of assessment information. The focus of the health care provider and the nurse would differ, making the information gathered not complete for the development of the plan of care. The nursing plan of care would be developed from the assessment data and would not be a source of assessment data directly.
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? a) Cognitive b) Affective c) Behavioral d) Psychomotor
Correct Response: a) Cognitive Explanation: Educating a new mother about the physiology of the breast and its role in milk production is an example of cognitive learning.
The nurse has educated the client on the pathophysiology of osteoarthritis and degenerative joint disease. This is an example of what learning theory? a) Cognitive learning theory b) Behavioral learning theory c) Adaptive learning theory d) Developmental learning theory
Correct Response: a) Cognitive learning theory Explanation: Cognitive learning theory is the result of people wanting to make sense of the world around them by assimilating and processing information to gain new understandings and insights.
Which response from the nurse allows the nurse to determine the effectiveness of a recent medication teaching session for an older adult client who is diagnosed with tuberculosis? a) "It is okay to make mistakes, but not with your medications." b) "Can you tell me how you are going to take this medication?" c) "Will your relatives be here on time to give you your medications?" d) "Please call me when you are ready to take your medications."
Correct Response: b) "Can you tell me how you are going to take this medication?" Explanation: "Can you tell me how you are going to take this medication?" is a form of feedback to confirm that the client has understood what has been taught. The other questions are less significant.
The nurse is using Teach-Back to evaluate the client's understanding of new information given during discharge. Which statement indicates the use of this technique? a) "Is someone able to review the instructions with you?" b) "Please repeat to me the different signs and symptoms of stroke." c) "Use the instructions on this paper to clean your wounds at home." d) "Will you promise to read these instructions when you go home?"
Correct Response: b) "Please repeat to me the different signs and symptoms of stroke." Explanation: Teach-Back is a technique used to evaluate the information received by the client. This technique uses open-ended questions, allowing the client to repeat the information back to the nurse in his own words.
A nurse is discussing the benefits of smoking cessation with a client. The nurse informs the client that smoking cessation will reduce his risk for cancer, improve his respiratory status, and enhance the quality of his life. The nurse also shares her 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 his feelings on smoking cessation and verbalizes a desire to quit smoking. What type of counseling did the nurse provide to this client? a) Situational counseling b) Motivational counseling c) Long-term counseling d) Developmental counseling
Correct Response: b) Motivational counseling Explanation: Motivational counseling involves discussing feelings and incentives with the client. Long-term counseling extends over a period of time. Developmental counseling occurs when a client is going through a developmental stage or passage. Situational counseling occurs when a client faces an event or situational crisis.
When caring for a diabetic client, the nurse notes that the client learns better when he practices the self-administration of the insulin injection by himself. In which learning domain does this client's learning style fall? a) Affective domain b) Psychomotor domain c) Interpersonal domain d) Cognitive domain
Correct Response: b) Psychomotor domain Explanation: Because the client learns better by practicing the self-administration of the insulin injection himself, his learning style falls in the psychomotor domain. The psychomotor domain is a style of processing that focuses on learning by doing. The client's learning style does not fall in the cognitive, affective, or interpersonal domain. The cognitive domain is a style of processing information by listening to, or reading, facts and descriptions. The affective domain is a style of processing that appeals to a person's feelings, beliefs, or values. The interpersonal domain is a style of processing that focuses on learning through social relationships.
A nurse evaluates whether a middle-age client with chronic back pain has been performing the different exercises and physiotherapy procedures recommended by the physician. What would the nurse most likely use to evaluate the client? a) Written test b) Return demonstration c) Oral test d) Simulation
Correct Response: b) Return demonstration Explanation: The nurse is evaluating psychomotor skills; thus, a return demonstration is a method of testing skill performance. Written tests are time-consuming, intimidating, and not always specific to the client. Oral tests can be useful in testing cognitive learning. Simulation evaluates whether the client can apply learning in different situations, but not his ability to perform the exercises
The nurse is providing instrcutions to a client about performance of breast self-examination. What outcome does the nurse evaluate regarding this education? a) The client will demonstrate self-efficacy and improved body image. b) The client will use the self-examination for breast cancer detection and prevention. c) The client will demonstrate improved coping skills. d) The client will have restoration of breast function.
Correct Response: b) The client will use the self-examination for breast cancer detection and prevention. Explanation: Client education also focuses on the knowledge and skills for early detection or prevention of disease and disability. Studies have proven the importance of early detection in support of teaching breast self-examination.
Which principle of teaching-learning is an accurate guideline for the nurse/teacher? a) Planning learner objectives should be done by the teacher alone. b) The teaching-learning process can be facilitated by a helping relationship. c) Client education should occur independently of the nursing process. d) Past life experience should not be a factor when helping clients assimilate new knowledge.
Correct Response: b) The teaching-learning process can be facilitated by a helping relationship. Explanation: The teaching-learning process can be facilitated by a helping relationship. This is an important principle for the nurse/teacher to remember. Teaching is part of the nursing process. Past life experiences should be a factor when helping clients assimilate new knowledge because this is the application to Knowles's adult learning principles. Planning learner objectives should not be done by the teacher alone; the entire process should involve the client to be sure that the plan is focused on the individual client's needs.
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. a) "Why are you repeatedly holding the injection at the wrong angle?" b) "Try to angle the syringe a little more this way." c) "Lots of people have the same concern." d) "You've just about figured out how to give yourself an injection." e) "It will be better if you ask someone responsible to administer the injection."
Correct Response: c) "Lots of people have the same concern." , d) "You've just about figured out how to give yourself an injection." , b) "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 trying to encourage a client with paraplegia, who is depressed and not adhering to his treatment program, to join a support group. What would be most appropriate for the nurse to do when attempting to modify the client's attitude? a) Aggressively work to change the client's current viewpoint. b) State emphatically that the nurse is the one who knows what is correct. c) Acknowledge the client's ability to accept or reject suggestions. d) Emphasize that the client's views and thoughts are misguided and skewed.
Correct Response: c) Acknowledge the client's ability to accept or reject suggestions. Explanation: The nurse should acknowledge the client's ability to accept or reject the material in order to empower the client and lead to more healthy decision making. Although frustrating, the choice to follow suggestions in the end is the client's and the nurse must respect it as such. The nurse who states emphatically that she is correct and that the client's views are misguided and skewed loses all credibility and influence. The nurse should be nonjudgmental, nonthreatening, and need not be more assertive than the client. However, the nurse should listen carefully to what the client values and work from there.
The nurse is assisting a male client 55 years of age to understand the anatomy and physiology of the heart following a heart attack. What type of learning is taking place? a) Affective b) Pedagogy c) Andragogy d) Psychomotor
Correct Response: c) Andragogy Explanation: Andragogy is the art and science of helping adults learn.
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? a) Replace one-on-one teaching with written materials. b) Delegate the health education to a colleague. c) Assess for cultural differences. d) Boost the morale of the client.
Correct Response: c) 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.
A client has received a temporary ostomy during her treatment for colon cancer. Which technique is most likely to facilitate the client's ability to independently empty and change the ostomy after discharge? a) Discussion b) Lecture c) Demonstration d) A brochure
Correct Response: c) Demonstration Explanation: Demonstration of a technique allows for cognitive, psychomotor, and affective learning to simultaneously take place. Lectures, brochures, and discussions can foster cognitive learning but have significant limitations in the psychomotor domain and, to a lesser degree, in affective learning.
Educating women on diet and exercise is an example of what type of client education? a) Health restoration b) Disease prevention c) Health promotion d) Health protection
Correct Response: c) Health promotion Explanation: Health promotion activities are general recommendations and concentrate on improving someone's overall well-being.
A female client has recently been diagnosed with early-stage Alzheimer's disease and her husband has asked the nurse to recommend Web sites that may supplement his learning about her diagnosis. How should the nurse respond to the husband's request? a) Direct the husband to online databases such as the Cumulative Index to Nursing and Allied Health Literature (CINAHL) b) Provide the husband with print-based materials that are clearly referenced and reflect his learning style. c) Identify and recommend some credible Web sites appropriate to his learning needs. d) Encourage the husband to avoid online resources due to the unregulated nature of the Internet.
Correct Response: c) Identify and recommend some credible Web sites appropriate to his learning needs. Explanation: Web-based resources can be a useful tool in client education, but suitability and accuracy need to be carefully considered. Many online databases exist for health professionals, but these are less likely to be accessible or appropriate for those outside the health professions.
A nurse assisting a new mother in the act of breastfeeding is represented by which form of learning? a) Cognitive b) Affective c) Psychomotor d) Simplistic
Correct Response: c) Psychomotor Explanation: Psychomotor refers to the muscular movements learned to perform new skills and procedures.
A Chinese client who was previously treated at the health care facility for an open wound has been admitted again because the wound has become gangrenous. It has been identified that the client failed to understand proper wound care. What is the probable reason for the client failing to understand the instruction? a) The client is a passive learner. b) The client has a short attention span. c) The client belongs to a different culture. d) The client is not interested.
Correct Response: c) The client belongs to a different culture. Explanation: The probable reason for the client failing to follow proper care for the wound could be that the client belongs to a different culture. As a result, he failed to understand the language in which the nurse imparted the instructions. If the client is a passive learner or has short attention, he would have retained at least part of the instructions. The client being uninterested is also not a reason for his not understanding the instructions.
The nurse identifies which client response as a need for additional education? a) Follow-up visit demonstrates a weight loss of 5 lb (2.3 kg) in 1 month. b) The client reports taking levothyroxine every morning with only water for 30 minutes. c) The client states, "I only have to worry about lowering the top number of my blood pressure." d) The client gives a return demonstration of cleaning the side of finger with alcohol before using lancet.
Correct Response: c) The client states, "I only have to worry about lowering the top number of my blood pressure." Explanation: Cleaning the side of the finger to check blood glucose, losing weight at a rate of 0.5 to 1 lb (0.23 to 0.45 kg) per week, and taking levothyroxine on an empty stomach with nothing but water for 30 minutes are all appropriate actions. The statement about worrying only about the systolic blood pressure indicates the client does not understand the diagnosis of hypertension.
While applying dressings to a client's wound, the nurse teaches the client about his wound care. To promote the most effective teaching-learning relationship with this client, what would be most important for the nurse to keep in mind? a) Nurses have control over the client because of their knowledge and expertise. b) Nurses barter knowledge of medication with the client for compliance. c) The nurse and client relationship is based on mutual sharing and negotiation. d) Nurses are experts who generously bestow knowledge upon clients.
Correct Response: c) The nurse and client relationship is based on mutual sharing and negotiation. Explanation: When providing nursing care, the teaching-learning relationship between the nurse and client is special, characterized by mutual sharing, advocacy, and negotiation. Effective learning occurs when clients and health care professionals are equal participants in the teaching-learning process. Unlike some traditional views, nurses are not experts who generously bestow knowledge upon clients, nor do they barter knowledge for compliance. Both images represent the relationship as a power imbalance in which nurses, because of their knowledge and expertise, control the situation.
A client is meeting with the nurse to discuss options for smoking cessation. Which statement by the nurse is most appropriate for this client? a) "Reduce your stress and it will be easy." b) "Did you know that smoking can cause lung cancer?" c) "I think you should just go cold turkey." d) "What do you see as your biggest hurdle to stopping?"
Correct Response: d) "What do you see as your biggest hurdle to stopping?" Explanation: When counseling a client, the focus should be on assisting the client to make his own decisions, finding ways to reach goals, and supporting the client. The nurse should never give advice. Asking open-ended questions that encourage the client to speak freely about the topic at hand and help define goals is the best option.
A nurse is caring for an older adult client with arthritis. Which action is the priority for the nurse when conducting the health education for the client? a) Provide an environment that promotes learning. b) Divide information into manageable amounts. c) Identify how long the education session will last. d) Find out what the client wants to know.
Correct Response: d) Find out what the client wants to know. Explanation: Finding out what the client wants to know helps the nurse in showing personal interest, which facilitates better learning to an adult client. Dividing information into manageable amounts, providing an environment that promotes learning, and identifying how long the education session will last can be done only when the assessment of the client is completed.
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 her class? a) Role modeling b) Panel discussion c) Programmed instruction d) Role-playing
Correct Response: d) Role-playing Explanation: Role-playing allows the learner to experience, relive, or anticipate an event. The nurse explains the scenario and then allows the individual to play out the scene. Role modeling involves a nurse's behaviors and the client observing and learning from these behaviors. Programmed instruction incorporates the use of books as the instructor, independent of study with a teacher. A panel discussion involves a presentation of information by two or more people.
An experienced nurse is educating a client about his disease and how best to promote his optimal health. The nurse is focusing the education on the cognitive domain of learning. The nurse would focus the education on: a) emotions or feelings. b) muscular movements. c) physical demonstration. d) critical thinking.
Correct Response: d) critical thinking. Explanation: Cognitive learning refers to rational thought or critical thinking. Affective learning is influenced by emotions or feelings. Pychomotor learning refers to the muscular movements learned to perform new skills and procedures; for example, when a mother successfully and independently breast-feeds her infant, she has physically demonstrated psychomotor learning.