Chapter 21: Teacher and Counselor

A nurse refers a client with a new colostomy to a support group. This nurse is practicing which of the following aims of nursing? A) Promoting health B) Preventing illness C) Restoring health D) Facilitating coping

Ans: D Feedback: Not all clients fully recover from their illness or injury; many clients will need to learn to cope with permanent health alterations.

When a nurse is planning for learning, who must decide who should be included in the learning sessions? a) The client and the client's family b) The nurse and the client c) The doctor and nurse d) The health care team

b) The nurse and the client

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) "I think you should just go cold turkey." b) "Reduce your stress and it will be easy." c) "Did you know that smoking can cause lung cancer?" d) "What do you see as your biggest hurdle to stopping?"

d) "What do you see as your biggest hurdle to stopping?"

The nurse as a teacher

know about subject being taught, don't use medical jargon, use nonverbal communication & active listening, use empathy, reinforce positive behaviors & clarify inaccuracies Much patient education focuses on three critical areas: -Preparation for receiving care -Preparation before discharge from a health care facility -Documentation of patient education activity T: Tune into the patient E: Edit patient information A: Act on every teaching moment C: Clarify often H: Honor the patient as a partner in the education process

Preventing illness

to reduce the risk for illness, to promote good health habits, and to maintain optional functioning; by using an occasional program such as -prenatal care -smoking cessation program -community programs -literature television -radio more Internet information -health assessment -First aid -safety -Immunization -Screening -ID management of risk factors

Factors affecting patient learning: Cultural influences and language deficits

-Develop an understanding of the patients culture -Work with a multicultural team in developing educational programs -Be aware of personal assumptions, biases, and prejudices -Understand the core cultural values -develop written materials in the patients native language -use testimonials of people with the same cultural background as patient

Factors affecting patient learning: Age/Developmental level -Child -adolescent -Adult

-Simplify -concrete examples or demonstrations -no detailed patho , that will confuse -Preschoolers may have lots of questions but their skills are advanced (bc of video games) -Explanations should be short School aged: capable of logical reasoning, should be included in teaching/learning process -Clear explanations -simple and logical manner -need learning to be reinforced by parent or health care professional Adolescents: assess to see their stage Piaget refers to as formal operations (ability to use logical reasoning) -If development is delayed, they may still be in the period of concrete operations (use of logical reasoning to solve concrete problems) but less skilled in thinking abstractly. -Peer group acceptance is critical for most adolescents. -Need for independence -need to establish trusting relationship MOTOR skills (fine) is key for patients who may be administering their own insulin shots. Adults: -independent -Previous experience is a rich resource for learning -Readiness to learn is often related to developmental task or social role -Material should be useful immediately, rather than at some time in the future.

Facilitating Coping for teachers/counselors to have for patients may include:

-measures that maximize independence and enhance self-concept -stress management -environmental alterations -community resources -appropriate referrals -grief and bereavement counseling A nurse refers a patient with a new colostomy to a support group. This nurse is practicing which of the following aims of nursing?

A nurse discusses the importance of eating healthy to the patient. This nurse is practicing which of the following aims of nursing? A) Promoting health B) Preventing illness C) Restoring health D) Facilitating coping

A Developmental and maturational issues Normal childbearing Hygiene Nutrition Exercise Mental Health

Factors affecting patient learning: Health literacy

Ability to read, understand and act on health information Answer these 3 questions for patients: 1. What is my main problem 2. What do I need to do? 3. Why is it important for me to do this?

A nursing faculty member is teaching a class of second-degree students who have an average age of 32. What is important to remember when teaching adult learners? A) A focus on the immediate application of new material B) A need for support to reduce anxiety about new learning C) Older students may feel inferior in terms of new learning D) All students, regardless of age, learn the same

Ans: A Feedback: Adults need to be taught differently. Andragogy, the study of teaching adults, is based on several principles. One of those is that most adults' orientation to learning is that new material should be immediately applicable.

A nurse instructs a client to tell her about the side effects of a medication. What learning domain is the nurse evaluating? A) Affective B) Cognitive C) Psychomotor D) Emotional

Ans: B Feedback: Cognitive learning involves storing and recalling new knowledge in the brain. Cognitive learning may be evaluated through oral questioning.

The National Patient Safety Foundation recently collaborated with the Partnership for Clear Health Communication (2007) to create awareness of the need for improved health literacy and developed the Ask Me 3 tool. Which of the following is an Ask Me 3 question? Select all that apply. A) Who will be my health care provider? B) What is my main problem? C) What do I need to do? D) Where will I get help? E) Why is it important for me to do this?

Ans: B, C, E Feedback: Ask Me 3 questions are: What is my main problem? What do I need to do? Why is it important for me to do this?

A nurse educating a new mother on how to bathe her infant uses the acronym TEACH to maximize the effectiveness of the education plan. Which of the following are guidelines based on this acronym? Select all that apply. A) Tune out the individual client. B) Edit client information. C) Act on every teaching moment. D) Always refer a client to counseling. E) Clarify often.

Ans: B, C, E Feedback: To maximize the effectiveness of patient education, the nurse should use the acronym TEACH — T: tune into the client, E: edit client information, A: act on every teaching moment, C: clarify often, H: honor the client as a partner in the education process.

When the newly diagnosed, insulin-dependent diabetic client tells the nurse that he has never received instruction on the administration of injections, an appropriately stated nursing diagnosis for the client is what? A) Self-care deficit related to lack of knowledge about injections B) Knowledge deficit related to lack of knowledge about injections C) Deficient knowledge of injection administration as verbalized by the client, related to the lack of instruction and experience D) Ineffective health care maintenance related to diabetic instructions

Ans: C Feedback: Many factors can contribute to deficient knowledge, such as a lack of exposure, lack of recall, information misinterpretation, cognitive limitations, lack of interest in learning, and unfamiliarity with information resources.

A mother of a toddler wants to learn how to do CPR. What education strategy would be most effective in helping her learn? A) Lecture B) Discussion C) Demonstration D) Discovery

Ans: C Feedback: When a client wants to learn a specific skill, such as CPR, demonstration is an effective strategy. The client's learning can be evaluated by return demonstration. Lecture, discussion, and discovery are not as effective in teaching a skill.

A nurse is designing a teaching program for individuals who have recently immigrated to the United States from Iraq. Which of the following considerations is necessary for culturally competent client teaching? A) Use materials developed previously for U.S. citizens. B) Use all visual materials when teaching content. C) Use a lecture format to teach content with few questions. D) Develop written materials in the client's native language.

Ans: D Feedback: -Develop written materials in the client's native language. -Work with a multicultural team in developing educational programs -Be aware of personal assumptions, biases, and prejudices -understand the core cultural values of the patient or group -use testimonials of people with the same cultural background as the patient

What word or phrase best describes an effective counselor? A) Technically skilled B) Knowledgeable C) Practical D) Caring

Ans: D Feedback: An effective counselor needs to be a caring individual with the interpersonal skills of warmth, friendliness, openness, and empathy.

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? A) Educational levels B) Home environment C) Infant bonding D) Baseline knowledge of these concepts

Ans: D Feedback: 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.

A male client age 42 years recovering from a MI is having difficulty following the care plan to stop smoking and exercise. What is the nurse's best response to this client? A) Praise him for trying. B) Tell him that he will have another MI and it will be his own fault. C) Tell him that his cigarettes will be taken away if he smokes again. D) Ignore the behavior and recommend a behavior modification program.

Ans: D Feedback: Negative reinforcement (criticism or punishment) is generally ineffective; undesirable behavior is usually best ignored. Behavior modification programs that reward desired behaviors and ignore undesired behaviors might be best for this client.

A student is developing an education plan for her assigned client. The student wants to educate the client on what symptoms to report after chemotherapy. What would the student need to do first? A) Ask other students what should be included in content. B) Ask the client what he or she wants to know. C) Tell the instructor that this topic hasn't been covered yet. D) Review information available in writing and on the Internet.

Ans: D Feedback: New nurses (and students) usually need to research the subject to be taught to determine what information exists on the topic. Books, journals, manuals, and Web-based sources may be used to find information.

A nurse telling a group of middle schoolers the importance of understanding the risks that smoking has on the lungs. This nurse is practicing which of the following aims of nursing? A) Promoting health B) Preventing illness C) Restoring health D) Facilitating coping

B First aid safety immunizations screenings ID and management of risk factors.

A nurse tells a 17 year old male patient that the facility is having free STD checks. This nurse is practicing which of the following aims of nursing? A) Promoting health B) Preventing illness C) Restoring health D) Facilitating coping

B First aid safety immunizations screenings ID and management of risk factors.

The nurse is discussing with a patient the expectations of one another during an interview. This nurse is practicing which of the following aims of nursing? A) Promoting health B) Preventing illness C) Restoring health D) Facilitating coping

C -Orientation to treatment center and staff -Patients' and Nurses' expectations of one another -Illness and physical condition , significance of symptoms, etiology of problem. -how the patient can participate in care

Teaching strategies: What are the main strategies for the three learning domains? Cognitive Affective Psychomotor

Cognitive: Use words like Compares, defines, identifies, names, prepares, plans, solves, states, summarizes, gives examples, explains, Lecture or discussion Panal discussion Discovery Audiovisual materials Printed materials Programmed instruction COMPUTER-ASSISTED INSTRUCTION PROGRAMS Affective: Use words like Chooses, defends, displays, forms, gives, helps, initiates, justifies, relates, revises, selects, shares, uses, values Role modeling Discussion Panal discussion Audiovisual Materials ROLE PLAYING Printed materials Psychomotor: use words like Adapts, arranges, assembles, begins, changes, constructs, creates, demonstrates, manipulates, moves, organizes, rearranges, shows, starts, works DEMONSTRATION Discovery Audiovisual materials Printed materials

A nurse is discussing with the patient ways to manage stress after being diagnosed with Lupus. This nurse is practicing which of the following aims of nursing? A) Promoting health B) Preventing illness C) Restoring health D) Facilitating coping

D Grief and bereavement counseling Community resources Stress management Measures that maximize independence and enhance self concept

Aims of teaching and counseling: Patient education

Influences the behavior to effect changes in -Knowledge -attitudes -skills needed to maintain and improve health. This results in -Fewer hospitalizations Must take into account -patients plan of care -educational level -need for care across the continuum from hospital to home care to long term care. -Pt educations plans should be developed with entire health care team, home care agencies, wellness facilities, long-term agencies. Basic purpose of teaching and counseling is to help develop self care abilities.

Outcomes for Teacher/Counselors to have for their patients

Nurse caregivers who are skilled teachers and counselors can promote the following outcomes: -High-level wellness and related self-care practices -Disease prevention or early detection -Quick recovery from trauma or illness with minimal or no complications -Enhanced ability to adjust to developmental lifestyle changes, acute, chronic, and terminal illness -Family acceptance of the lifestyle changes necessitated by illness of disability

maintaining and promoting health

Nurses can help patients to value health and develop specific health practices that promote wellness. Health teaching is varied and ranges from teaching passive exercises to a patient with left-sided paralysis to designing a safe exercise program for a young athlete. -Developmental and maturational issues -Normal childbearing -Hygiene -Nutrition -Exercise -Mental Health -Spiritual health

How teacher/counselors can help the process of Restoring health in patients

Nursing activities include the following: -Providing direct care to the ill person -Performing diagnostic and assessment procedure -Consulting with other health care professionals about client problems teaching clients about recovery activities -Rehabilitating clients to their optimal functional level following physical or mental illness, injury, or chemical addiction -Orientation to treatment center and staff -Pt and nurses expectations of one another -Illness and physical condition: anatomy and physiology, etiology of problem, significance of symptoms, prognosis -Medical and nursing regimens and how patient can participate in care -Self-care practices the patient and family need to manage the patients condition independently

Factors affecting patient learning: Family support networks and financial resources

Working with the family can help the patient cope. C: Creativity- help the family overcome obstacles to carrying out health care management O: Optimism- Help the family caregivers learn how to view the caregiving situation with confidence P: Planning: Help the family learn how to plan for future problems E: Expert info: Help family learn how to obtain expert information from health care providers.

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) Psychomotor learning c) Cognitive learning d) Behavioral learning

a) Affective learning

A nurse is caring for a 42-year-old male patient who is admitted to the hospital with injuries sustained in a motor vehicle accident. The patient suffered from a TBI and is completely paralyzed on his left side. The nurse is aware that the patient will most likely be in need of which type of counseling? a) Long-term developmental b) Short-term situational c) Short-term motivational d) Long-term motivational

a) Long-term developmental Long-term counseling extends over a prolonged period; a patient experiencing a developmental crisis, for example, might need long-term counseling. Short-term counseling might be used during a situational crisis, which occurs when a patient faces an event or situation that causes a disruption in life, such as a flood. Motivational interviewing is an evidence-based counseling approach that involves discussing feelings and incentives with the patient. A caring nurse can motivate patients to become interested in promoting their own health.

A school nurse is discussing bike and outdoor safety measures with a group of Boy Scouts. What type of health education and counseling is the nurse providing to this group of children? a) Preventing illness b) Restoring health c) Promoting health d) Facilitating coping

a) Preventing illness

A registered nurse assumes the role of nurse coach to provide teaching to patients who are recovering from strokes. One example of an intervention the nurse may provide related to this role is: a) The nurse uses discovery to identify the patients' personal goals and create an agenda that will result in change. b) The nurse is the expert in providing teaching and education strategies to provide dietary and activity modifications. c) The nurse becomes a mentor to the patients and encourages them to create their own fitness programs. d) The nurse assumes an authoritative role to design the structure of the coaching session and support the achievement of patient goals.

a) The nurse uses discovery to identify the patients' personal goals and create an agenda that will result in change. A nurse coach establishes a partnership with a patient and, using discovery, facilitates the identification of the patient's personal goals and agenda to lead to change rather than using teaching and education strategies with the nurse as the expert. A nurse coach explores the patient's readiness for coaching, designs the structure of a coaching session, supports the achievement of the patient's desired goals, and with the patient determines how to evaluate the attainment of patient goals.

A nurse is engaged in teaching a 5-year-old boy that is newly diagnosed with type 1 diabetes. His mother is his primary caregiver and is present with him. The nurse is preparing to teach insulin injections. The client's mother informs the nurse that she has a fear of needles. What is appropriate for a successful education session? Select all that apply. a) ensuring 20 minutes of uninterrupted teaching time b) using a doll so that the client can practice this skill c) asking the client's mother to leave the room because she will be a distraction d) providing the client's mother with an informational pamphlet about insulin injection

a, b, d

A nurse who is caring for a morbidly obese male teenager forms a contractual agreement with him to achieve his weight goals. Which statement best describes the nature of this agreement? a) "This agreement forms a legal bond between the two of us to achieve your weight goals." b) "This agreement will motivate the two of us to do what is necessary to meet your weight goals." c) "This agreement will help us determine what learning outcomes are necessary to achieve your weight goals." d) "This agreement will limit the scope of the teaching session and make stated weight goals more attainable."

b) "This agreement will motivate the two of us to do what is necessary to meet your weight goals." A contractual agreement is a pact two people make setting out mutually agreed-on goals. Contracts are usually informal and not legally binding. When teaching a patient, such an agreement can help motivate both the patient and the teacher to do what is necessary to meet the patient's learning outcomes. The agreement notes the responsibilities of both the teacher and the learner, emphasizing the importance of the mutual commitment.

Which statement best describes the client most motivated to learn? a) A 52-year-old male; hired to drive client home from clinic b) A 70-year-old female; learning care so spouse can come home c) A 29-year-old male; significant other insisting on education d) A 25-year-old female; just completed a course of physical therapy

b) A 70-year-old female; learning care so spouse can come home

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) Assess for cultural differences. c) Boost the morale of the client. d) Delegate the health education to a colleague.

b) Assess for cultural differences. 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.

When deciding what information the patient needs to meet the learner objectives successfully, the nurse is planning which part of the teaching plan? a) Teaching strategies b) Content c) Learning activities d) Learning domains

b) Content The nurse is planning the content when the nurse decides what information the client needs to meet the learner objectives successfully. The teaching strategies would be what the nurse would include to be sure the teaching was effective. The learning activities would be designed by the nurse to meet the needs of the client. Learning domains, including cognitive, affective, psychomotor, are the different types of learning.

A nurse has taught a diabetic patient how to administer his daily insulin. The nurse should evaluate the teaching-learning process by: a) Determining the patient's motivation to learn b) Deciding if the learning outcomes have been achieved c) Allowing the patient to practice the skill he has just learned d) Documenting the teaching session in the patient's medical record

b) Deciding if the learning outcomes have been achieved The nurse cannot assume that the patient has actually learned the content unless there is some type of proof of learning. The key to evaluation is meeting the learner outcomes stated in the teaching plan.

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

b) The nurse should be able to draw from the previous experience of the client to emphasize the importance of stress reduction.

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) Encourage the husband to avoid online resources due to the unregulated nature of the Internet. 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) Direct the husband to online databases such as the Cumulative Index to Nursing and Allied Health Literature (CINAHL)

c) Identify and recommend some credible Web sites appropriate to his learning needs.

A nurse is teaching a 50-year-old male patient how to care for his new ostomy appliance. Which teaching aid would be most appropriate to confirm that the patient has learned the information? a) Ask Me 3 b) Newest Vital Sign c) Teach-back tool d) TEACH acronym

c) Teach-back tool The teach-back tool is a method of assessing literacy and confirming that the learner understands health information received from a health professional. The Ask Me 3 is a brief tool intended to promote understanding and improve communication between patients and their providers. The Newest Vital Sign (NVS) is a reliable screening tool to assess low health literacy, developed to improve communications between patients and providers. The TEACH acronym is used to maximize the effectiveness of patient teaching by tuning into the patient, editing patient information, acting on every teaching moment, clarifying often, and honoring the patient as a partner in the process.

A client is admitted to the health center with chronic diarrhea. When should the nurse begin imparting health teaching about the benefits of proper diet to the client so that the risk of diarrhea is minimized? a) When providing treatment b) When discharging the client c) When admitting the client

c) When admitting the client

The nurse is visiting a client who was released from inpatient rehabilitation 6 weeks ago after a 5-month recovery from a motor vehicle accident that left him immobile. As the nurse enters the home, the client braces his hands on the arms of his chair to rise and uses crutches to walk across the room. What is the best response by the nurse? a) "Are you supposed to be out of the wheelchair?" b) "Let me document that you can walk." c) "Those physical therapists work wonders. d) "You have made an amazing recovery."

d) "You have made an amazing recovery."

The nurse has been working with a client for several days during the client's recovery from a femoral head fracture. How should a nurse best evaluate whether client education regarding the prevention of falls in the home has been effective? A) "What changes will you make around your house to reduce the chance of future falls?" B) "Do you have any questions about the fall prevention measures that we've talked about?" C) "In light of what we've talked about, why is it important that you remove the throw rugs in your house?" D) "Do you think that the safety measures I taught you are clear and realistic?"

A Feedback: An open-ended question that requires the client to apply the information that has been taught is often the most accurate way to evaluate the effectiveness of client education. Yes/no questions are much less effective ("Do you have any questions?"; "Do you think that the safety measures I taught you are clear and realistic?"). Asking the client about the importance of preventing falls does not directly assess what the client will actually do to prevent falls.

Which of the following strategies might a nurse use to increase compliance with education? A) Include the client and family as partners. B) Use short, simple sentences for all ages. C) Provide verbal instruction at all times. D) Maintain clear role as the authority.

Ans: A Feedback: Compliance is facilitated by including the client and family in the education-learning process. Other strategies include making sure instructions are understandable, using interactive education methods, and having a strong interpersonal relationship with clients and their families.

A nurse is using motivational interviewing to find out why a client refuses to participate in the recommended rehabilitation program. Which of the following is an example of using the skill of reflective listening to help motivate this client? A) So, you feel that you are not ready to start a program this week...? B) Why do you feel that you are not ready to start rehabilitation? C) I understand that you are afraid to start rehabilitation; where do you see yourself in a week? D) Remember we discussed what needs to be done to get you back on your feet...How do you feel about getting started?

Ans: A Feedback: Four skills have proved effective in motivational interviewing. These include: (answer A) reflective listening (restates the client's response back to him or her), (answer B) asking open questions (encourages discussion of the reason for making desired changes), (answer C) affirming (supports the client's efforts and encourages further exploration), and (answer D) summarizing (links and reinforces material that has been discussed).

A diabetes nurse educator is teaching a client, newly diagnosed with diabetes, about his disease process, diet, exercise, and medications. What is the goal of this education? A) To help the client develop self-care abilities B) To ensure the client will return for follow-up care C) To facilitate complete recovery from the disease D) To implement ordered teaching and counseling

Ans: A Feedback: The basic purpose of educating and counseling is to help clients and families develop the self-care abilities (knowledge, attitude, skills) needed to maintain and improve health.

A male client age 61 years has been admitted to a medical unit with a diagnosis of pancreatitis secondary to alcohol use. Which of the client's following statements suggests that nurses' education has resulted in affective learning? A) "I'm starting to see how my lifestyle has caused me to end up here." B) "I understand why they're not letting me eat anything for the time being." C) "My intravenous drip will keep me from getting dehydrated right now." D) "I can see how things could have been much worse if I hadn't gotten to the hospital when I did."

Ans: A Feedback: 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.

At completion of the health education for a client, the nurse documents the details of the health education in the client's medical record. What can be determined by this documentation? A) Proof of compliance with education standards B) Client's response to the health education C) Self-administration of medications D) Dietary instructions for the client

Ans: A Feedback: The information about who was taught, what was taught, the education method, and the evidence of learning is the best proof of compliance with education standards. These are entered in the client's medical record. The client's response to the health education cannot be determined by this document. Self-administration of medications and dietary instructions for the client are not implied from who was taught, what was taught, the education method, and the evidence of learning.

A nurse is writing learning outcomes for a client recovering from severe burns. Which of the following verbs would be good choices to use when preparing outcomes related to learning how to change dressings? Select all that apply. A) Assembles B) Demonstrates C) Gives examples D) Identifies E) Chooses

Ans: A, B Feedback: Changing dressings falls into the psychomotor domain. "Assembles" and "demonstrates" are appropriate verbs for outcomes. "Gives examples" and "identifies" are verbs best used for the cognitive domain. "Chooses" and "values" relate to the affective domain.

A nurse is educating an elderly client with diabetes and his family members about the importance of a nutritious diet. The nurse knows that client education promotes which of the following purposes? Select all that apply. A) Helps the nurse to restore optimal health in the client B) Helps the client to cope with alterations in health status C) Helps the nurse to be more aware of the client's health D) Helps the nurse to diagnose the client's illness early E) Helps the nurse to be well-informed about the client's care

Ans: A, B, Feedback: 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) 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's family in the process.

According to Rosenstock, which of the following are health beliefs critical for client motivation? Select all that apply. A) Clients view themselves as susceptible to the disease in question. B) Clients view the disease as a serious threat. C) Clients believe there are actions they can take to reduce the probability of contracting the disease. D) Clients believe the threat of taking these actions is greater than the disease itself. E) Patients view themselves as victims of the disease in question.

Ans: A, B, C Feedback: A client's health beliefs can have great influence on motivation. The health belief model identifies several health beliefs as critical for client motivation (Rosenstock, 1974). Motivation is enhanced when clients view themselves as susceptible to the disease in question; when clients view the disease as a serious threat; when clients believe there are actions they can take to reduce the probability of contracting the disease; when clients believe the threat of taking these actions is not as great as the disease itself.

When is the best time to evaluate one's own teaching effectiveness? A) During the education session B) Immediately after an education session C) 1 week after the education session D) 1 month after the education session

Ans: B Feedback: It is best to evaluate one's own teaching effectiveness immediately after an education session by quickly reviewing how one feels the plan was implemented; noting both strengths and weaknesses helps plan for subsequent sessions.

Developing an education plan is comparable to what other nursing activity? A) Documenting in the nurses notes B) Formulating a nursing care plan C) Performing a complex technical skill D) Using a standardized form or format

Ans: B Feedback: Planning for learning involves the development of an education plan. Both education plans and nursing care plans follow the steps of the nursing process.

When caring for a client, the nurse gives day-to-day examples to explain certain points of the health education. The nurse also notes the client's concentration level and educates when the client is active. Which category does the client fall into? A) Motivation B) Attention and concentration C) Learning readiness D) Learning needs

Ans: B Feedback: The client's attention and concentration affect the duration, delivery, and education methods employed. It is helpful to observe the client and implement health education when he or she is most alert and comfortable. This also means involving the client in an active way by providing examples of day-to-day activities. Learning is optimal when a person has a purpose for acquiring new information. The client needs to be motivated to learn new things. Readiness refers to the client's physical and psychological well-being. The best education and learning take place when both are individualized. To be most efficient and personalized, the nurse must gather pertinent information from the client and determine the client's needs when learning.

A nurse in a neighborhood clinic is conducting educational sessions on weight loss. What aim of nursing is met by these educational programs? A) Practicing advocacy B) Preventing illness C) Restoring health D) Facilitating coping E) Maintaining and promoting health

Ans: B, C, E Feedback: If this education is directed toward those who are healthy, weight loss information can help maintain health and prevent illness. If this education is used in those already ill (hypertension, diabetes), weight loss can restore health. The nurse is not practicing advocacy or facilitating coping by providing weight loss education.

A young mother asks the nurse in a pediatric office for information about safety, diet, and immunizations for her baby. Which nursing diagnosis would be appropriate for this client? A) Knowledge Deficit: Infant care B) Impaired Health Maintenance C) Readiness for Enhanced Parenting D) Readiness for Enhanced Coping

Ans: C Feedback: A client who requests information is demonstrating motivation and readiness to learn. The appropriate nursing diagnosis would be Readiness for Enhanced Parenting.

Which of the following is an essential component of the definition of learning? A) Increases self-esteem B) Decreases stress C) Can be measured D) Cannot be measured

Ans: C Feedback: Learning is the process by which a person acquires or increases knowledge, or changes behavior in a measurable way, as a result of an experience.

An older adult client is very stressed about who will care for his pets while he is hospitalized for a fall that caused a fractured hip. What type of counseling would the nurse conduct? A) None B) Long-term C) Short-term D) Motivational

Ans: C Feedback: Short-term counseling focuses on an immediate problem or concern of the client or family. Even if it is a relatively minor concern, it needs immediate attention.

A client 36 years of age is able to understand the health education when she is given the opportunity to put the education into practice. The nurse helps the client to self-administer the medication dosage before the client is discharged from the health care facility. Which domain correctly identifies the client's learning style? A) Cognitive domain B) Affective domain C) Psychomotor domain D) Interpersonal domain

Ans: C Feedback: The client's learning style falls into the psychomotor domain, which is a style of processing that focuses on learning by performing what has been learned. The cognitive domain is a style of processing information by listening or reading facts and descriptions. The affective domain is a style of processing, which appeals to a person's feelings, beliefs, or values. The interpersonal domain is a style of processing that focuses on learning through social relationships.

When providing client education it is essential for the nurse to incorporate what action so that learning can be optimized? A) Have the clients read material after client education B) Be sure that clients are formally engaged C) Include educational strategies that encourage clients to be active participants D) Administer tests to evaluate learning

Ans: C Feedback: The teaching-learning relationship is a dynamic, interactive process that involves active participation from the nurse and client.

What client characteristic is important to assess when using the health belief model as the framework for teaching? A) Developmental level B) Source of information C) Motivation to learn D) Family support

Ans: C Feedback: When assessing a client's learning readiness, it is important to consider his or her motivation. Motivation is influenced by an individual's health beliefs and plays a key role in the health belief model. Motivation encourages the client to adopt health promotion and disease prevention actions.

What is the most critical element of documentation of education? A) A summary of the education plan B) The implementation of the education plan C) the client's need for learning D) Evidence that learning has occurred

Ans: D Feedback: Documentation of the education-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. If the desired learning has not occurred, the notes should indicate how the problem was resolved. It is insufficient to document only what was taught; the charting must show evidence that the client or significant other has actually learned the material taught.

A nurse is working with an older adult client, educating the client on how to ambulate with the aid of a walker. The nurse notes that the client appears to lack the motivation to learn how to use device. The client states, "I'm just too old to learn." Which of the following would be most appropriate for the nurse to do to motivate this client? A) Tell the client how to move the walker as he ambulates. B) Explain how the walker supports the client's lower extremities C) Fully discuss the rationale for using the walker. D) Describe how the walker can improve the client's quality of life.

Ans: D Feedback: Motivating the older adult client can be done by showing the client how the new knowledge will improve his quality of life, regardless of how long that may be. It will also demonstrate how the new knowledge could improve the client's level of independence. Although demonstrating the use of the walker and explaining how the walker assists with ambulation (and the rationale for its use) can be used to educate the client, these actions would not promote motivation for the client to learn.

To meet accreditation standards regarding client care, a health care facility must show evidence of what? A) Employee satisfaction surveys B) Financial accounts and statements C) Documentation of indigent care D) Client education documentation

Ans: D Feedback: The Joint Commission also has established standards for client education that health care agencies must meet to receive accreditation.

A nurse notices that a toddler is constantly snatching toys from the hands of other preschool children at the health care facility, placing the toddler and other children at risk for injury. Which of the following would be a most effective method for teaching the toddler not to snatch toys? A) Ask the children to play another game. B) Tell the toddler that God punishes children who snatch. C) Give the toddler another toy with which to play. D) Enlist the aid of the toddler's parents in education.

Ans: D Feedback: The nurse should inform the toddler's parents as to his or her behavior. Since toddlers and preschoolers are accustomed to learning from and communicating with their parents, the parents are usually the most effective teachers. Children learn through play, so using dolls or toys as models can enhance learning. Giving another toy to the toddler or asking the children to play another game may not solve the problem, as the toddler would still want someone else's toys. Telling the toddler that God punishes children who snatch is not correct because the nurse is indirectly trying to scare and threaten the toddler.

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

a) Cognitive learning theory

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? a) Deficient Knowledge: Imbalanced nutrition: more than body requirements, and ineffective health maintenance. b) Deficient Knowledge: Risk for chronic low self esteem, and risk for unstable blood glucose level. c) Deficient Knowledge: Risk for imbalanced nutrition: more than body requirements, and sedentary life style. d) Deficient Knowledge: Readiness for enhanced nutrition, and risk for disturbed body image.

a) Deficient Knowledge: Imbalanced nutrition: more than body requirements, and ineffective health maintenance.

A nurse is preparing to teach a 45-year-old male patient with asthma how to use his inhaler. Which teaching tool is one of the best methods to teach the patient this skill? a) Demonstration b) Lecture c) Discovery d) Panel session

a) Demonstration Demonstration of techniques, procedures, exercises, and the use of special equipment is an effective patient teaching strategy for a skill. Lecture can be used to deliver information to a large group of patients but is more effective when the session is interactive; it is rarely used for individual instruction, except in combination with other strategies. Discovery is a good method for teaching problem-solving techniques and independent thinking. Panel discussions can be used to impart factual material but are also effective for sharing experiences and emotions.

A nurse is forming an education plan for a client who is being discharged from the nursing unit after cardiac catheterization. Which diagnosis and intervention are most appropriate for this client? a) Knowledge Deficient: Risk for altered perfusion secondary to re-occlusion b) Knowledge Deficient: Impaired mobility related to lying flat for 8 hours c) Knowledge Deficient: Altered urinary output related to catheterization d) Knowledge Deficient: Risk for ineffective breathing pattern related to incisional pain

a) Knowledge Deficient: Risk for altered perfusion secondary to re-occlusion Urinary output should not be changed from a cardiac catheterization. The incision for this procedure may require 8 hours of lying flat, but mobility returns to baseline before discharge home. The risk for ineffective breathing pattern would not be due to incisional pain, which would be in the groin or elbow. Educating the client to be aware for the safety issue of chest pain resulting from the newly opened coronary arteries becoming re-occluded and blocking blood flow to the heart is the highest priority focus.

A nurse is providing teaching to patients in a short-term rehabilitation facility. Which examples are common teaching mistakes made by health care professionals? (Select all that apply.) a) The nurse fails to accept that patients have the right to change their minds. b) The nurse negotiates goals with the patient. c) The nurse evaluates what the patient has learned. d) The nurse reviews educational media when planning learner objectives. e) The nurse ignores the restrictions of the patient's environment. f) The nurse uses medical jargon frequently when discussing the teaching plan.

a, e, f

The nurse observes that a client responds better to health education when the nurse motivates him and assures him about the benefits of the teaching. In which of the following learning domains does the client's learning style fall? a) Psychomotor domain b) Affective domain c) Interpersonal domain d) Cognitive domain

b) Affective domain

A nurse is caring for a client 72 years of age with arthritis. Which action is the highest priority for the nurse when conducting the health education for the client? a) Identify how long the education session will last. b) Find out what the client wants to know. c) Divide information into manageable amounts. d) Provide an environment that promotes learning.

b) Find out what the client wants to know. 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.

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) Developmental counseling b) Motivational counseling c) Long-term counseling d) Situational counseling

b) Motivational counseling

A nurse is teaching first aid to counselors of a summer camp for children with asthma. This is an example of what aim of health teaching? a) Promoting health b) Preventing illness c) Restoring health d) Facilitating coping

b) Preventing illness Teaching first aid is a function of the goal to prevent illness. Promoting health involves helping patients to value health and develop specific health practices that promote wellness. Restoring health occurs once a patient is ill, and teaching focuses on developing self-care practices that promote recovery. When facilitating coping, nurses help patients come to terms with whatever lifestyle modification is needed for their recovery or to enable them to cope with permanent health alterations.

A pediatric nurse provides education to numerous clients in her care. Which group of children benefits most from being involved in the teaching-learning process? a) Infants b) School-age children c) Toddlers d) Preschoolers

b) School-age children Infants= teaching is directed towards parents. school age= teaching-learning toddlers/preschoolers= Use patient-teaching activities

A nurse is caring for a 42-year-old male patient who is admitted to the hospital with injuries sustained in a motor vehicle accident. While he is in the hospital, his wife tells him that the bottom level of their house flooded, damaging their belongings. When the nurse enters his room, she notes that the patient is visibly upset. The nurse is aware that the patient will most likely be in need of which type of counseling? a) Long-term developmental b) Short-term situational c) Short-term motivational d) Long-term motivational

b) Short-term situational Short-term counseling might be used during a situational crisis, which occurs when a patient faces an event or situation that causes a disruption in life, such as a flood. Long-term counseling extends over a prolonged period; a patient experiencing a developmental crisis, for example, might need long-term counseling. Motivational interviewing is an evidence-based counseling approach that involves discussing feelings and incentives with the patient. A caring nurse can motivate patients to become interested in promoting their own health.

A client, eager to go home from an acute care facility, calls out to have discharge education completed. The nurse is not able to get to the client's room until an hour later, and finds the client asleep. The client's significant other states, "She will be out for a couple hours after that pain medication." Which of the following best describes what must happen with the education session? a) The nurse cannot determine the subject matter to teach if the client is asleep. b) The client is not demonstrating readiness to learn due to the effects of medication. c) The client can be awakened when she falls asleep during the session. d) The significant other can be taught now, and then teach the client later on.

b) The client is not demonstrating readiness to learn due to the effects of medication. The nurse knows the client's plan of care and should know what needs to be taught to this individual. The client is experiencing a side effect of pain medication and is not ready to be taught at this time. The nurse, not the significant other, is responsible for teaching the client about self-care. If the client cannot remain awake, then the client is not able to learn.

A nurse is developing a contractual agreement with a client. Which statement is true of a contractual agreement? a) The contract is a formal agreement. b) The contract serves to meet the client's learning outcomes. c) The contract serves to meet nursing goals. d) The contract is legally binding.

b) The contract serves to meet the client's learning outcomes. A contractual agreement is a pact between two people setting out mutually agreed-upon goals. The contracts are usually informal and not legally binding. The contract can serve to motivate the client and nurse to do what is necessary to meet the learning needs of the client; the contract does not serve to meet nursing goals.

Which of the nurse's following actions is most likely to promote a patient's compliance with her antiretroviral drug regimen for the treatment of human immunodeficiency virus (HIV)? a) Refer to the characteristics of the HIV virus when explaining how antiretrovirals treat HIV. b) Use interactive and learner-appropriate teaching techniques. c) Ensure that teaching materials are evidence-based and explicitly referenced. d) Emphasize the consequences of noncompliance at various points in patient teaching.

b) Use interactive and learner-appropriate teaching techniques. Noncompliance has serious consequences for the health of patients. It can often be prevented by ensuring that patient teaching is interactive and appropriate to the needs and development of each individual learner. Patient education should indeed be evidence-based, but this does not necessarily enhance compliance. Overemphasizing the negative and grounding the education in virology or other forms of science will also not guarantee compliance.

A nurse is planning teaching strategies for patients addicted to alcohol, in the affective domain of learning. What are examples of strategies promoting behaviors in this domain? Select all that apply. a) The nurse prepares a lecture on the harmful long-term effects of alcohol on the body. b) The nurse explores the reasons alcoholics drink and promotes other methods of coping with problems. c) The nurse asks patients for a return demonstration for using relaxation exercises to relieve stress. d) The nurse helps patients to reaffirm their feelings of self-worth and relate this to their addiction problem. e) The nurse uses a pamphlet to discuss the tenants of the Alcoholics Anonymous program to patients. f) The nurse reinforces the mental benefits of gaining self-control over an addiction.

b, d, f. Affective learning includes changes in attitudes, values, and feelings (e.g., the patient expresses renewed self-confidence to be able to give up drinking). Cognitive learning involves the storing and recalling of new knowledge in the brain, such as the learning that occurs during a lecture or by using a pamphlet for teaching. Learning a physical skill involving the integration of mental and muscular activity is called psychomotor learning, which may involve a return demonstration of a skill.

The nurse is caring for a 70-year-old client with a fractured wrist. Which of the following is the best method to determine if the client has retained the information taught? a) Test the client on the health education and information imparted. b) Observe the change in client's behavior for a month. c) Ask the client to recall after approximately 15 minutes. d) Ask the client to administer the doses of drug himself.

c) Ask the client to recall after approximately 15 minutes.

A nurse is educating a 4-year-old client about cast care following a tibia-fibula fracture. Which action is not developmentally appropriate to include in the nurse's education? a) Ensuring the client's parents are present. b) Giving stickers as a reward for task completion. c) Blocking 30 minutes of time for skill teaching. d) Using dolls to demonstrate psychomotor skills.

c) Blocking 30 minutes of time for skill teaching.

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) Psychomotor b) Behavioral c) Cognitive d) Affective

c) Cognitive

A nurse is teaching patients of all ages in a hospital setting. Which examples demonstrate teaching that is appropriately based on the patient's developmental level? Select all that apply. a) The nurse plans long teaching sessions to discuss diet modifications for an older adult diagnosed with type 2 diabetes. b) The nurse recognizes that a female adolescent diagnosed with anorexia is still dependent on her parents and includes them in all teaching sessions. c) The nurse designs an exercise program for a sedentary older adult male patient based on the activities he prefers. d) The nurse includes an 8-year-old patient in the teaching plan for managing cystic fibrosis. e) The nurse demonstrates how to use an inhaler to an 11-year-old male patient and includes his mother in the session to reinforce the teaching. f) The nurse continues a teaching session on STIs for a sexually active male adolescent despite his protest that "I've heard enough already!"

c, d, e. Successful teaching plans for older adults incorporate extra time, short teaching sessions, accommodation for sensory deficits, and reduction of environmental distractions. Older adults also benefit from instruction that relates new information to familiar activities or information. School-aged children are capable of logical reasoning and should be included in the teaching-learning process whenever possible; they are also open to new learning experiences but need learning to be reinforced by either a parent or health care provider as they become more involved with their friends and school activities. Teaching strategies designed for an adolescent patient should recognize the adolescent's need for independence, as well as the need to establish a trusting relationship that demonstrates respect for the adolescent's opinions.

A nurse is counseling a 19-year-old male athlete who had his right leg amputated below the knee following a motorcycle accident. During the rehabilitation process, the patient refuses to eat or get up to ambulate on his own. He says to the nurse, "What's the point. My life is over now and I'll never be the football player I dreamed of becoming." What is the nurse counselor's best response to this patient? a) "You're young and have your whole life ahead of you. You should focus on your rehabilitation and make something of your life." b) "I understand how you must feel. I wanted to be a famous singer, but I wasn't born with the talent to be successful at it." c) "You should concentrate on other sports that you could play even with a prosthesis." d) "I understand this is difficult for you. Would you like to talk about it now or would you prefer me to make a referral to someone else?"

d) "I understand this is difficult for you. Would you like to talk about it now or would you prefer me to make a referral to someone else?" This answer communicates respect and sensitivity to the patient's needs and offers an opportunity to discuss his feelings with the nurse or another health care professional. The other answers do not allow the patient to express his feelings and receive the counseling he needs.

The nurse is working with a 26-year-old smoker who is a client in an outpatient center. The client states that she is very committed to quitting smoking to improve her health as well as to provide a good example for her young son. The nurse knows that participating in a smoking cessation support group is a key component to smoking cessation. 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? a) Elicit-provide-elicit b) Evoking change talk c) Rating d) Assessing importance

d) Assessing importance Using the 0 to 10 scale is a key aspect of assessing importance with motivational interviewing. It helps the nurse to understand the client's feelings toward the recommended activity and can help start a conversation about why the client chose that rating number—and what the nurse could do to increase the number.

Mrs. Shields is a 46-year-old obese woman diagnosed with hypertension and type 2 diabetes. She tells the nurse that she knows she needs to lose weight. She recently visited her 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 Mrs. Shields in related to her weight loss? a) Precontemplation b) Maintenance c) Contemplation d) Preparation

d) Preparation

A client is reluctant to learn to do finger sticks for her home INR monitoring. What is the best statement by the nurse? a) Most people are afraid of sticking themselves. b) Are you worried about the pain? c) Why don't you want to do this? d) Tell me what you know about these tests.

d) Tell me what you know about these tests.

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 has a short attention span. b) The client is a passive learner. c) The client is not interested. d) The client belongs to a different culture.

d) The client belongs to a different culture. 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.

Before starting the education process, the nurse should determine the preferred learning style, age and developmental level, capacity to learn, motivation level, readiness to learn, and learning needs of the client. How does this help the nurse in the client's health education? a) by assisting the client's learning b) by reducing chances of any miscommunication c) by fulfilling the client's requirements d) by implementing effective teaching

d) by implementing effective teaching