Teacher and Counselor

The nurse is preparing to teach four clients. Which client will the nurse plan to teach using principles associated with gerogogy?

79-year old who has slight cognitive changes Gerogogy is the unique techniques that enhance learning among older adults. Therefore, the nurse will use gerogogy with the 79-year-old client. Pedagogy is the science of teaching children or those with cognitive ability comparable to children, and would be appropriate for the 4-year-old client. Andragogy is the principles of teaching adult learners, and would be appropriate for the 31-year-old client and the 56-year-old client.

Which guideline is most important for the nurse to keep in mind when planning to teach an exercise class to a group of older adults?

Allow ample time for psychomotor skills. Older adults need more time to learn psychomotor skills. Sessions of 2 to 3 hours are too long; short-term rather than long-term memory loss affects older adults; and information can be structured or non-structured, depending on the content.

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?

Blocking 30 minutes of time for skill teaching. Preschool age children (2 to 5 years) have short attention spans. Five- to ten-minute blocks of time are age appropriate. A 30-minute block is more appropriate for an older client.

The nurse has educated the client on the pathophysiology of osteoarthritis and degenerative joint disease. This is an example of what learning theory?

Cognitive learning theory 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.

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?

Demonstration 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.

The nurse needs to understand the teaching-learning process when administering

Educational interventions Educational interventions require the application of the teaching-learning process.

Four elements should be considered in each assessment of client learning needs.

First, identify what the client considers of importance to learn, as well as new knowledge, attitudes, or skills necessary for the clients and family to learn to manage the client's health care. Determine if the client is prepared to learn and if he or she has a support system available if necessary. Readiness is distinguished from the client's actual ability to learn, which is the third element. The fourth element of assessment is of the client's strengths and not determination of weaknesses. Strengths are the personal resources that can be harnessed to facilitate the teaching-learning process

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

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

The nurse is educating a client regarding a new skill. When evaluating the client's knowledge about the topic covered, what best represents that the client has learned a new skill?

The client organizes materials needed and gives return demonstration. Skills require more than verbalization or passing a written test. Nodding and assisting with clean up does not indicate that learning has occurred, but may indicate a lack of readiness to learn. Being able to gather all equipment needed for a skill, and then performing it, demonstrates proficiency.

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 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.

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. 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.

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?

return demonstration 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.

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?

Altered body image related to surgical incision

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. 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.

The nurse is providing instructions to a client about performance of breast self-examination. What outcome does the nurse evaluate regarding this education?

The client will use the self-examination for breast cancer detection and prevention. 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.

A nurse assisting a new mother in the act of breastfeeding is represented by which form of learning?

psychomotor Psychomotor refers to the muscular movements learned to perform new skills and procedures.

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." 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.

An older adult female client who is recovering from a stroke is scheduled to be transferred to the rehabilitation unit in the morning. She is tearful and verbalizes that she feels lonely and abandoned in the hospital unit. The nurse noticed that family visits daily and that there are flowers and cards in the room. Documentation in the chart indicates that the client's pastor has been by twice in the past week to visit. Which nursing diagnosis and outcome criteria need to be addressed immediately for this client?

Ineffective Coping; verbalizes support systems. When considering appropriate evaluation criteria, be certain it relates directly to the diagnosis, and the diagnosis relates to the assessment data. There are not data to support unilateral neglect. Tying shoes evaluates client abilities, not mobility. The nurse assessed that the family visits daily, so the family process is functional. Ineffective coping is appropriately evaluated by identification of coping mechanisms, such as support systems.

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?

Acknowledge the client's ability to accept or reject suggestions. 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.

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?

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.

When providing client education it is essential for the nurse to incorporate what action so that learning can be optimized?

Include educational strategies that encourage clients to be active participants. The teaching-learning relationship is a dynamic, interactive process that involves active participation from the nurse and client.

The nurse is working with Mr. Milner, a 55-year-old man who recently underwent a coronary artery bypass graft (CABG). He is taking furosemide and metoprolol following his procedure. Together the nurse and Mr. Milner are developing a plan for a heart-healthy diet. During their planning, Mr. Milner states that he really thinks that his diet did not contribute to his heart disease. If he continues to take his medications, he should be fine. According to the Transtheoretical Model of Change, what stage of change is Mr. Milner in related to his diet?

Precontemplation The precontemplation stage is the first stage change, in which the client does not indicate that he will make any changes within the next 6 months. Mr. Milner gives no indication that he will be ready to change his diet within the next 6 months.

The nurse has provided teaching for a client with a sinus infection who has been prescribed antibiotics and a decongestant. What is the appropriate nursing response when the client states, "I'm not sure how many days I'm supposed to take this antibiotic."

Re-teach the length of time to take the prescription. Client teaching requires a circular approach, specifically if the client has not understood the teaching. The nurse needs to reteach the information that has not been understood. Asking the client to restate the teaching, telling the client to take the antibiotic, and proceeding with teaching about the decongestant are not effective teaching methods.

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:

critical thinking 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.

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

positive feedback Important keys to success when evaluating learning are consistent, immediate, and frequent positive reinforcement, and teaching a small number of skills at any one time, thus creating a high possibility that the learner will master them.

The nurse is preparing to educate a client newly diagnosed with diabetes about various aspects of home management techniques to maintain control of blood glucose levels. When performing education, what actions should the nurse take when assessing the learning needs of the client? Select all that apply.

Ask the client what he or she feels is the greatest learning need to manage diabetic care Determine if the client has a support system in place to assist if necessary Determine if the client is ready to learn about the care of diabetes

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

Short-term counseling Short-term counseling would help a client solve a situational crisis. A patient experiencing a developmental crisis, for example, might need long-term counseling. Motivational counseling is an evidence-based counseling approach that involves discussing feelings and incentives with the patient. Professional counseling is a general term.

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

Talk with animation and vocal inflection, to stimulate the client aurally. Talking with animation and vocal inflection to stimulate the client is effective for keeping the client's attention when the client loses focus. It is not appropriate to request family members to serve as translators, provide less teaching due to communication barriers, or elongate the teaching session.

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?

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

school-age children Education related to infants, toddlers, and preschool children should be directed at the parents. School-age children are capable of logical reasoning and should be included in the teaching-learning process whenever possible.

The nurse is teaching an 80-year-old client how to instill eye drops for glaucoma. The client's daughter asks, "How do you know that my parent understands what to do?" What is the appropriate nursing response?

"When 15 minutes have passed, I will ask your parent to show me how to instill the drops." Older clients may interact in a socially appropriate manner and may indicate that they understand the material being taught. Asking a client to recall what has been discussed after approximately 15 minutes have passed may help determine what information has actually been retained. The other responses do not demonstrate proper understanding of the condition.

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?

"You have made an amazing recovery" Reinforcement of learning shows that the nurse supports and wants to encourage the client. Giving credit where it is due communicates these values. Documenting is necessary, but stating this does not show interest in the client's progress. Crediting the therapists does not encourage the client. Asking about permission to ambulate negates the goal for improving wellness.

Which statement best describes the client most motivated to learn?

A 70-year-old female; learning care so spouse can come home Adults learn best when the information given to them is something they need to use immediately, when they are strongly motivated to learn, and if there is an internal motivation to learn the topic. When the adult learner does not see importance in the topic, or has no emotional need to learn, motivation is low. Motivation to learn may also be lacking if the adult learner has just reached completion of a major task. The adult learner who is seeking knowledge to assist a loved one may be the most motivated.

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

Include the child in the education; ask questions of both mother and child. School-age children are able to make decisions and provide care for themselves. Focusing on the mother or teaching them separately does not make good use of time or validate the child's abilities.

The nurse identifies which client response as a need for additional education?

The client states, "I only have to worry about lowering the top number of my blood pressure." 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.

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.)

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

When establishing a teaching-learning relationship with a client, it is most important for the nurse to remember that effective learning can best be achieved through which concept?

the client and the nurse are equal participants Effective learning occurs when clients and health care professionals are equal participants in the teaching-learning process.

When a nurse is planning for learning, who must decide who should be included in the learning sessions?

the nurse and the client The nurse and the client should be the individuals who decide who should be included in the learning sessions. The nurse cannot assume that family members are wanted by the client to be included. The client must always be included in the learning session.

The client reports to the clinic as ordered by her primary care provider for counseling on weight loss to improve overall health. The client received printed information in the mail to review before the session, and states having read through it before the appointment. Which client statement alerts the nurse to a need for clarification and further education?

"I will be doing well if I lose between 5 and 10 lb (2.3 and 4.5 kg) per week." Blood pressure can be reduced with weight loss. Osteoarthritis may be caused by destruction of cartilage from the pressure on the knee joints caused by excessive weight. Measuring portions is essential to understanding caloric intake. Healthy weight loss is generally accepted as 1 to 2 lb (0.45 to 0.90 kg) per week, or a reduction of 500-1000 calories per day, which includes decreased intake of foods and burning calories with exercise.

A 20-year-old client reads the nutritional chart and follows it accurately. The nurse also notes that the client understands the need of a balanced diet and its relationship with a quick recovery. Which domain correctly identifies the client's learning style?

Cognitive domain As the client is able to understand the need for a balanced diet after the session and follows the nutritional chart accurately, the client's learning style falls in the cognitive 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 psychomotor domain is a style of processing that focuses on learning by doing. The interpersonal domain is a style of processing that focuses on learning through social relationships.

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

Have client rate pain level and reschedule the teaching session. The client is not ready or able to learn and is reporting a need that first must be met. Assessing the client's knowledge of self-care or redirecting the subject only delays the care that must be done before the client is able to learn. Although providing written materials is an excellent supplement to an teaching session, it does not replace teaching the client. It is best to address the physical needs before attempting to educate the client.

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

Personal perception of health and aging Knowing about the client's orthopedic history, religious beliefs, and barriers to mobility in the home are all helpful for an overall plan of care, but do not address individualism. Gaining insight into the client's own perceptions of health and aging, however, will allow the nurse to tailor the plan of care to the client's personal needs.

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?

motivational counseling 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.

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

observing a mother expressing the breast milk Observing is one of the levels of psychomotor skills, which involves watching an experienced person perform a physical skill. Telling, showing, and advising are examples of cognitive domain, which help the mothers process information by listening or reading facts.

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?

Identify and recommend some credible Web sites appropriate to his learning needs. 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 56-year-old executive meets with the nurse for education about recently diagnosed atrial fibrillation. He verbalizes concerns about the time he will spend away from his work, and that he is not sure it is necessary to have blood tests every week. He feels it is a waste of time when he does not have any symptoms. Which is the best motivational statement by the nurse for this client?

"The medicine and blood work for atrial fibrillation can help prevent blood clots that have the potential to cause debilitating strokes. What have you heard about warfarin therapy?" Adults learn best when the information given to them will be used immediately, is presented as important to the client, and when the client's autonomy is preserved. As with all learners, the teaching approach must reflect respect for what the client already knows. By presenting the facts in a way that gives the client control over a health alteration, and by assessing current knowledge, these qualities that are important to forming a learning plan for an adult are met. When education plans take control out of the client's hands, (such as stating the doctor wants compliance) or when the lifestyle change is presented as a burden, motivation may be low. If the nurse shows interest in working with and discussing issues with the client, a partnership is formed that can boost motivation.

A nurse is counseling several clients for depression. Four of them do not seem to be improving, which leads the nurse to suggest a referral to a psychiatric nurse practitioner. Which of these clients would be most likely to attend the scheduled appointment?

A 28-year-old female; works nights, willing to try, asking about insurance coverage of appointment. Cultural issues, poor family support, or lack of transportation may cause barriers to obtaining needed care. If a client must choose between work and keeping an appointment, scheduling is an important factor. The characteristics of a client who will keep appointments with specialists include those clients who have been well educated about the importance of the referral, understand the benefit to seeing a specialist, and those who will not have to struggle to keep the appointment. A client who agrees, who has input in scheduling, and shows curiosity or hope about the benefit of the referral is more likely to keep the appointment.

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?

Preparation Mrs. Shields is in the preparation stage as she is actively making changes to lose weight. She has moved beyond the contemplation stage by obtaining a gym membership and enrolling in classes.

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?

Role-playing 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.

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

The client describes signs and symptoms of hypoglycemia. The client's ability to describe the signs and symptoms of hypoglycemia demonstrates cognitive learning (the storing and recalling of new knowledge in the brain). Demonstrating a skill, such as insulin injection, is an example of psychomotor learning. Affective learning includes changes in attitudes, values, and feelings (e.g., desire to lose weight).

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?

The nurse and client relationship is based on mutual sharing and negotiation. 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 nurse is writing learner objectives for a client who was recently diagnosed with type 2 diabetes. Which statement best describes the proper method for writing objectives?

The nurse writes one long-term objective for each diagnosis, followed by several specific objectives. The statement that best describes the proper method for writing objectives would be that the nurse writes one long-term objective for each diagnosis, followed by several specific objectives. The nurse would not use general statements that could be accomplished in any amount of time because this action is not addressing the specific needs of the client, and the setting in which the client is in. The nurse would not plan learner objectives with another nurse and would not always obtain input from the family of the client. The objectives need to be specific so the outcomes can be measured in the evaluation phase.