Ch 8 Client Teaching
When caring for a client, the nurse observes that the client enjoys reading books and magazines. In which of the following learning domains does the client's learning style fall? A) Cognitive domain B) Affective domain C) Psychomotor domain D) Interpersonal domain
Ans: A Feedback: As the client enjoys reading books and magazines, the client's learning style would fall in the cognitive domain, where information is processed by listening 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.
A nurse has received change-of-shift report and is briefly reviewing the documentation about a client in the client's medical record. A recent entry reads, ìClient was upset throughout the morning.î How could the charting entry be best improved? A) The entry should include clearer descriptions of the client's mood and behavior B) The entry should avoid mentioning cognitive or psychosocial issues C) The entry should list the specific reasons that the client was upset D) The entry should specify the subsequent interventions that were performed
Ans: A Feedback: Entries in the medical record should be precise, descriptive, and objective. An adjective such as ìupsetî is unclear and open to many interpretations. As such, the nurse should elaborate on this description so that a reader has a clearer understanding of the client's state of mind. Stating the apparent reasons that the client was ìupsetî does not resolve the ambiguity of this descriptor. Cognitive and psychosocial issues are valid components of the medical record. Responses and interventions should normally follow assessment data but the data themselves must first be recorded accurately.
A nurse is teaching the importance of nutrition to a group of clients using geragogy. Which of the following clients is the nurse addressing? A) Elderly people B) Pregnant women C) Infants D) Adults
Ans: A Feedback: Geragogy is a technique that enhances learning among elderly clients. Pedagogy is the science of teaching children or those with cognitive abilities comparable to children. Andragogy is the science of teaching adult learners.
Why should a nurse immediately begin the health teaching of a client who has been admitted to the health care facility for a routine physical examination? A) There is limited hospitalization time. B) The client may not be in the condition to learn afterward. C) The client may take a longer time to learn. D) It helps to understand the learning style of the client.
Ans: A Feedback: It is important for a nurse to begin teaching as soon as possible after admission of the client because there is the possibility of limited hospitalization time. The nurse should avoid making assumptions about the client's condition in the future, the client's learning style, and the time needed for learning before the teaching begins.
A client is admitted to the health center with chronic diarrhea. When should the nurse begin imparting health teaching about mitigating the effects of this problem? A) When admitting the client B) When providing treatment C) When discharging the client D) When the client requests information
Ans: A Feedback: Potential teaching needs should be identified from the time when the client is admitted. The client would therefore need to be taught the benefits of a proper diet during admission so as to minimize the risk of diarrhea. There is a greater probability of the client retaining the teaching if the teaching starts during admission. The teaching may be amended during the caring, treatment, and discharge phases.
The nurse notes that a diabetic client has been readmitted to the health care facility with a high blood sugar level as the client had not followed the proper diet. The client is unable to read and speak English properly and can only sign his name. Which of the following categories does the client fall into? A) Functionally illiterate B) Moderately illiterate C) Illiterate D) Literate
Ans: A Feedback: The client in this case is functionally illiterate. Functionally illiterate people possess minimal literacy skills, which means they can sign their names and perform simple mathematical tasks. Literacy is the ability to read and write. An illiterate person cannot read or write. This does not mean moderately illiterate.
A nurse is caring for a 45-year-old male client who lost function in both of his legs due to an automobile accident. Which of the following should the nurse do first to personalize the client's learning? A) Gather pertinent information from the client B) Analyze the client's behavior C) Prepare the training plan for the client D) Develop confidence in the client
Ans: A Feedback: To personalize the learning, the nurse must first gather pertinent information from the client. Analyzing the client's behavior, preparing the training plan for the client, and developing confidence in the client are the next steps to personalize the learning.
When caring for a client at the health care facility, the nurse observes that the client is having difficulty understanding the health teaching. Which action should the nurse take when conducting the health teaching for this client? A) Assess for cultural differences B) Boost the morale of the client C) Vary the voice tone and pitch D) Increase the detail of the teaching
Ans: A Feedback: 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 teaching. Boosting the morale of the client, varying the tone and pitch of voice to stimulate the client aurally, and increasing detail are only effective when the client understands the language being spoken.
The nurse is caring for a 70-year-old client with a fractured wrist. Which of the following is the best method to determine whether the client has retained the information taught? A) Observe the change in client's behavior for a month. B) Ask the client to recall the information after approximately 15 minutes. C) Formally test the client on the health teaching and information imparted. D) Ask the client if he has thoroughly understood the material that was taught.
Ans: B Feedback: Asking a client to recall what has been discussed after approximately 15 minutes have passed helps determine what information the client has actually retained. Observing the change in the client's behavior for a month, testing the client on the health teaching and information imparted, and asking the client whether he understood are not appropriate methods to determine the information that has actually been retained.
A client with a history of type 1 diabetes is discussing his medication regimen with his nurse. The client is able to relate the pathophysiology of diabetes to each of the potential complications of the disease and is well-versed in different types of insulin and oral antihyperglycemics. The nurse should recognize that this client demonstrates a high level of: A) Health autonomy B) Personal responsibility C) Health literacy D) Learning needs
Ans: B Feedback: Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Health literacy is not synonymous with personal responsibility. This client is likely to have fewer learning needs than an individual who has a smaller knowledge base.
A nurse is working with a client who has recently had an ostomy created after bowel resection surgery. The client is preparing to be discharged home and the nurses in the hospital unit have been performing and documenting relevant client education. Client teaching is specifically mandated for health care organization accreditation by which of the following? A) Center for Disease Control (CDC) B) Joint Commission C) National League of Nursing (NLN) D) US Department of Health and Human Services
Ans: B Feedback: Health teaching is a mandated nursing activity. State nurse practice acts require health teaching, and the Joint Commission on Accreditation of Healthcare Organizations has made it a criterion for accreditation. The CDC, NLN, and HHS are unanimously supportive of health education but neither has specifically mandated the practice.
A client is scheduled for discharge from the hospital and her primary care provider has prescribed subcutaneous injections of an anticoagulant for the next 10 days. The nurse has to teach the client how to correctly self-administer the medication but the client speaks very little English. How should the nurse meet this client's learning needs? A) Write out the instructions in English and arrange for the pharmacy to have them translated B) Arrange for a professional interpreter to be present when the nurse performs client education C) Demonstrate the correct technique for injecting the medication while relying on nonverbal communication D) Find a web site in the client's language that shows correct technique and provide the client with the address
Ans: B Feedback: Language barriers do not justify omitting health teaching. In most cases, if neither the nurse nor the client speaks a compatible language, a translator or acceptable alternative is needed. It would be inappropriate to limit teaching to nonverbal communication or a web site address. Client education should not be delegated to the pharmacist.
The nurse observes that a client responds better to health teaching 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) Cognitive domain B) Affective domain C) Psychomotor domain D) Interpersonal domain
Ans: B Feedback: Since the client responds better to health teaching when he is motivated and is assured about its benefits, the client's learning style falls into the affective domain. The affective domain is a style of processing that appeals to a person's feelings, beliefs, or values. This learning style would be suitable for this client. The cognitive domain is a style of processing information by listening to or reading facts and descriptions. 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.
An elderly female client has been admitted to the hospital with a suspected bowel obstruction. The nurse is reviewing the admitting physician's orders and reads the order ìNPOî. Based on this order, what action should the nurse take? A) Apply oxygen by nasal prongs if necessary B) Ensure that the client does not eat or drink anything C) Ensure that the client's record is made available to her insurer D) Insert a nasogastric or oropharyngeal tube if necessary
Ans: B Feedback: The abbreviation ìNPOî denotes that the client should take nothing by mouth. It is irrelevant to insurance status, oxygenation, or gastric intubation.
A nurse is providing health teaching to a client who has been admitted to the health care facility with chicken pox. How should the nurse prove that teaching standards are met? A) Ask the client about the teaching and learning gained. B) Record the teaching and learning in the client's medical record. C) Ask the physician about the teaching standards followed. D) Study the change in the client's behavior after teaching and learning.
Ans: B Feedback: The best proof of compliance with teaching standards is to document teaching and learning in the client's medical record. Asking the client or the physician does not prove that the teaching standards have been followed. Studying the change in the client's behavior is also not the best way to document the fact that the standards have been adhered to.
When caring for a client, the nurse notes the client's concentration level and teaches when the client is attentive. What variable that affects learning is the nurse considering? A) Willingness B) Concentration C) Learning readiness D) Learning needs
Ans: B Feedback: The client's attention and concentration affect the duration, delivery, and teaching methods employed. It is helpful to observe the client and implement health teaching when he or she is most alert and comfortable. This does not necessarily indicate an awareness of the client's willingness, learning needs, or learning readiness.
While covering a colleague's lunch break, a nurse on an orthopedic unit has responded to a client's call light. The client has requested assistance in transferring from the bed to the bathroom. The nurse has not previously provided care for this client and is unsure of the client's current activity orders. The client's current level of activity can be most easily verified by consulting what written source? A) Nursing care plan B) Nursing kardex C) Checklist D) Flow sheet
Ans: B Feedback: The nursing kardex provides a succinct and accessible record of many aspects of a client's current orders. The care plan would address the issue of mobility but may not specify the current orders for the client's activity at this point in recovery. Checklists and flow sheets are not places where current orders are recorded and updated.
When caring for a client at a health care facility, the nurse discovers that the client is unable to read or write. Which of the following teaching approaches is most useful for the client? A) Teach the client basic reading and writing. B) Use verbal and visual presentation modes. C) Keep the teaching sessions short. D) Involve the client in an active way.
Ans: B Feedback: Using verbal and visual modes of instruction is most appropriate for a client who is unable to read or write. Teaching the client how to read and write is not within the scope of nurses' responsibilities. Keeping the session short and involving the client in an active way will not meet the special needs of the client who is unable to read or write.
A client who is bedridden is scheduled to receive subcutaneous injections of heparin at 8:00 a.m. and 8:00 p.m. each day. The client's medication administration record would present these times as: A) 0800 and 1800 B) 800 and 2200 C) 0800 and 2000 D) 0800 and 2200
Ans: C Feedback: 8:00 a.m. is 0800 in military time and 8:00 p.m. is 2000.
A client has been admitted to the health care facility and a plan of nursing care has been created. The nursing care plan specifies that client education should begin as soon as possible and a nurse has begun an assessment in preparation for this education. What assessment parameter should the nurse prioritize during this assessment? A) The client's occupation B) The client's social support network C) The client's motivation D) The client's coping skills
Ans: C Feedback: All of the listed factors may be relevant to client education for some clients. However, the client's motivation to learn is paramount, since this has a significant bearing on the content and style of education.
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 of the following learning domains does this client's learning style fall? A) Cognitive domain B) Affective domain C) Psychomotor domain D) Interpersonal domain
Ans: C Feedback: 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.
The nurse is caring for a 70-year-old female client with an ineffective health maintenance regimen. Which of the following is the most appropriate method the nurse should use to conduct new learning? A) Begin the session with the implications of inadequate learning. B) Provide current written learning materials. C) Begin the session with a reference to the client's actual experience. D) Talk to the client's relatives and get a detailed account of the client's history.
Ans: C Feedback: Beginning the session with a reference to the client's actual experience will help provide a link to which the new learning can connect. Written materials may or may not be effective for the client. The nurse should not focus on the consequences of inadequate learning. Talking to the client's relatives and getting a detailed client history help the nurse to know more about the client but are not the most appropriate methods to connect new learning.
A nurse on a cardiac care unit performs client education at many different points during clients' treatment. However, the nurse has recently been assigned to teach a formal, group education series for adults who have undergone recent cardiac bypass graft surgery. When preparing to provide formal teaching, the nurse should: A) Ensure that all teaching materials are no higher than a third grade reading level B) Divide the learners into small groups based on their culture of origin C) Create a learning plan that identifies specific learning outcomes and learning activities D) Have the learners teach one another the material rather than the nurse presenting it directly to the group
Ans: C Feedback: Formal teaching necessitates a learning plan. Without a plan, teaching becomes haphazard. Materials must be broadly accessible, but a third grade reading level is a standard that is too low to convey many important teaching points. It is not normally appropriate to divide groups according to culture or ethnicity. Participant-to-participant teaching can be effective but it should not wholly replace instruction from the nurse.
When caring for a client, the nurse also plans to provide health teaching to the client. On which of the following subject areas should the nurse primarily focus during the teaching? A) Daily routine of the client B) Postdischarge coping skills C) Self-administration of medications D) Guidance to client's relatives
Ans: C Feedback: Teaching the client about the self-administration of medications is one of the primary subject areas on which to focus during the health teaching. Discussing the daily routine, postdischarge coping, and providing guidance to the client's relatives are included in the teaching program but are not the primary subject areas.
The nurse is caring for a 10-year-old client with gastritis. During the health teaching, which of the following points should the nurse keep in mind with regards to the characteristics of pedagogic learners? A) They are often goal-oriented. B) They tend to think abstractly. C) They often respond to competition. D) They are usually crisis learners.
Ans: C Feedback: When caring for a 10-year-old client, the nurse should keep in mind that pedagogic clients respond better to competition. They are not goal-oriented and do not think abstractly. They are not crisis learners. Andragogic learners are goal-oriented and think abstractly. Gerogogic learners are crisis learners.
The nurse is required to provide formal teaching to a client admitted to the health care facility. Which of the following should the nurse consider first when providing formal teaching? A) Teaching spontaneously B) Using diagrams C) Showing enthusiasm D) Creating a plan
Ans: D Feedback: Creating a plan is an essential component of formal teaching. Teaching spontaneously is an unplanned activity and is not included in formal teaching. Using diagrams and showing enthusiasm help in the teaching, but are not the first things a nurse should consider when providing formal teaching.
During a health teaching session, the nurse notes that the client is not attentive and loses concentration easily. Which of the following techniques is most appropriate to capture the attention of the client during the teaching? A) Repeat directions several times B) Tell the client when the session will end C) Use verbal modes of instruction D) Involve the client in an active way
Ans: D Feedback: Involving the client in an active way is recommended for a client who has low attention and concentration power. Repeating directions several times and using verbal and visual modes of instruction are appropriate for clients with functional illiteracy but may not capture interest. Telling the client when the session will end is unlikely to increase interest.
A health care agency is applying for accreditation and the accrediting agency is conducting audits of randomly selected medical records. To support the agency's accreditation, these medical records should include: A) Evidence of home care and nursing follow-up for six weeks following discharge B) Self-reflection from nursing and other care providers about the quality of their care C) Evidence that nurses have set goals for improving their future practice D) Evidence that nursing interventions have been evaluated in terms of the client's response
Ans: D Feedback: The medical record serves multiple purposes, including a role in accreditation. Accreditors look for evidence of evaluation following interventions. The medical record is not the correct venue for nurses' self-reflection or personal goal-setting. Many clients do not require community-based follow up after they have been discharged.
When conducting health teaching for a client, the nurse uses the client's name frequently throughout the instructional period. Which of the following learning barriers is the nurse trying to resolve? A) Functional illiteracy B) Sensory deficits C) Cultural differences D) Shortened attention span
Ans: D Feedback: The nurse uses the client's name frequently throughout the instructional period to refocus his or her attention. This technique is not normally used to overcome illiteracy, sensory deficits, or cultural differences.