Chapter 09: Teaching and Counseling
The nurse is interacting with a new client who reported to the clinical facility for a health problem. Place the following statements by the nurse in the order of the nurse-client relationship. Use all options.
"Hello. I am the nurse assigned to you. My name is...." "What health problem are you seeking help for?" "This medication has been prescribed by the health care provider to treat your problem." "The health care provider has recommended you to return in 1 week." Explanation: There are three phases in the nurse-client relationship. The first phase is the introductory phase. In the introductory phase, the nurse gets acquainted with the client by introducing oneself and identifying the role of the nurse. The nurse assists the client in identifying the health problems for which the client is seeking help. The next phase in the nurse-client relationship is the working phase. The working phase is the period when tasks are performed, such as medication administration. The terminating phase is when the relationship comes to an end. An example is when the client is being discharged.
A 56-year-old client meets with the nurse for education about a recently diagnosed atrial fibrillation. The client verbalizes concerns about being away from work too long and doubts about the necessity of having blood tests every week, as the client has no symptoms. Which is the best motivational statement by the nurse for this client?
"The medicine and blood work can help prevent blood clots, which can lead to strokes. What do you know about warfarin therapy?" Explanation: 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.
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 the client immobile. As the nurse enters the home, the client braces hands on the arms of a 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." Explanation: 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 describes the person who is likely the most motivated to learn?
A 70-year-old female who is the client's spouse and is learning the care so the client can come home Explanation: Adults learn best when the information given to them is something they need to use immediately, when they are strongly motivated to learn, and when they have an internal motivation to learn the topic. When the adult learner does not see the importance of the topic or has no emotional need to learn (such as the client who appears to be undergoing the education only at the insistence of the client's significant other), motivation is low. Motivation to learn may also be lacking if the adult learner has just reached completion of a major task, such as the client who just completed a course of physical therapy. The adult learner who is seeking knowledge to assist a loved one may be the most motivated. On the other hand, a stranger to the client who has just been hired to bring the client home from the clinic is the least likely to be motivated to learn.
The client has Alzheimer disease and is a new admission to the nursing home. The client was transferred from the hospital. When first meeting the client, what technique(s) will the nurse use to facilitate communication with this client? Select all that apply.
Approach the client from the front of the client. Call the client by the client's preferred name. Use simple words and short sentences when talking with the client. Explanation: When communicating with a client who has Alzheimer disease, the nurse must use techniques that will facilitate communication. The nurse will approach from the front of the client to obtain the attention of the client. Coming from the side or the back of the client may startle or agitate the client. Using the client's preferred name will also gain the client's attention. The nurse will use simple words and short sentences to allow the client to understand the nurse. The nurse must show patience and allow the client time to respond. The client may have difficulty finding the correct words or expressing thoughts. Correcting the client or providing information may confuse or agitate the client even more.
A nurse is working with a 15-year-old client with sickle cell anemia. The client was started on a new pain management plan today, and the nurse is evaluating the effectiveness of the plan. Which is not appropriate to include in the nursing care?
Asking only the client's parents to be present at the education session Explanation: Peers are often more influential than parents, nurses, or teachers at this age. It is often appropriate to include a close friend in on the education session. The other answers are developmentally appropriate for a 15-year-old.
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: a 7-year-old male with diabetes mellitus type 1 with a hemoglobin A1C level of 8.3%, a body mass index (BMI) of 31.7, and a BMI percentile of 99. What are the most appropriate learning diagnoses for this first session?
Deficient Knowledge: Imbalanced nutrition: more than body requirements, and ineffective health maintenance. Explanation: The data present for the nurse to use for planning the educational session do not give enough information to determine the parents' concepts of their child's health. Before making judgments on their readiness to learn, the nurse must assess them. There are not enough data to support sedentary lifestyle. When making a diagnosis, do not address actual problems as risks. With the hemoglobin A1C level of 8.3%, the nurse knows that the client's glucose control is an actual problem, as is a BMI of 31.7 and a BMI percentile of 99. The assessment data on the client do reflect enough data to make the learning diagnoses of imbalanced nutrition and ineffective health maintenance.
When caring for a diabetic client, the nurse notes that the client learns better when practicing the self-administration of the insulin injection alone. In which learning domain does this client's learning style fall?
Psychomotor Explanation: Because the client learns better by practicing the self-administration of the insulin injection alone, the client's 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.
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. Explanation: Effective learning occurs when clients and health care professionals are equal participants in the teaching-learning process, not when the nurse is viewed as the expert. Although it is important for the nurse to be able to handle criticism and to understand and apply psychomotor concepts when teaching, these are not as important as viewing the client and nurse as equal participants.
Which documentation example best reflects the complexity of client teaching by the nurse?
"Client and spouse taught how to use phone app to count carbohydrates; client return demonstrated carb counting for a hypothetical meal." Explanation: The nurse should document who the teaching was provided to, what was taught, the teaching method, and the evidence of learning. The other answer choices are not as comprehensive and, therefore, are not the best examples of teaching.
The nurse is conducting a teaching session regarding HIV/AIDS for adult clients in the community. What consideration(s) will the nurse make when teaching this type of session? Select all that apply.
-identifying the length of the session -beginning with basic concepts about HIV/AIDS -providing adequate lighting and comfortable temperature -identifying the time, place, and content for the next teaching session Explanation: The nurse should identify the length of the session because it prepares the participants for the demand on time and attention. The nurse should begin with basic concepts about HIV/AIDS, as this allows for the participants to learn from the simple to the complex. The nurse should provide adequate lighting and comfortable temperature, as these will promote an environment for learning. The nurse should identify the time, place, and content for the next teaching session, because it allows participants to plan ahead and prepare for the next session. The nurse should try not to use medical terms or allow time to explain the terms in simple language, as this allows the nurse to accept some accountability for the participants' comprehension.
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 who works nights, is willing to try, and asks about insurance coverage of the appointment Explanation: Cultural issues, a low income, poor family support, and lack of transportation are potential 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 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.
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. Explanation: 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 nonstructured, depending on the content.
The nurse is planning to provide teaching to a client who is recovering from abdominal surgery. When is the most appropriate time to teach the client?
As the client is sitting quietly, reading a book Explanation: A client is most ready to learn when the client is comfortable, nourished, pain-free, and has time to learn. It is not an appropriate time to educate the client when the meal tray arrives, at the time of pain medication administration, or immediately before discharge home, as the client may be distracted.
The nurse is caring for a 60-year-old client with an improper bowel movement regimen. Which is the most appropriate method for the nurse to use in teaching this client?
Begin the session with a reference to the client's actual experience. Explanation: Beginning the session with a reference to the client's actual experience will help provide a link to which the new learning can connect. Although it may be appropriate to refer the client to online resources on proper bowel health, to encourage the client to join a support group, and to consult the client's family regarding the client's history, the nurse should first engage with the client to find out the client's experience and specific issues.
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?
Cognitive Explanation: Educating a new mother about the physiology of the breast and its role in milk production is an example of cognitive learning, which involves the client's critical thinking and reason. Affective learning involves the client's beliefs, emotions, and values. Psychomotor learning involves physically performing a task--learning by doing. Behavioral learning involves learning new behaviors and unlearning others.
The nurse has educated the client on the pathophysiology of osteoarthritis and degenerative joint disease. This type of teaching best illustrates which learning theory?
Cognitive learning theory Explanation: Cognitive learning theory is the result of people wanting to make sense of the world around them by assimilating and processing information to gain new understandings and insights. Developmental learning theory focuses on considering the patient's physical maturation and abilities, psychosocial development, and cognitive capacity when providing education. Behavioral learning theory focuses on how one learns and unlearns behaviors. Adaptive learning theory explains how learning is optimized when teaching is adapted to the particular learning style of the learner.
The nurse is preparing to teach a client from Generation X about hypertension. Which teaching approach should the nurse plan to implement?
Demonstrate the MyFoodPyramid phone app, to show the best food choices on a lunch tray. Explanation: Those who represent Generations X, Y, and Z may share many learning characteristics. They are or will be technologically literate, having used or grown up with computers, smart phones, and tablet devices. Therefore, it is most appropriate to teach them using some form of multimedia, such as a phone app. The other teaching approaches are less appropriate for this client population.
A nurse is assessing a client who has come to the clinic for a follow-up appointment. The client was diagnosed with asthma several months ago and has missed several appointments since that time. The client also has not been following the medication plan and has not kept the appointment for allergy testing. The nurse suspects that the client may be experiencing problems with health literacy. The nurse teaches the client about the condition and prescribed treatment. Which question from the nurse would help to assess the client's health literacy about the condition?
"How are you supposed to take your medication?" Explanation: The teach-back method assesses health literacy, seeking to confirm that the learner understands the health information received from the health professional. The question about how to take the medication reflects this method. Clients and caregivers have the opportunity to repeat back to the health care provider the key points they understand from a teaching session. Asking whether the client understands, has questions, or is having trouble getting the medications are "yes" or "no" type questions, which do not allow the nurse to determine the client's ability to obtain, read, understand, and act on health information.
Which statement made by a client who was recently admitted to the medical unit with a diagnosis of pneumonia indicates a physical inability to learn?
"I am having difficulty breathing." Explanation: The statement "I am having difficulty breathing" indicates that the client is not physically well and that the client is unable to learn effectively until comfort is restored. "The pain in my chest has gone" and "May I have something to eat?" is suggesting that the client is physically well and is ready to learn. "Finally, I am getting medical attention" is suggesting that the client is psychologically ready to learn.
Which response from the client enables the nurse to determine the effectiveness of a recent medication teaching session for an older adult client who is diagnosed with tuberculosis (TB)?
"I will be taking the TB medication for at least 6 months, because it takes a long time to kill the TB germs." Explanation: The response about taking TB medication for at least 6 months points to an effective teaching session because clients diagnosed with TB have to take TB medication for 6 months or longer. In order to be effective, the client cannot skip medication doses. While having a responsible family member dispense the TB medication to the client is acceptable, it is an indicator that the client may not understand the medication instructions, and that a family member should be included in the teaching.
While the nurse is caring for a hearing impaired client, and a family member of the client states, "What do you think is the best way to communicate?" What is the best response by the nurse?
"Use flash cards and writing pads." Explanation: Using flash cards and writing pads to communicate is a good substitute for verbal instructions for persons with hearing impairment. Speaking words that begin with "f," "s," "k," and "sh" typically requires forming high-pitched sounds, which are difficult for clients with hearing impairment to discriminate. Do not limit communication, because it will alienate the client from family and friends. Lowering (rather than increasing) the vocal pitch is better, as hearing loss is generally in the higher pitch ranges.
A nurse is providing teaching to clients in a short-term rehabilitation facility. Which examples are common teaching mistakes made by health care professionals? Select all that apply.
A nurse is providing teaching to clients 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 clients 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 client's environment. Explanation: Common teaching mistakes made by health care professionals would include the following: the nurse failing to accept that clients have the right to change their minds; the nurse using medical jargon frequently when discussing the teaching plan; and the nurse ignoring the restrictions of the client's environment. The nurse does negotiate goals with the client. The nurse would evaluate what the client had learned. The nurse would review educational media when planning learner objectives.
The nurse is teaching a client with diabetes how to inject daily insulin. Which method is most effective in evaluating the teaching?
Ask the client to demonstrate how to self-inject the morning insulin. Explanation: By using the teach-back method, the nurse teaches and demonstrates a skill, then the client returns the skill as if teaching the nurse how it is done. This is an effective way to determine the client's ability to independently perform a skill. Asking the client to repeat the steps is good, but self-administering the injection is a better indicator. A brochure could be used as a teaching aid, but it is not the most effective means of determining if the client can perform the skill. Providing a teaching session that includes questions and answers should be done; however, the client should demonstrate the skill.
The nurse is caring for a 70-year-old client with a fractured wrist. Which is the best method to determine whether the client has retained the information taught?
Ask the client to recall after approximately 15 minutes. Explanation: Asking a client to recall what has been discussed after approximately 15 minutes helps determine what information the client has actually retained. Observing the change in the client's behavior for a month is not feasible or timely. Testing the client on the health education and information imparted would be time-consuming and unnecessarily involved. Asking the client to self-administer the doses of drug (if even appropriate) would help demonstrate the client's understanding of how to actually administer the drug but not any other aspect of teaching related to a fracture.
A client informs the nurse about being committed to quitting smoking to improve health. 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?
Assessing importance Explanation: 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. In the elicit-provide-elicit strategy, the nurse elicits information from the client about a topic, provides teaching on the topic, and then further elicits information from the client. Evoking change talk is when the nurse presents a potential change to the client for consideration. Prioritizing is helping a client determine how to order one's priorities.
A client states, "I understand when the nurse explains the possible complications of my illness. I am appreciative of what insulin does to my body, and I can now give myself insulin." Which domains of learning does the nurse identify for this client as having been successfully addressed by education?
Cognitive, affective, and psychomotor Explanation: "I understand when the nurse explains the possible complications of my illness. I am appreciative of what insulin does to my body, and I can now give myself insulin" is an example of the cognitive, affective, and psychomotor domains, respectively. Pedagogy is the science of teaching children and is not a domain of learning. Andragogy is the principle of teaching adults and is not a domain of learning. Gerogogy enhances learning among older adults and is not a domain of learning.
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 the device. The client states, "I'm just too old to learn." What would be most appropriate for the nurse to do to motivate this client?
Describe how the walker can improve the client's quality of life. Explanation: Motivating the older adult client can be done by showing the client how the new knowledge will improve the client's 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.
The nurse is coaching a client who stated a desire to stop smoking without medication. At several sessions to assess the client's success with agreed-upon interventions, the client reports barriers to each action and continues to smoke. What is the best action of the nurse?
Discuss the client's case with a colleague. Explanation: The focus is not to have the client please the nurse, but to improve client health behaviors. Telling a client that the client's efforts are disappointing is not an effective communication technique and can result in disruption of the therapeutic trust relationship between the nurse and client. The client does not necessarily need therapy just because initial attempts have been unsuccessful. The client desires not to have medication, so arranging for medications goes against the client's wishes in the plan of care. A colleague may shed light on additional actions based on experience with similar issues in the past.
Which developmental consideration is a nurse assessing when determining that an 8-year-old child is not equipped to understand the scientific explanation of the child's disease?
Intellectual development Explanation: Piaget's theory of intellectual development is a major learning theory. By understanding how children and adolescents develop learning abilities, the nurse can use this knowledge when teaching clients. School-age children are capable of logical reasoning and should be included in the teaching-learning process whenever possible. Teaching strategies that include clear explanations and reasons for procedures, stated in a simple and logical manner, are most successful. These children are open to new learning experiences but need learning to be reinforced by either a parent or health care personnel as they become more involved with their friends and school activities. Motor development would be focused on a hands-on skill for example, not the scientific explanation of the disease. Psychosocial development looks at stages of development and goals or tasks for different stages.
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?
Knowledge Deficient: Risk for altered perfusion secondary to re-occlusion Explanation: 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.
What is the most appropriate teaching strategy for the nurse to use for a 1-hour presentation on the prevention of osteoporosis to a group of 30 college-age women?
Lecture/discussion Explanation: Lecture/discussion is appropriate for this topic, audience, and group size. A lecture is a formal presentation of information by a teacher to a group of learners. This format is most effective when communicating facts. Role play would not be an appropriate teaching strategy for this topic, as key points cannot be acted out, or for this size of a group, as there are too many students for each one to be able to participate in role play. Demonstration would not be appropriate, either, as the topic does not focus on particular skills that can be demonstrated. Test taking is not appropriate for teaching but for evaluation of learning.
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 Explanation: 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.
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 Explanation: 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. Positive reinforcement is also known as positive feedback, which is what the nurse is providing in this case. Negative reinforcement or feedback would be attempting to change a client's behavior by pointing out and criticizing or even punishing mistakes or undesirable behaviors. Motivation refers to the client's desire to learn or make a change. Health promotion is a topic that may be covered in client teaching and that pertains to optimizing one's health through maintaining proper nutrition, exercise, and hygiene.
The nurse completed education with a client. Which documentation entry represents the most complete teaching plan?
Printed and verbal information provided on gluten-free diet. Questions answered. Verbalizes understanding. Follow-up scheduled. Explanation: Just like a plan of care, a teaching plan must show that evaluation of the intervention was performed, which demonstrates that learning occurred. Complete documentation records the topic taught, methods used to teach, clarification of concepts, and the method used to evaluate how well the client understands the material.
Which strategy should the nurse use when providing education to the older adult client?
Remain calm and conduct the teaching session in a quiet environment. Explanation: Remaining calm and conducting the teaching session in a quiet environment would decrease anxiety or distractions that interfere with learning for the older adult. Keeping the session short will increase concentration, but is not unique to older adults. The nurse is to use colorful materials in a variety of ways and the nurse's tone and pitch should vary.
A nurse may attempt to help a client solve a situational crisis during what type of counseling session?
Short-term counseling Explanation: Short-term counseling would help a client solve a situational crisis. A client 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 client. Professional counseling is a general term.
A client is reluctant to learn to do finger sticks for home international normalized ratio (INR) monitoring. What is the best statement by the nurse?
Tell me what you know about these tests. Explanation: Saying something to encourage the client to openly discuss personal issues is the best option. Assessing worry about pain narrows the client's answer to only addressing pain. Asking "why" questions may be considered probing or accusatory and tends to block communication. Generalizing the client's fear is belittling. Assessing the client's perceptions about checking the INR opens up the discussion about the client's barrier to learning to perform this test.
The nurse is conducting discharge teaching for a client who has been diagnosed with type 2 diabetes. The nurse is teaching the client how to inject insulin at home. Which cue(s) will alert the nurse that the client has poor health literacy? Select all that apply.
The client has a history of several missed health appointments. The client's hospital admission forms were incomplete. The client has a history of medication nonadherence. The client did not follow up when asked to book an appointment with a specialist. Explanation: Because many illiterate or functionally illiterate people are not always willing or able to volunteer information about their reading problems, literacy may be difficult to assess. Some indications that clients have low health literacy are missed appointments, incomplete health forms, nonadherence to medication regimen, unable to provide a coherent health history and lack of follow-up on tests and referrals. Language barriers and immigration are not signs that a client is health illiterate. Clients may be fully health literate in their first language. If a language barrier exists or the client is new to the country and requires further health information due to differences from their country of origin, the nurse must make a full effort to secure a medical interpreter and/or seek out educational material that helps the client learn more about local health resources. The nurse must not assume the client is not health literate.
When a nurse is planning for learning, who must decide who should be included in the learning sessions?
The nurse and the client Explanation: 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.
A parish nurse is preparing to provide a health promotion class to a group of adults in the parish. In preparing to meet the learning needs of this group, the nurse recognizes which as a characteristic of an adult learner?
Their readiness to learn is often related to a developmental task or social role. Explanation: An adult's readiness to learn is often related to a developmental task or social role. The previous experience of the adult is a rich resource for learning. Most adults' orientation to learning is that material should be useful immediately. Peer group acceptance is a critical issue for the adolescent group and not adults.
A client shares with the nurse how much the client appreciates understanding the physiology of breastfeeding. The client states, "I felt very comfortable with what you explained to me, and I feel I will be successful at breastfeeding." In affective learning, this represents the nurse:
creating an atmosphere for discussion of feelings. Explanation: When working with clients to change beliefs, values, and attitudes (i.e., affective learning), the nurse creates an atmosphere in which clients can honestly and freely discuss their feelings and emotions. Creating specific learning sessions for new information and creating an opportunity for rational thought and learning pertain more to cognitive learning, which involves the client's critical thinking and reason. In this scenario, the nurse has provided an educational opportunity in the present, not for the future.
The nurse will be caring for a client with a new diagnosis of hypertension. The client will be arriving for laboratory testing. When should the nurse begin client teaching?
during the admission process Explanation: Limited hospitalization time demands that nurses begin teaching as soon as possible. The client should be educated during the process of admission regarding what to expect, client rights, etc. The client should be educated prior to diagnostic testing. Although the client may require additional education when the test results become available, education should begin earlier. Waiting until immediately prior to discharge to begin teaching does not give the opportunity for return demonstration or to adequately determine whether the education was successful.
The nurse needs to understand the teaching-learning process when administering
educational interventions. Explanation: Educational interventions require the application of the teaching-learning process. The other interventions listed would not, as their primary goal is not to educate the client.
The nurse is caring for a client who demonstrates a health literacy concern. The nurse adjusts client teaching in which way?
uses videos, diagrams, and pictures rather than focusing on verbal teaching Explanation: To address health literacy concerns, the nurse should avoid technical language, limit information to three to five key points, and be specific rather than general. Using medical terminology to help the client feel smarter, providing general teaching instead of specific teaching, and giving instructions in multiple ways are not effective ways to adjust client teaching for those who demonstrate low health literacy.
The nurse has provided education to a client about home care for an open surgical wound on the lower left extremity. When evaluating learning through the cognitive domain, what statement by the nurse would be appropriate?
"Tell me about what signs of infection you will report to the health care provider." Explanation: Cognitive domain learning may be evaluated through oral questioning. The return demonstration is an excellent way of evaluating psychomotor domain learning. Providing an opportunity for and encouraging clients to change their own dressing, for example, provides concrete evidence of satisfactory or unsatisfactory performance of the procedure.
A nurse is discussing the benefits of smoking cessation with a client. The nurse informs the client that smoking cessation will reduce the client's risk for cancer, improve respiratory status, and enhance the quality of life. The nurse also shares a personal 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 feelings on smoking cessation and verbalizes a desire to quit smoking. What type of counseling did the nurse provide to this client?
Motivational Explanation: Motivational counseling involves discussing feelings and incentives with the client. Long-term counseling extends over a period of time. Developmental counseling occurs when a client is going through a developmental stage or passage. Situational counseling occurs when a client faces an event or situational crisis.
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?
The client is not demonstrating readiness to learn due to the effects of medication. Explanation: 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.
The nurse is educating a client regarding a new skill. When evaluating the client's knowledge about the topic covered, which best represents that the client has learned a new skill?
The client organizes materials needed and gives return demonstration. Explanation: Confirmation that a client has learned a skill requires more than the client verbalizing understanding, passing a written test, nodding, or assisting with cleanup. Being able to gather all equipment needed for a skill and then perform it demonstrates proficiency.
