Chapter 25: Patient Education (Teaching/Learning)

The nurse is teaching a group of young college-age women the importance of using sunscreen when going out in the sun. What type of content is the nurse providing?

A. Simulation B. Restoring health C. Coping with impaired function *D. Health promotion and illness prevention* Rationale: Health promotion and illness prevention are the focus when nurses provide information to help patients improve their health and avoid illness. Pg. 337

The nurse is teaching a 27-year-old gentleman how to adjust his insulin dosages based on his blood sugar results. What type of learning is this?

*A. Cognitive* B. Affective C. Adaptation D. Psychomotor Rationale: Cognitive learning requires thinking; learning how to adjust insulin requires analysis, synthesis, and evaluation, which are all types of cognitive learning. Pg. 339

The nurse has to teach a patient how to change dressings at home. What qualities will enable the patient to perform such tasks at home? Select all that apply.

*A. Adequate strength* *B. Sensory acuity* *C. Coordination* D. A caregiver's attitude E. Self-esteem Rationale: The patient should have enough strength to get up and perform dressing changes. The patient should also possess sensory acuity and proper coordination to perform and learn the required tasks. A caregiver's attitude is required when providing care to others. Having self-esteem is unrelated to performing the activity of dressing change. Pg. 341-342

The nurse is planning to teach a patient about the importance of exercise. When is the best time for teaching to occur? Select all that apply.

A. When there are visitors in the room *B. When the patient's pain medications are working* *C. Just before lunch, when the patient is most awake and alert* D. When the patient is talking about current stressors in his or her life E. In the evening, when the patient is tired but the floor is quiet Rationale: Plan teaching when the patient is most attentive, receptive, alert, and comfortable. Test-Taking Tip: Before moving to the next question, recheck whether a question requires just one answer or multiple responses. Be sure not to submit an answer with just one response when a multiple response has been indicated. You may have jumped at the first correct response you found without examining the other possible choices. Pg. 346

The nurse is planning a teaching session on hygiene practices for preschoolers. What teaching methods should the nurse use? Select all that apply.

*A. Use role-playing and imitation.* *B. Encourage questions and offer explanations.* *C. Encourage the children to learn together through short stories and pictures.* D. Encourage participation in a teaching plan. E. Encourage independent learning. Rationale: The teaching methods should be appropriate to the developmental stage of the preschoolers. Role-play and imitation should be used to make learning fun. Asking questions should be encouraged; simple explanations should be provided. Preschoolers love to learn through short stories and pictures. Learning in a group is more fun than learning alone. Preschoolers will not be able to participate in a teaching plan or do independent learning. These teaching methods are more suitable for a young or middle-aged adult. Pg. 341-342

The registered nurse (RN) is teaching a nursing student about effective teaching. Which statements made by the nursing student about teaching indicates effective learning? Select all that apply.

*A. "Teaching is most effective when it responds to the learner's needs."* B. "Teaching is a process of both understanding and applying newly acquired concepts." *C. "Teaching is the concept of imparting knowledge through a series of directed activities."* D. "Teaching is the purposeful acquisition of new knowledge, attitudes, behaviors, and skills through an experience or external stimulus." *E. "Teaching consists of a conscious, deliberate set of actions that help individuals gain new knowledge, change attitudes, adopt new behaviors, or perform new skills."* Rationale: Teaching is most effective when it responds to the learner's needs. The learner's needs are assessed by asking questions and determining learner's interest. Teaching is the concept of imparting knowledge through a series of directed activities. Effective teaching consists of a conscious, deliberate set of actions that help the learners to gain new knowledge, change attitudes, adopt new behaviors, or perform new skills. Learning, not teaching, is a process of both understanding and applying newly acquired concepts. Likewise, learning is purposeful attainment of new knowledge, attitudes, behaviors, and skills through an experience or external stimulus. Pg. 338

The registered nurse (RN) is preparing to teach a nursing student about the process of learning in nursing practice. Which information should the RN include in the nursing plan? Select all that apply.

A. Learning involves setting an appropriate pace. B. It requires the educator to be knowledgeable about subject matter. *C. Learning includes both understanding and applying newly acquired concepts.* D. Learning involves imparting knowledge through a series of directed activities. *E. It is the acquisition of new knowledge, behaviors, and skills through an experience.* Rationale: Learning is a process that includes both understanding and application of newly acquired concepts. It is the purposeful acquisition of new knowledge, behaviors, and skills through an experience. Teaching involves the educator or guide pacing the learning process appropriately. The educator should be knowledgeable about the subject matter in the process of teaching. Teaching imparts knowledge through a series of directed activities. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Pg. 338

The nurse has to teach a group of morbidly obese patients the significance of proper eating habits and exercise. Where would be an ideal setting to impart this teaching?

A. Cafeteria B. Hospital lobby C. Gymnasium *D. Classroom* Rationale: An ideal setting for teaching would be a classroom, because patients would be able to sit comfortably, the room would have proper ventilation and light so that everyone could see and hear the teacher without distraction, and the patients would be able to observe one another during the teaching session. A cafeteria, hospital lobby, or noisy and busy places would have numerous distractions that could interfere with the teaching process. A gymnasium would not have comfortable seating arrangements for the patients to optimally concentrate on the teaching. Pg. 344

The nurse is attempting to teach a below-the-knee amputee patient to walk with the help of crutches. The patient is doubtful about doing it, but the nurse strongly believes in the patient's ability to walk. What source of self-efficacy does the nurse use to convince the patient?

A. Enactive mastery B. Vicarious experience *C. Verbal persuasion* D. Physiological and affective states Rationale: The nurse uses verbal persuasion to express the belief that the patient can walk on crutches. The nurse could demonstrate the use of crutches through facilitating participation in the activity, which is called a vicarious experience. Enactive mastery involves the patient demonstrating the use of crutches, and physiological and affective states would be used when the patient successfully walks with crutches. This improves self-efficacy and increases the rate of achievement of treatment outcomes. Pg. 340

The nurse shows a patient how to use a sphygmomanometer to record blood pressure and asks the patient to confirm understanding of the procedure by performing it successfully. Which teaching method has the nurse employed?

A. Practice B. Demonstration C. Independent projects *D. Return demonstration* Rationale: Psychomotor learning involves acquiring motor skills that require coordination. It includes integration of mental and physical movements. With the return demonstration method of teaching, the nurse encourages the patient to use newly learned skills under the nurse's observation. The practice method of teaching involves the nurse providing a controlled environment for the patient to perform skills. With the demonstration method, the nurse provides presentations of the procedures or skills the patient should learn. An independent project involves a teaching method that promotes adaptation and origination of psychomotor learning. It also permits the learner to use new skills. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Pg. 350

While studying the different domains of learning, the nurse finds discussion to be the most appropriate teaching method based on cognitive learning. What are the characteristics of the discussion method? Select all that apply.

*A. It allows peer support.* *B. It involves both the nurse and the patient.* C. It involves presentation of procedures or skills by the nurse. *D. It helps the patient to learn from others' experiences.* E. It allows the patient to assume responsibility for completing learning activities at his or her own pace. Rationale: The discussion method involves interaction between both the nurse and the patient. This method allows peer involvement and enables the patient to learn from others' experiences. Demonstration is the teaching method that involves presentation of procedures or skills by the nurse. Unlike the role-play method, the demonstration method does not allow the patient to assume responsibility for completing learning activities at his or her own pace. Pg. 339

The nurse is designing a teaching plan for a patient to prevent urinary tract infections. When planning the teaching, what factors should the nurse keep in mind? Select all that apply.

*A. It should cater to the needs of the patient.* *B. Teaching should be problem based.* *C. Provide only necessary information.* D. Teaching should be based on mutually exclusive experiences. *E. It should prompt the learner to engage in activities that lead to a desired change.* Rationale: Before preparing the teaching plan, the nurse should understand the patient's need. The nurse should consider the problem the patient is facing and provide only the necessary information. This will help prevent information overload for the patient. The objective of the teaching is to educate the patient about the prevention of urinary tract infections. Therefore, the teaching should prompt the patient to adopt the preventive measures against urinary tract infections. The teaching should be based on real-life experiences rather than mutually exclusive ones. Pg. 346

After interacting with the wife of a patient's who has terminal cancer, the nurse anticipates that the patient is experiencing denial. Which statement by the caregiver supports the nurse's conclusion?

*A. "My husband wants to get another opinion, even after a clear diagnosis."* B. "My husband is blaming the primary healthcare provider for his condition." C. "My husband is not showing any interest in his favorite games and movies." D. "My husband says he wants to spend as much time as possible with the family." Rationale: The patient is not ready to accept reality and thinks his diagnosis is wrong, so he wants a second opinion. This indicates that the patient is in the denial stage. The patient blames and shows anger toward his primary healthcare provider in the anger stage of grief. If the patient does not show any interest in normal activities, such as playing games and watching movies, it indicates that the patient is experiencing depression and has lost the will to live. Wanting to spend as much time with family as possible indicates that the patient is showing acceptance. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Pg. 341

Which is involved in the characterizing level of affective learning?

*A. Acting and responding with a consistent value system* B. Listening to a process and responding verbally or nonverbally C. Developing a value system by organizing values according to their worth D. Paying attention to the process of learning or while receiving information Rationale: Affective learning involves the expression of feelings and development of values, attitudes, and beliefs. It may include value clarifications as an example. Characterizing is the most complex behavior of affective learning. It involves an action and response with a consistent value system. The responding level the affective learning involves active participation through listening along with a verbal or nonverbal response. Organizing behavior requires the development of a value system by organizing values according to their worth. At the receiving level, the learner is passive and simply takes in information by paying attention. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Pg. 340

While caring for a patient with mental illness, the nurse notices that the patient is actively participating in group activities verbally and nonverbally. Which domain of learning does the nurse recognize in this patient?

*A. Affective* B. Cognitive C. Attentional D. Psychomotor Rationale: The patient who participates in affective learning will exhibit good responding behavior. Verbal and nonverbal responses in group activities indicate affective learning development. The patient is not acquiring any knowledge about new factors or new facilities; instead, the patient is showing effective verbal and nonverbal communication. Therefore, the patent is not exhibiting cognitive learning. The attentional set is not a domain of learning; it is a mental state that allows a learner to focus on an activity. The patient is not using his or her mental or muscular activity to acquire a skill. Therefore, the patient is not exhibiting psychomotor development. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking and look for key words, (2) Read each answer thoroughly and see if it completely covers the material asked by the question, and (3) Narrow the choices by immediately eliminating answers you know are incorrect. Pg. 339

The nurse is teaching a patient with newly diagnosed congestive heart failure about behavioral and lifestyle modifications. Which domains of learning should the nurse focus on while teaching this patient? Select all that apply.

*A. Cognitive* *B. Affective* C. Psychomotor D. Attentive E. Psychosocial Rationale: The cognitive domain involves acquisition of knowledge, comprehension, and application of the acquired knowledge. The affective domain involves expressing feelings and accepting attitudes, opinions, and values. The nurse should focus on these two domains while educating the patient on behavioral modifications. The psychomotor domain involves the use of mental and muscular activity. "Attentive" and "Psychosocial" are not domains of learning. Study Tip: What domains of learning do you use when studying? You probably spend most of your study time in the cognitive domain. Consider whether the information you are studying could be retained by using the psychomotor domain as well. Could you make up a dance or hand gestures to coordinate with the information? How about speaking information in rhythm or to the tune of a song you already know? Just the attempt at a rhyme, rhythm, or tune will help link information to additional areas in your mind, helping you retain it! Pg. 339

A patient with chronic diabetes is started on insulin therapy. The nurse has to teach the patient how to self-administer insulin and to adjust the insulin dosage according to blood sugar levels. What domain is required for this learning? Select all that apply.

*A. Cognitive* B. Affective C. Attentive *D. Psychomotor* E. Psychosensory Rationale:Learning to self-administer insulin injections is a skill of the psychomotor domain. It requires complex mental and muscular coordination to complete the tasks. Adjusting dosages appropriately is a skill of the cognitive domain, as it requires thinking, analyzing, and making an accurate judgment. The affective domain deals with acceptance of values and attitudes. "Attentive" and "Psychosensory" are not domains of learning. Pg. 339

A patient's breast biopsy results return as positive for cancer. The patient says that there is some mistake and that she cannot have breast cancer. What actions should the nurse take to provide further information to this patient? Select all that apply.

*A. Explain the situation to her relative or significant other.* *B. Explain carefully the significance and need for prompt tumor removal.* C. Discuss chemotherapy treatment. D. Inform the patient about breast implants. E. Talk to the patient in a firm voice. Rationale: When the patient is in the denial stage secondary to a new diagnosis, the nurse should try to explain the situation to a relative or significant other, because the patient is not willing to accept the new condition or any other information regarding the same. The nurse should carefully and empathetically inform the patient about surgical treatment and the significance of the same. During the denial stage, discussion of detailed and future information such as chemotherapy and the possible necessity for breast implants should be avoided. The nurse should not use a firm voice while dealing with a patient in the denial stage of grieving. Pg. 341

The nurse attends to a group of patients with depression. The nurse conducts a group discussion with the patients to teach them effective learning skills. How will the group discussion help the patients? Select all that apply.

*A. It will allow patients to receive support from other patients in the group.* B. It will allow patients to express concerns. C. It will allow patients to discuss personal and sensitive things. *D. It will help patients to learn from others' experiences.* *E. It will help promote responsiveness, valuing others, and organization.* Rationale: If patients with depression sit in a group and interact with other patients who have similar symptoms, they receive support from other patients in the group. The group discussion helps them learn from the experiences of others and promotes responsiveness, valuing others, and organization. However, patients may not speak of their concerns or about sensitive topics in a group. For that, the nurse will need to have a one-on-one conversation. Test-Taking Tip:Calm yourself during the exam by closing your eyes, putting down your pencil (or computer mouse), and relaxing. Take deep breaths for a few minutes (or as needed, if you feel especially tense) to relax your body and to relieve tension. Pg. 349

The nurse is teaching a patient about hygiene practices. During the interaction, the patient expresses feelings and opinions about the teaching provided and hygiene practices. The nurse understands that these expressions are a part of the affective domain of learning. Which behaviors are included in affective learning? Select all that apply.

*A. Organizing* B. Perception *C. Responding* *D. Characterizing* E. Comprehension Rationale: Affective learning deals with the expression of feelings, beliefs, or values. It includes behaviors like organizing, responding, and characterizing. Organizing refers to developing a value system by identifying and organizing values and resolving conflicts. Responding refers to active participation through listening and reacting verbally and nonverbally. Characterizing refers to acting and responding with a consistent value system. Comprehension is a part of cognitive learning. Perception is a type of psychomotor learning. Pg. 338-339

Which aspect of psychomotor learning involves an awareness of qualities through the use of sensory stimulation?

*A. Perception* B. Adaptation C. Origination D. Mechanism Rationale: Psychomotor learning involves acquiring motor skills that require coordination. It also includes learning skills that require integration of mental and physical movements. Perception is the simplest behavior in the hierarchy. It involves the awareness of objectives or qualities through the use of sensory stimulation. In adaptation, motor skills are well developed and movements are modified due to unexpected problems. Origination includes the use of existing psychomotor skills for the creation of new movement patterns. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Pg. 340

A patient recently diagnosed with Acquired Immunodeficiency Syndrome (AIDS) states, "I am perfectly fine, and I don't want to discuss my treatment and condition." After considering the patient's current stage of grief, which action by the nurse would be appropriate?

*A. The nurse should explain the situation to the patient's family.* B. The nurse should focus on skills the patient will require in the coming weeks. C. The nurse should provide necessary information to the family for the patient's discharge. D. The nurse should convince the patient that the treatment for the illness is essential. Rationale: It is difficult for a patient to accept a temporary or permanent loss of health. The patient needs to grieve. This process of grieving provides time to adapt psychologically to the emotional and physical implications of the illness. Here, the patient is avoiding discussion about the illness and may be distorting information that has not been presented clearly. Therefore, the nurse should carefully explain the situation to the patient's family. The nurse should not focus on teaching important skills or knowledge because the patient has not accepted the reality of the condition. When a patient reaches the psychosocial stage of acceptance, the nurse should provide necessary discharge information to the patient or the patient's family. The nurse should avoid any attempt to convince the patient about the illness. This will likely result in further anger or withdrawal. Pg. 342

The nurse needs to discuss the treatment plan with a cancer patient. What should the nurse ensure before beginning the discussion? Select all that apply.

*A. The patient does not have any pain.* B. The patient is hungry. C. The patient is anxious. D. The patient's friends are present. *E. The patient is not watching TV.* Rationale: Before initiating any educational discussion, the nurse should make sure that the patient is not in any kind of pain or physical discomfort. The patient should be focused and should not do any other activity such as watching TV. A hungry or anxious patient will lack the level of concentration required to make informed decisions and the nurse should avoid that. Distractions such as friends or visitors around the patient will also prevent learning from occurring. Pg. 348

The nurse is planning to include information about coronary artery disease in the discharge notes of a patient. Which learning objectives should be evaluated in the discharge notes? Select all that apply.

*A. The patient is able to state the signs of heart attack.* B. The patient understands the importance of exercises to improve heart function. C. The patient verbalizes feelings of anxiety related to limitation of activity imposed by the condition. D. The patient increases his or her knowledge about the lifestyle modifications required to prevent heart failure. *E. The patient is able to perform exercises in the correct way that is necessary to improve cardiac function and prevent trauma as well.* Rationale: To evaluate a learning objective, it should be measurable. The nurse can evaluate patient learning by asking the patient to state the signs of heart attack and to demonstrate exercises because these performances can be measured. Objectives such as understanding a concept, verbalizing feelings, and increasing knowledge are vague and ambiguous and cannot be measured. Pg. 338

The nurse is planning to prepare a teaching plan on healthy nutrition. What are the factors that the nurse should consider before preparing the plan? Select all that apply.

*A. The patient's educational status* *B. The socioeconomic status of the patient* *C. The culture to which the patient belongs* D. The consent of the healthcare provider *E. The willingness of the patient to participate* Rationale: The teaching plan should be based on the patient's educational status so that the patient understands what is being taught. An important factor is the consideration of culture because there are many practices that are specific to certain cultures. If the patient experiences symptoms such as pain, the patient may not be receptive to the teaching. Therefore, the nurse should determine if the patient is willing to accept the teaching. Socioeconomic status should be considered to provide the most useful and helpful information to the patient regarding his or her current situation. It is the nurse's duty to inform the patient about his or her condition; the nurse does not need the consent of the healthcare provider to do so. Pg. 345, 346

A 69-year-old patient is diagnosed with myocardial infarction. The patient is scheduled for coronary artery bypass grafting surgery. The nurse teaches the patient about coughing and deep breathing exercises. Before starting to teach, which questions should the nurse ask to assess the patient's attentiveness? Select all that apply.

A. "Are you able to hear me properly?" B. "Is there any history of heart disease in your family?" *C. "Do you have any pain now?"* *D. "Are you comfortable here?"* E. "Do you want to listen to music to relax yourself?" Rationale: Physical discomfort, anxiety, and environmental distractions are known to influence an individual's attention. The presence of any of these should be checked to ensure that the patient is attentive and will be able to understand the information provided. The presence of pain may make the patient uncomfortable. By asking whether the patient is comfortable, the nurse determines whether the patient is anxious or if any environmental factor is distracting. The ability to hear properly is not a factor that determines a person's attention. However, it may be important for the patient who has a hearing impairment. Asking questions about the patient's family history of heart disease and the need for relaxation does not help in assessing attentiveness. Test-Taking Tip: The NCLEX ® exam is not a timed test except that there is a limit of 5 hours. Both the number of questions and the time to complete the test vary according to each candidate's performance. However, if the test taker uses the maximum of 5 hours to answer the maximum of 265 questions, each question equals 1.3 minutes. Pg. 340

While caring for a patient with cancer, which of the nurse's statements demonstrate the evaluation level of cognitive learning? Select all that apply.

A. "I will ask the patient to describe his illness." *B. "I will measure the outcomes of medications."* C. "I will study the patient's pretreatment laboratory reports." *D. "I will assess the adverse effects of radiation therapy."* E. "I will segregate the laboratory data in accordance with an observed pattern." Rationale: Cognitive learning encompasses the acquisition of knowledge and intellectual skills. Evaluation is the ability to judge the value of something for a given purpose. The nurse here implements evaluation by measuring the outcomes of the medication and assessing the adverse effects associated with radiation therapy. The understanding level includes the ability to comprehend the meaning of learned material, for example, when the patient is able to describe his or her illness. The applying level involves using newly learned ideas in an actual situation, for example, when the nurse reads the patient's pretreatment laboratory reports. Analyzing involves the breakdown of information into organized parts. The nurse implements analyzing when segregating data in accordance with observed patterns. Pg. 340

In the context of teaching an infant's mother about the child's developmental capacity, which statement(s) by the nurse would be most appropriate? Select all that apply.

A. "You should encourage learning through the use of pictures." *B. "You should keep consistent routines of feeding and bathing."* C. "You should use role play and imitation to make learning fun." *D. "You should speak softly to convey a sense of trust to the baby."* E. "You should use simple words to promote the child's understanding." Rationale: The nurse should implement teaching methods and actively involve the patient or caregiver in learning activities. The nurse should guide the infant's mother to keep consistent routines of feeding and bathing. The mother should also foster a sense of trust by speaking softly to her infant. The mother should encourage learning in a preschooler through pictures and short stories. The use of role play, imitation, and play would make the learning healthy and interesting for a preschooler. The mother of a toddler, not an infant, should use simple words while communicating. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Pg. 343

While providing medical care, the nurse intends to provide the patient with clear information about his or her rights. Which statement by the nurse would make the patient pay more attention to the care being provided?

A. "You should learn about the medical tests." B. "You should ask questions if you do not understand something." C. "You should ask a trusted family member to be your advocate." *D. "You should make sure that you are getting the right treatment from the right health care professional."* Rationale: The nurse is responsible for teaching patients about their rights. This teaching helps patients make informed decisions about their care, and the information must be accurate, complete, and relevant to patients' needs, language, and literacy. The nurse may need to emphasize that the patient should pay more attention to the care being provided by asking the patient to ensure about the right treatment from the right health care professional. The nurse may encourage the patient to be more educated by learning about the medical tests being prescribed. The patient is advised to actively ask questions in case of any lack of clarity. The nurse may ask the patient to include a trusted family member or friend as an advisor or supporter. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Pg. 338

A patient is learning about his disease and trying to understand how it relates to his present condition. Which learning domain is the patient using?

A. Affective *B. Cognitive* C. Psychosocial D. Psychomotor Rationale: Cognitive learning occurs when a patient acquires knowledge and comprehends it to gain information about his or her condition. Because the patient is not expressing his feelings, opinions, or values about the disease, the patient is not exhibiting affective learning. "Psychosocial" is not a learning domain; rather, psychosocial adaptation involves a patient coming to terms with a temporary or permanent loss of health. The patient is not exhibiting psychomotor learning, because the he is not integrating mental and muscular activity to learn about his disease. Pg.339

A patient needs to learn to use a walker. Which domain is required for learning this skill?

A. Affective domain B. Cognitive domain C. Attentional domain *D. Psychomotor domain* Rationale: Using a walker requires the integration of mental and muscular activity. Test-Taking Tip: If you cannot recall the meanings of terms in a question or choices, take the word apart in your mind and examine the word roots. In the choice "Psychomotor domain," you see psycho and motor. You know psych is the word root for mind, that motor indicates motion, and that both mind and body are important in learning a physical skill, so you have the answer. Pg. 341

A patient who was hospitalized due to a smoking-related illness tells the nurse, "I am ready to accept responsibility for learning and I need your help." Which stage of psychosocial grief is reflected in this statement?

A. Anger B. Disbelief *C. Resolution* D. Bargaining Rationale It is difficult for a patient to accept a temporary or permanent loss of health. The process of grieving provides time to adapt psychologically to the emotional and physical implications of their illnesses. In the resolution stage, the patient begins to sense a need for help, is ready to accept responsibility for learning, and begins to express his or her emotions openly. The stage of anger is reflected when the patient direct anger towards the nurse or others. The stage of disbelief would be characterized by the patient avoiding discussions about illness. The bargaining stage would be indicated by the patient offering to live a better life in exchange for the promise of better health. Pg. 342

A patient with chronic alcoholism is hospitalized in critical condition. The patient tells the nurse, "If God lets me live this time, I promise to quit drinking forever." Which stage of grieving does the patient demonstrate through this statement?

A. Anger B. Resolution *C. Bargaining* D. Acceptance Rationale: It is difficult for a patient to accept a temporary or permanent loss of health. The patient needs to grieve. This process of grieving provides time to adapt psychologically to the emotional and physical implications of the illness. In this scenario, the patient is offering to live better in exchange for the promise of better health, which indicates the bargaining stage of psychosocial adaptation to illness. A patient may place blame, complain, and direct anger towards the nurse or others in the anger stage. In the resolution stage, the patient may begin to express emotions openly. He or she realizes that the illness has created changes. When a patient is in the acceptance stage, he or she recognizes the reality of the condition, actively pursues information, and strives for independence. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Pg. 342

The nurse assures a patient that the nurse is always available to talk. Which stage of grieving would most likely trigger this action of the nurse?

A. Anger B. Resolution C. Bargaining *D. Denial or disbelief* Rationale: In the denial or disbelief stage of grieving, the patient is not prepared to deal with a problem. Therefore, the nurse should provide support and empathy and ensure the patient that he or she is always available for discussion. In the anger stage of grieving, the nurse should not argue with the patient and should calmly listen to patient's concerns. In the resolution stage of grieving, the nurse should encourage the patient to express his or her feelings. In bargaining stage of grieving, the nurse should convey only reality to the patient. Pg. 342

Which stage of cognitive learning involves the breakdown of information into organized parts?

A. Applying *B. Analyzing* C. Evaluating D. Understanding Rationale: The analyzing level of cognitive learning involves the ability to break information down into organized parts. Applying involves using learned concepts in real situations. The cognitive process of evaluation is the ability to judge the value of an action for a given purpose. Understanding is described as the ability to understand the meaning of learned material. Pg. 240

The registered nurse (RN) is teaching a patient about The Joint Commission (TJC) Speak Up Initiatives. Which action taken by the patient indicates that the patient needs further teaching about these initiatives?

A. Asking about the medication errors B. Asking the qualification of the primary health care provider C. Asking the purpose of medications given during the treatment *D. Asking the primary health care provider to act as his or her advocate* Rationale: According to the TJC Speak Up Initiatives, the patient should ask a trusted family member or a friend to act as his or her advocate (advisor or supporter). The patient should know the medications and their purpose in the treatment, and medication errors that are most common health care mistakes. Patients should make sure that the treatment and medications they are getting are right and are provided by the right health care professionals. Therefore, the patient has a full right to ask about the qualification of the primary health care provider. The patient should have knowledge about the medications and their purpose in the treatment. Pg. 338

A patient with newly diagnosed Alzheimer's disease expresses concern to the nurse that the disease has affected her daily life. The patient feels sad about it. What stage of grieving is this patient in?

A. Denial B. Anger *C. Resolution* D. Acceptance Rationale: The patient realizes that the Alzheimer's disease has changed her life and expresses herself by asking questions. This is the resolution stage of grieving. In the stage of denial, the patient is not ready to accept the altered condition. During the anger stage, the patient expresses anger towards others. During the acceptance stage, the patient accepts the medical condition, pursues information, and is willing to deal with the implications of the diagnosis. Pg. 341

The nurse needs to teach a group of college students the importance of donating blood. What nursing action would encourage active participation of the students? Select all that apply.

A. Hand out pamphlets. *B. Teach while touring the blood bank.* C. Give a lecture in a hallway. *D. Ask the students questions during the session.* *E. Demonstrate the procedure of blood donation in the actual setting.* Rationale: The nurse should teach the students about blood donation while touring the blood bank where students can see the blood bank activities, which can increase their interest levels. The nurse should ask questions to engage the students in the learning activity and should demonstrate an actual blood donation. This would allow active participation of the students, make them aware of the procedure, and allow them to make informed decisions. Handing out pamphlets would not engage the students in learning. Giving a lecture in the hallway would be distracting and the students might not participate in the teaching. Pg. 342, 348

Which teaching method should the nurse include for a toddler?

A. Having the toddler touch different textures B. Speaking softly to convey a sense of trust *C. Using play to teach procedures and activities* D. Using pictures to teach how to perform hygiene Rationale: For a toddler, the nurse uses play to teach procedures and activities. The nurse would have an infant touch different textures. The nurse speaks softly to an infant to convey a sense of trust. For a preschooler, the nurse uses pictures to teach how to perform hygiene. Pg. 343

The nurse is educating a diabetic patient on how to self-administer insulin. Which are the appropriate methods used by the nurse to educate this patient? Select all that apply.

A. Lecture *B. Demonstration* *C. Return demonstration* D. Role-playing E. Question and answer session Rationale: Learning how to self-administer insulin requires handling a needle and syringe, and occurs in the psychomotor domain. Demonstration and return demonstration are the appropriate methods of teaching this patient. A demonstration of the procedure by the nurse helps the patient to observe the nurse's behavior and allows the nurse to control questioning. A return demonstration allows the patient to perform the procedure as the nurse observes and provides excellent feedback. A lecture is a teaching method involving the cognitive domain. Role-playing focuses on the cognitive and affective domains of learning. A question and answer session is appropriate when addressing a patient's particular concerns in the cognitive domain. Test-Taking Tip: Because skills are psychomotor activities, they are best taught by demonstration and return demonstration. `The other choices for this question do not offer the patient the chance to view and practice the psychomotor aspects of the skill; that is why they are incorrect. To help you recall that psychomotor activities are learned best by demonstration and return demonstration. imagine a friend teaching you a new dance. A lecture or question-and-answer session would not work nearly as well as the demonstration and return demonstration. Pg. 349

The school nurse is about to teach a freshman-level high school health class about nutrition. What is the best instructional approach to ensure that the students meet the learning outcomes?

A. Provide information using a lecture. B. Use simple words to promote understanding. *C. Develop topics for discussion that require problem solving.* D. Complete an extensive literature search focusing on eating disorders. Rationale: Adolescents learn best when they are able to use problem solving to help them make choices. Test-Taking Tip: Keep developmental stages in mind when a question specifies a certain age group. Pg. 342

The nurse is caring for a patient with cancer who was previously in a state of denial but has now accepted the illness. The patient asks the nurse questions about the illness and expresses emotions openly. What interventions should the nurse perform at this stage? Select all that apply.

A. Provide support and empathy. *B. Involve the family in teaching information for discharge.* C. Introduce only reality. *D. Encourage the expression of feelings.* *E. Set aside formal times for discussion.* Rationale: As the patient has accepted the illness and talks about it openly, it is important to encourage the patient to express feelings and set aside formal times to discuss and share information needed for the future. When a patient strives for independence, creating a discharge plan can be done; family members are included in the teaching. Providing support and empathy is needed when the patient is in a state of denial. Because the patient has accepted the illness, apart from explaining the reality, it is important to share information needed for the future. Pg. 340-341

A patient with cancer is irritated with the side effects of chemotherapy and blames the nurse for his or her condition. Taking into consideration the patient's current stage of grief, which nursing actions are appropriate? Select all that apply.

A. Provide teaching on present occurrences. B. Convince the patient to undergo treatment. *C. Listen quietly to the patient's concerns.* *D. Tell the patient's family that this behavior is normal.* E. Focus on knowledge that the patient will require in the upcoming weeks. Rationale: It is difficult for a patient to accept a temporary or permanent loss of health. The patient needs to grieve, and this process of grieving provides time to adapt psychologically to the emotional and physical implications of the illness. Here, the patient is expressing anger towards the nurse. The patient also complains about the treatment, and needs an opportunity to express feelings and anger. When the patient is in the anger stage, the nurse should quietly listen to the patient's concerns. The patient's family may feel worried about the patient's behavior, and the nurse should inform the family that this behavior is normal. The nurse should provide teaching on present occurrences when the patient has reached the acceptance stage. The nurse should not focus on the skills required by the patient in the future, because he or she is still not prepared to face the future. Pg. 341

The nurse is teaching hand washing to a group of preschoolers. Which teaching interventions would facilitate learning in this group? Select all that apply.

A. Teach psychomotor skills needed to maintain health. *B. Use role-playing, imitation, and play to make learning fun.* C. Provide information regarding the health problem to the child. D. Allow the preschooler to make decisions about health and health promotion. *E. Encourage learning together through pictures and short stories about how to perform hygiene.* Rationale: To facilitate learning in a preschooler, the teaching aids should be developmentally appropriate. Therefore, role-playing, imitation, and play would be appropriate methods of teaching. The preschoolers should be encouraged to learn together through pictures and short stories. Teaching psychomotor skills, providing information regarding health problems, and allowing the preschoolers to make decisions about health and health promotion are not appropriate interventions for a preschooler as understanding these would require more maturity. Pg. 342

Which nursing action is an example of teaching to a patient's cognitive learning style?

A. The nurse gives patients examples of other patients' experiences. *B. The nurse orally explains to the patient how to use the wheelchair.* C. The nurse asks the patient to demonstrate the use of the wheelchair after teaching. D. The nurse shows the patient how to use the wheelchair. Rationale: The cognitive domain of learning involves discussion of specific patient concerns. Therefore, the action of the nurse teaching the patient orally about the use of the wheelchair is an example of the cognitive domain of teaching. In the affective domain of teaching, the nurse will allow the patient to learn from others' experiences. Psychomotor teaching enables the patients to perform skills as observed. Therefore, showing the patient how to use the wheelchair and asking the patient to demonstrate its use is an example of psychomotor teaching. Pg. 339

A patient who is diagnosed with Parkinson disease tells the nurse, "I recognize the reality of my condition and want to strive for independence." After considering the current stage of grief, which plan of action by the nurse would be appropriate? Select all that apply.

A. The nurse teaches about past occurrences. B. The nurse continues to introduce only reality. C. The nurse encourages the expression of feelings. *D. The nurse focuses teaching on knowledge required in the future.* *E. The nurse teaches family necessary information for the patient's discharge.* Rationale: It is often difficult for a patient to accept his or her loss of health. Patients need to grieve, and this process gives them time to adapt psychologically to their illnesses. The stages of grieving include a series of responses that the patient experiences. In the stage of acceptance, the patient recognizes the reality of the condition. He or she actively pursues information and strives for independence. Therefore, in this stage, the nurse should focus teaching on the skills and knowledge that the patient will require in the future. The nurse should also teach the family and significant others the necessary information for discharge. The nurse should avoid discussing past occurrences, which would only demotivate the patient. In the acceptance stage, the patient has already accepted the reality of the condition. Therefore, the nurse would no longer need to persistently convey the reality. This action would be suitable in the bargaining stage. In the resolution stage, encouragement about feelings or expression would be more relevant. Pg. 342