FUNDS EXAM CH 9

A couple has just learned that their newborn infant has a congenital cardiac anomaly that will require many lifestyle modifications, surgical corrections, and hospital stays. Place the following aspects of the couple's client education in the correct order that nurses should conduct them. Determine their emotional readiness to learn. Revise the learning plan if needed. Select educational strategies. Implement various educational techniques. Draft learning outcomes.

1. Determine their emotional readiness to learn. 2. Draft learning outcomes. 3. Select educational strategies. 4. Implement various educational techniques. 5. Revise the learning plan if needed. The education process parallels the learning process. It begins with assessment of variables such as readiness to learn, and learning needs that lead to a determination of learning outcomes. Teaching strategies are selected, implemented, evaluated, and then revised if necessary.

A nurse in a provider's office is collecting data from the caregiver of a 12-month-old infant who asks if the child is old enough for toilet training. Following an educational session with the nurse, the client agrees to postpone toilet training until the child is older. Learning has occurred in which of the following domains? A. Cognitive B. Affective C. Psychomotor D. Kinesthetic

B. CORRECT: Affective learning has taken place because the client's ideas about toilet training changed.

A nurse is observing a client drawing up and mixing insulin. Which of the following findings should the nurse identify as an indication that psychomotor learning has taken place? A. The client is able to discuss the appropriate technique. B. The client is able to demonstrate the appropriate technique. C. The client states an understanding of the process. D. The client is able to write the steps on a piece of paper.

B. CORRECT: Demonstrating the appropriate technique indicates that psychomotor learning has taken place.

A nurse is evaluating how well a client learned the information presented in an instructional session about following a heart-healthy diet. Which of the following actions should the nurse take to evaluate the client's learning? A. Encourage the client to ask questions. B. Ask the client to explain how to select or prepare meals. C. Encourage the client to fill out an evaluation form about how the nurse presented the information. D. Ask whether the client has resources for further instruction on this topic.

B. CORRECT: Having the client explain the information in their own words will allow the nurse to evaluate exactly what the client remembers and whether the client comprehends the information.

A nurse is providing preoperative education for a client who will undergo a mastectomy the next day. Whichof the following statements should the nurse identify as an indication that the client is ready to learn? A. "I don't want my spouse to see my incision." B. "Will you give me pain medicine after the surgery?" C. "Can you tell me about how long the surgery will take?" D. "My roommate listens to everything I say."

C. CORRECT: Asking a concrete question about the surgery indicates that the client is ready to discuss the surgery. The client's new diagnosis of cancer can cause anxiety, fear, or depression, all of which can interfere with the learning process.

A nurse is preparing an instructional session for a client about managing stress incontinence. Which of the following actions should the nurse take first when meeting with the client? A. Encourage the client to participate actively in learning. B. Select instructional materials. C. Identify goals the nurse and the client agree are reasonable. D. Determine what the client knows about stress incontinence.

D. CORRECT: The first action to take using the nursing process is to assess or collect data from the client. Determine how much the client knows about stress incontinence, the accuracy of this knowledge, and what the client needs to learn to manage this problem before instructing the client.

The nurse is providing education for a client that will be providing self-care at home. The client states, "I just don't think I can do all of this. It's too much to learn." What is the best response by the nurse? a) "I understand that you feel overwhelmed with all of the information. Tell me what I can do to help." b) "If you don't learn how to do it, who will take care of you?" c) "You will be just fine." d) "It's not difficult information, you just need to listen carefully to the instructions."

a) "I understand that you feel overwhelmed with all of the information. Tell me what I can do to help." Letting the client know that the nurse is aware the information is overwhelming and placing some of the control with the client is a therapeutic approach to the statement. The other responses are non- therapeutic. Informing the client that "You will be just fine" is offering false reassurance. Informing the client that the information is not difficult is demeaning. Instilling fear into the client by asking who will take care of them is non-therapeutic.

The nurse is using Teach-Back to evaluate the client's understanding of new information given during discharge. Which statement indicates the use of this technique? a) "Please repeat to me the different signs and symptoms of stroke." b) "Will you promise to read these instructions when you go home?" c) "Is someone able to review the instructions with you?" d) "Use the instructions on this paper to clean your wounds at home."

a) "Please repeat to me the different signs and symptoms of stroke." Teach-Back is a technique used to evaluate the information received by the client. This technique uses open-ended questions, allowing the client to repeat the information back to the nurse in his own words.

Educating women on diet and exercise is an example of what type of client education? a) Health promotion b) Disease prevention c) Health restoration d) Health protection

a) Health promotion Health promotion activities are general recommendations and concentrate on improving someone's overall well-being.

The nurse is providing instrcutions to a client about performance of breast self-examination. What outcome does the nurse evaluate regarding this education? a) The client will use the self-examination for breast cancer detection and prevention. b) The client will demonstrate self-efficacy and improved body image. c) The client will demonstrate improved coping skills. d) The client will have restoration of breast function.

a) The client will use the self-examination for breast cancer detection and prevention. Client education also focuses on the knowledge and skills for early detection or prevention of disease and disability. Studies have proven the importance of early detection in support of teaching breast self- examination.

Which principle of teaching-learning is an accurate guideline for the nurse/teacher? a) The teaching-learning process can be facilitated by a helping relationship. b) Client education should occur independently of the nursing process. c) Planning learner objectives should be done by the teacher alone. d) Past life experience should not be a factor when helping clients assimilate new knowledge.

a) The teaching-learning process can be facilitated by a helping relationship. The teaching-learning process can be facilitated by a helping relationship. This is an important principle for the nurse/teacher to remember. Teaching is part of the nursing process. Past life experiences should be a factor when helping clients assimilate new knowledge because this is the application to Knowles's adult learning principles. Planning learner objectives should not be done by the teacher alone; the entire process should involve the client to be sure that the plan is focused on the individual client's needs.

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

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

A nurse is preparing to teach a patient with asthma how to use his inhaler. Which teaching method would be the BEST choice to teach the patient this skill? a. Demonstration b. Lecture c. Discovery d. Panel session

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

A client is meeting with the nurse to discuss options for smoking cessation. Which statement by the nurse is most appropriate for this client? a) "I think you should just go cold turkey." b) "What do you see as your biggest hurdle to stopping?" c) "Reduce your stress and it will be easy." d) "Did you know that smoking can cause lung cancer?"

b) "What do you see as your biggest hurdle to stopping?" When counseling a client, the focus should be on assisting the client to make his own decisions, finding ways to reach goals, and supporting the client. The nurse should never give advice. Asking open-ended questions that encourage the client to speak freely about the topic at hand and help define goals is the best option.

A nurse is documenting assessment data for a new client. What is the best source of assessment information for the nurse? a) Physician b) Client c) Nursing plan of care d) Family and friends

b) Client The best source of assessment information for the nurse is the client. Nursing care is individualized to the needs of the client. In emergency situations, other sources might be used, such as family and friends. The physician would not be a source of assessment information. The focus of the health care provider and the nurse would differ, making the information gathered not complete for the development of the plan of care. The nursing plan of care would be developed from the assessment data and would not be a source of assessment data directly.

A nurse is discussing the benefits of smoking cessation with a client. The nurse informs the client that smoking cessation will reduce his risk for cancer, improve his respiratory status, and enhance the quality of his life. The nurse also shares her story of smoking cessation, provides information on other individuals who have successfully quit, and encourages the client to attend a support group for smoking cessation. The client discusses his feelings on smoking cessation and verbalizes a desire to quit smoking. What type of counseling did the nurse provide to this client? a) Long-term counseling b) Motivational counseling c) Situational counseling d) Developmental counseling

b) Motivational counseling Motivational counseling involves discussing feelings and incentives with the client. Long-term counseling extends over a period of time. Developmental counseling occurs when a client is going through a developmental stage or passage. Situational counseling occurs when a client faces an event or situational crisis.

The nurse is conducting a community health promotion class and has developed scenarios that will involve active participation by the class attendees. What type of education strategy is the nurse incorporating into her class? a) Programmed instruction b) Role-playing c) Role modeling d) Panel discussion

b) Role-playing Role-playing allows the learner to experience, relive, or anticipate an event. The nurse explains the scenario and then allows the individual to play out the scene. Role modeling involves a nurse's behaviors and the client observing and learning from these behaviors. Programmed instruction incorporates the use of books as the instructor, independent of study with a teacher. A panel discussion involves a presentation of information by two or more people.

A Chinese client who was previously treated at the health care facility for an open wound has been admitted again because the wound has become gangrenous. It has been identified that the client failed to understand proper wound care. What is the probable reason for the client failing to understand the instruction? a) The client is a passive learner. b) The client belongs to a different culture. c) The client is not interested. d) The client has a short attention span.

b) The client belongs to a different culture. The probable reason for the client failing to follow proper care for the wound could be that the client belongs to a different culture. As a result, he failed to understand the language in which the nurse imparted the instructions. If the client is a passive learner or has short attention, he would have retained at least part of the instructions. The client being uninterested is also not a reason for his not understanding the instructions.

While applying dressings to a client's wound, the nurse teaches the client about his wound care. To promote the most effective teaching-learning relationship with this client, what would be most important for the nurse to keep in mind? a) Nurses are experts who generously bestow knowledge upon clients. b) The nurse and client relationship is based on mutual sharing and negotiation. c) Nurses barter knowledge of medication with the client for compliance. d) Nurses have control over the client because of their knowledge and expertise

b) The nurse and client relationship is based on mutual sharing and negotiation. When providing nursing care, the teaching-learning relationship between the nurse and client is special, characterized by mutual sharing, advocacy, and negotiation. Effective learning occurs when clients and health care professionals are equal participants in the teaching-learning process. Unlike some traditional views, nurses are not experts who generously bestow knowledge upon clients, nor do they barter knowledge for compliance. Both images represent the relationship as a power imbalance in which nurses, because of their knowledge and expertise, control the situation.

An experienced nurse is educating a client about his disease and how best to promote his optimal health. The nurse is focusing the education on the cognitive domain of learning. The nurse would focus the education on: a) muscular movements. b) critical thinking. c) physical demonstration. d) emotions or feelings.

b) critical thinking. Cognitive learning refers to rational thought or critical thinking. Affective learning is influenced by emotions or feelings. Pychomotor learning refers to the muscular movements learned to perform new skills and procedures; for example, when a mother successfully and independently breast-feeds her infant, she has physically demonstrated psychomotor learning.

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

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

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

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

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

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

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

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

A nurse has taught a patient with diabetes how to administer his daily insulin. How should the nurse evaluate the teaching-learning process? a. By determining the patient's motivation to learn b. By deciding if the learning outcomes have been achieved c. By allowing the patient to practice the skill he has just learned d. By documenting the teaching session in the patient's medical record

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

When caring for a client at the health care facility, the nurse observes that the client is having difficulty understanding the health education. Which action is most appropriate? a) Delegate the health education to a colleague. b) Replace one-on-one teaching with written materials. c) Assess for cultural differences. d) Boost the morale of the client.

c) Assess for cultural differences. When the client is having difficulty learning, it may be possible that the client does not understand the language that the nurse speaks. In such a case, the nurse should take the necessary steps to break the cultural barrier and then proceed with the education. Written materials can enhance many clients' learning, but will not necessarily overcome many of the common barriers to understanding, including cultural and linguistic factors. The nurse should take action to overcome any barriers to the learning process before delegating to a colleague.

Which learning domain is the focus for instruction when the nurse educates a new mother about the breast and its role in milk production for feeding the newborn? a) Behavioral b) Affective c) Cognitive d) Psychomotor

c) Cognitive Educating a new mother about the physiology of the breast and its role in milk production is an example of cognitive learning.

A client has received a temporary ostomy during her treatment for colon cancer. Which technique is most likely to facilitate the client's ability to independently empty and change the ostomy after discharge? a) A brochure b) Discussion c) Demonstration d) Lecture

c) Demonstration Demonstration of a technique allows for cognitive, psychomotor, and affective learning to simultaneously take place. Lectures, brochures, and discussions can foster cognitive learning but have significant limitations in the psychomotor domain and, to a lesser degree, in affective learning.

When caring for a diabetic client, the nurse notes that the client learns better when he practices the self-administration of the insulin injection by himself. In which learning domain does this client's learning style fall? a) Interpersonal domain b) Affective domain c) Psychomotor domain d) Cognitive domain

c) Psychomotor domain Because the client learns better by practicing the self-administration of the insulin injection himself, his learning style falls in the psychomotor domain. The psychomotor domain is a style of processing that focuses on learning by doing. The client's learning style does not fall in the cognitive, affective, or interpersonal domain. The cognitive domain is a style of processing information by listening to, or reading, facts and descriptions. The affective domain is a style of processing that appeals to a person's feelings, beliefs, or values. The interpersonal domain is a style of processing that focuses on learning through social relationships.

A nurse is teaching patients of all ages in a hospital setting. Which examples demonstrate teaching that is appropriately based on the patient's developmental level? Select all that apply. a. The nurse plans long teaching sessions to discuss diet modifications for an older adult diagnosed with type 2 diabetes. b. The nurse recognizes that a female adolescent diagnosed with anorexia is still dependent on her parents and includes them in all teaching sessions. c. The nurse designs an exercise program for a sedentary older adult male patient based on the activities he prefers. d. The nurse includes an 8-year-old patient in the teaching plan for managing cystic fibrosis. e. The nurse demonstrates how to use an inhaler to an 11-year-old male patient and includes his mother in the session to reinforce the teaching. f. The nurse continues a teaching session on STIs for a sexually active male adolescent despite his protest t

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

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

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

Which response from the nurse allows the nurse to determine the effectiveness of a recent medication teaching session for an older adult client who is diagnosed with tuberculosis? a) "Will your relatives be here on time to give you your medications?" b) "It is okay to make mistakes, but not with your medications." c) "Please call me when you are ready to take your medications." d) "Can you tell me how you are going to take this medication?"

d) "Can you tell me how you are going to take this medication?" "Can you tell me how you are going to take this medication?" is a form of feedback to confirm that the client has understood what has been taught. The other questions are less significant.

A nurse is showing an older adult client with severe diabetes the correct method of self- administering an insulin injection. What should be the nurse's comment if the client continues making mistakes when learning how to self-administer an insulin injection? Select all that apply. a) "Try to angle the syringe a little more this way." b) "You've just about figured out how to give yourself an injection." c) "It will be better if you ask someone responsible to administer the injection." d) "Lots of people have the same concern." e) "Why are you repeatedly holding the injection at the wrong angle?"

d) "Lots of people have the same concern.", b) "You've just about figured out how to give yourself an injection.", a) "Try to angle the syringe a little more this way." Many adults are intimidated by learning a new skill, so encouragement and praise almost always improve performance. Comments such as, "Lots of people have that same concern" will help the client to feel less isolated. Positive corrective feedback such as, "You've just about figured out how to give yourself an injection; now, angle the syringe a little more this way," acknowledges and reinforces learning accomplishments, but at the same time provides significant correction to facilitate a better performance. Negative comments such as, "Why are you repeatedly holding the injection at the wrong angle?" or "It will be better if you ask someone responsible to administer the injection," will only make the client feel more nervous and intimidated.

A nurse is trying to encourage a client with paraplegia, who is depressed and not adhering to his treatment program, to join a support group. What would be most appropriate for the nurse to do when attempting to modify the client's attitude? a) Aggressively work to change the client's current viewpoint. b) State emphatically that the nurse is the one who knows what is correct. c) Emphasize that the client's views and thoughts are misguided and skewed. d) Acknowledge the client's ability to accept or reject suggestions.

d) Acknowledge the client's ability to accept or reject suggestions. The nurse should acknowledge the client's ability to accept or reject the material in order to empower the client and lead to more healthy decision making. Although frustrating, the choice to follow suggestions in the end is the client's and the nurse must respect it as such. The nurse who states emphatically that she is correct and that the client's views are misguided and skewed loses all credibility and influence. The nurse should be nonjudgmental, nonthreatening, and need not be more assertive than the client. However, the nurse should listen carefully to what the client values and work from there.

A client states to the nurse, "I understand that I need a mastectomy for the treatment of my breast cancer, but I am fearful of learning about the drains I will need to empty." This is an example of what kind of learning? a) Psychomotor learning b) Cognitive learning c) Behavioral learning d) Affective learning

d) Affective learning Affective refers to emotions or feelings. Affective learning changes beliefs, attitudes, or values.

A female adolescent is being taught about changing her abdominal dressing as part of the education for her care at home. When she removes the dressing, she becomes tearful when she sees her surgical incision. What knowledge deficit is best to address for this client at this moment? a) Infection related to surgical incision b) Self-care deficit secondary to surgical incision c) Pain related to surgical incision d) Altered body image related to surgical incision

d) Altered body image related to surgical incision There are few data to support infection, lack of self-care, or pain at this time. The client is attempting to learn about her dressing change and the nurse observes that she becomes emotional at the sight of her surgical incision. By opening the discussion about altered body image, the nurse can teach about the healing process. This may help alleviate some of the fears about physical changes.

The nurse is assisting a male client 55 years of age to understand the anatomy and physiology of the heart following a heart attack. What type of learning is taking place? a) Pedagogy b) Affective c) Psychomotor d) Andragogy

d) Andragogy Andragogy is the art and science of helping adults learn.

The nurse has educated the client on the pathophysiology of osteoarthritis and degenerative joint disease. This is an example of what learning theory? a) Behavioral learning theory b) Adaptive learning theory c) Developmental learning theory d) Cognitive learning theory

d) Cognitive learning theory Cognitive learning theory is the result of people wanting to make sense of the world around them by assimilating and processing information to gain new understandings and insights.

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

d) Find out what the client wants to know. Finding out what the client wants to know helps the nurse in showing personal interest, which facilitates better learning to an adult client. Dividing information into manageable amounts, providing an environment that promotes learning, and identifying how long the education session will last can be done only when the assessment of the client is completed.

A female client has recently been diagnosed with early-stage Alzheimer's disease and her husband has asked the nurse to recommend Web sites that may supplement his learning about her diagnosis. How should the nurse respond to the husband's request? a) Provide the husband with print-based materials that are clearly referenced and reflect his learning style. b) Direct the husband to online databases such as the Cumulative Index to Nursing and Allied Health Literature (CINAHL) c) Encourage the husband to avoid online resources due to the unregulated nature of the Internet. d) Identify and recommend some credible Web sites appropriate to his learning needs.

d) Identify and recommend some credible Web sites appropriate to his learning needs. Web-based resources can be a useful tool in client education, but suitability and accuracy need to be carefully considered. Many online databases exist for health professionals, but these are less likely to be accessible or appropriate for those outside the health professions

A nurse assisting a new mother in the act of breastfeeding is represented by which form of learning? a) Cognitive b) Affective c) Simplistic d) Psychomotor

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

A nurse evaluates whether a middle-age client with chronic back pain has been performing the different exercises and physiotherapy procedures recommended by the physician. What would the nurse most likely use to evaluate the client? a) Oral test b) Simulation c) Written test d) Return demonstration

d) Return demonstration The nurse is evaluating psychomotor skills; thus, a return demonstration is a method of testing skill performance. Written tests are time-consuming, intimidating, and not always specific to the client. Oral tests can be useful in testing cognitive learning. Simulation evaluates whether the client can apply learning in different situations, but not his ability to perform the exercises.

The nurse identifies which client response as a need for additional education? a) The client reports taking levothyroxine every morning with only water for 30 minutes. b) The client gives a return demonstration of cleaning the side of finger with alcohol before using lancet. c) Follow-up visit demonstrates a weight loss of 5 lb (2.3 kg) in 1 month. d) The client states, "I only have to worry about lowering the top number of my blood pressure."

d) The client states, "I only have to worry about lowering the top number of my blood pressure." Cleaning the side of the finger to check blood glucose, losing weight at a rate of 0.5 to 1 lb (0.23 to 0.45 kg) per week, and taking levothyroxine on an empty stomach with nothing but water for 30 minutes are all appropriate actions. The statement about worrying only about the systolic blood pressure indicates the client does not understand the diagnosis of hypertension.

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

d. This answer communicates respect and sensitivity to the patient's needs and offers an opportunity to discuss his feelings with the nurse or another health care professional. The other answers do not allow the patient to express his feelings and receive the counseling he needs.