NRS 222 CH 4 PREPU
What percentage of people older than 65 years of age has one or more chronic disease?
80 Explanation: Eighty percent of people older than 65 years of age have one or more chronic illness, and many are limited in their activity.
The nurse is providing discharge instructions to an elderly client. The nurse hands the client a paper about a new medication. The client cannot read. Learning does not occur. In this situation the nurse has failed to assess the
Appropriateness of teaching techniques Explanation: Teaching techniques and aids enhance learning if they are appropriate to the needs of the client. A client who cannot read will not be able to use a written report about a medication. Insufficient data are in the stem for the student to select the client's physical readiness, social and cultural patterns, and past experiences.
Which is an example of a direct measurement technique used to evaluate the teaching-learning process?
Behavioral observation Explanation: Direct measurement techniques include behavioral observation, checklists, and anecdotal notes to document the behavior. Client satisfaction surveys, attitude surveys, and oral questioning, and instruments that evaluate specific health status variables, are indirect measurements.
The nurse is planning to teach a client who was recently diagnosed with migraine headaches. It is best to teach the client
In a quiet room Explanation: Learning may be optimized by minimizing factors that interfere with the process. These factors include pain and fatigue, which are common during the headache recovery phase (which is immediately following a migraine). Also, the presence of visitors could interfere with learning. If family members are to participate in providing care, then learning sessions should be scheduled with family members present. A quiet room is appropriate to the learning situation.
Nonadherence to therapeutic regimens is a significant problem, especially in the elderly population. Nonadherence can lead to which outcome?
Increased cost of treatment Explanation: Nonadherence to therapeutic regimens is a significant problem for elderly people, leading to increased morbidity, mortality, and cost of treatment. There is an increasing rate of nonadherence among persons with chronic illness. Elderly people may also have problems that affect adherence to therapeutic regimens, such as the side effects of medications and financial constraints.
A current trend in health education that significantly influences nursing practice is:
Increased emphasis on patient involvement in their own care. Explanation: Much of the core of health education today is focused on increasing patient involvement and accountability for their care and treatment plans. Health education programs are often designed as patient safety initiatives and are geared toward encouraging increased communication between patients and care providers.
The nurse is assessing a family parented by a 60-year-old grandmother and her three school-age grandchildren. The nurse is aware that which problem may occur in a single-parent family at a greater level than in other types of families?
Increased financial concerns Explanation: Many single parent families are headed by women. Single parents often have special problems and needs, including financial concerns and role shifts (i.e., having the roles of both parents). Single-parent families are not less knowledgeable about child safety than other family types, nor is there a higher incidence of child abuse, neglect, or conflict among family members.
The nurse is providing information to a client about the safe use of a newly prescribed medication. The first question the nurse should ask is
Is the client ready to learn? Explanation: The nurse follows the nursing process when teaching a client. Probably the most important and first factor to assess is the client's readiness to learn. The other options are also components of the nursing process. The question what is the expected outcome is the goal of the nursing process. The use of teaching aids is part of the implementation process. Evaluating learning is the evaluation component of the nursing process.
A patient with a visual impairment would benefit from which of the following teaching strategies?
Magnifying lenses Explanation: A visually impaired patient would benefit from the use of optical devices, such as a magnifying lens. A hearing-impaired patient would benefit from the use of sign language, telecommunication devices, and captioned videos.
Which of the following is an example of adherence to treatment? Select all that apply.
Maintaining a healthy diet Self-monitoring for signs and symptoms of illness Taking prescribed medications Increasing daily activities Explanation: Examples of behaviors facilitating health include taking prescribed medications, maintaining a healthy diet, increasing daily activities and exercise, self-monitoring for signs and symptoms of illness, practicing specific hygiene measures, seeking recommended health evaluations and screening, and performing other therapeutic and preventative measures. Inability to comply with follow-up appointments is not an example of adherence to treatment.
When a person works to prevent relapse and to sustain the gains made from actions taken, he or she is in which stage of the Transtheoretical Model of Change?
Maintenance Explanation: A person is in the maintenance stage of the Transtheoretical Model of Change when there is work to prevent relapse and to sustain the gains made from the actions taken.
A nurse is providing feedback to a client who demonstrates how to use an incentive spirometer. What primary role does feedback have in the adult learning process?
Motivates learning Explanation: Feedback about progress motivates learning. This feedback should be presented as positive reinforcement when the learner is successful, and in the form of constructive suggestions when learning is not successful. Self-esteem may improve as the client increases knowledge; however, this is not the primary role that feedback has on the adult learning process. Decreased client questioning does not necessarily equate to enhanced learning. While effective feedback may enhance the nurse-client relationship, this is not the primary role feedback has in the adult learning process.
Which factor is a leading health indicator used to measure the health of the nation?
Overweight and obesity Explanation: Leading health indicators used to measure the health of the nation include overweight and obesity, physical activity, and mental health. Intelligence, cultural awareness, and religion are not leading health indicators.
A nurse developed a program of increased ambulation for a patient with an orthopedic disorder. This goal setting is a component of the nursing process known as:
Planning Explanation: Once assessment data are collected, the next step is to plan the teaching intervention, which begins with specifying immediate, intermediate, and long-term goals.
A nurse is preparing teaching for a client with an auditory perceptual disorder. Which educational strategy will be most effective?
Repeat and reinforce words frequently. Explanation: When caring for a client with an auditory perceptual disorder, the nurse should repeat and reinforce words frequently. Explaining important information verbally may not work the best for a client with an auditory perceptual disorder. A client with a visual impairment should have noises explained. Nurses should avoid medical terminology with clients that have a cognitive disability.
A nurse is evaluating a client's motivation to make decisions that promote healthy behavior change, using the transtheoretical model of change. Which description best describes the decision making stage of this model?
The client constructs a plan to change behavior. Explanation: In the decision making stage of the transtheoretical model of change, the client constructs a plan to change behavior. The contemplative stage is when the client is thinking about change in the near future. The action stage is when the client takes steps to put the plan into action. The maintenance state is when the client works to sustain gains made from actions taken.
The nurse develops outcome criteria for a patient with chronic obstructive pulmonary disease. Which outcome criteria are appropriate for this patient?
The patient will have the ability to climb a flight of stairs without experiencing difficulty in breathing. Explanation: Outcomes of teaching strategies can be stated in terms of expected behaviors of patients, families, or both. Outcomes should be realistic and measurable, and the critical time periods for attaining them should be identified. The desired outcomes and the critical time periods serve as a basis for evaluating the effectiveness of the teaching strategies.
The nurse is providing preoperative information about hip replacement to a group of clients scheduled for this surgery. One of the clients is slightly hearing impaired. What is the best action of the nurse?
Use a model of the hip. Explanation: For those people who have a hearing impairment, teaching strategies include using visual aids, such as models. The nurse should not speak louder, but should use normal or lower pitch to the voice and position himself or herself so that the clients can see mouth movement.
Which action would be incorporated in a teaching strategy for a hearing-impaired client?
Use of slow, directed, and deliberate speech Explanation: When teaching clients with a hearing impairment, the nurse should use slow, directed, and deliberate speech. Use of large-print materials and arrangement of materials in a clockwise position would be used for clients with a visual impairment. Demonstrating information and having the person perform a return demonstration would be appropriate for a person with a developmental disability.
The nurse is developing a teaching plan. What variables significantly influence non-adherence to a prescribed regimen? Select all that apply.
personal attitudes self-concept social support emotional make-up Explanation: Personal attitudes, self-concept, social support, and emotional makeup have been found to affect non-adherence to therapy. Race and ethnicity have not consistently been found to significantly affect non-adherence to prescribed therapy unless they are associated with low income or low literacy skills.
The termination stage of the Transtheoretical Model of Change occurs when
the person has the ability to resist relapsing back to unhealthy behavior. Explanation: The termination stage of the Transtheoretical Model of Change occurs when a person has the ability to resist relapsing back to unhealthy behavior. Operationalizing a plan of action, constructing a plan to change behavior, and not thinking about making a change are not part of the termination stage.
Which factor refers to a client's experiential readiness to learn?
Educational history and life experience Explanation: Experiential readiness refers to past experiences that influence a client's ability to learn. Emotional readiness refers to the client's acceptance of an existing illness or the threat of an illness and its influence on the ability to learn. Physical readiness refers to the client's ability to cope with physical problems and focus attention on learning.
Which of the following is an example of a direct measurement technique for evaluation of the teaching--learning process?
Behavioral observation Explanation: Direct measurement techniques include behavioral observation, checklists, and anecdotal notes to document the behavior. Patient satisfaction surveys, attitude surveys, and oral questioning, and instruments that evaluate specific health status variables are indirect measurements.
The nurse is caring for a 33-year-old male client. Which clinical screening should the client have, based on his age?
Lipid panel Explanation: A lipid panel should be performed at age 20, then mutually determined by both the client and clinician. A baseline hemoccult screening and colonoscopy should occur at age 50. An electrocardiogram should be performed at age 40.
A community health nurse is organizing community training on healthy behavior change. Which action will the nurse focus on when using the transtheoretical model of change as guidance for the teaching?
Motivation of individuals Explanation: The transtheoretical model of change focuses on the motivation of an individual to make decisions that promote healthy behavior change. The Resource Model of Preventive Health explores the various resources of health. Determinants of health are explored in the Achieving Health For All health promotion initiative. Reasons for choosing healthy behaviors are explored in the Health Belief Model of health promotion.
Which phase of the nursing process encompasses the establishment of expected outcomes?
Planning Explanation: Planning encompasses specifying expected outcomes. Assessment is directed toward the systematic collection of data about the client's learning needs and readiness to learn. In the implementation phase, the client, the family, and the members of the nursing and health care teams carry out activities outlined in the teaching plan.
A 27-year-old client is a regular smoker, has diabetes, and has been diagnosed with hypertension. The client says it is cumbersome and time consuming to visit the doctor regularly just for a blood pressure check. Which aspect of teaching would the nurse use with this client?
Suggest the client purchase a self-monitoring cuff Explanation: Because this client finds it time consuming to visit the health care provider just for a blood pressure reading, the nurse can suggest the client use an automatic cuff at a local pharmacy or purchase a self-monitoring cuff. Discussing methods for stress reduction, advising a smoking cessation, and applying glycemic control would constitute client education in managing hypertension.
The school nurse informs the mother of a second-grade student that lice were found in the child's hair. The mother explains to the nurse that she has another child to pick up and cannot stay to receive education related to the treatment of lice at this time. The mother reassures the nurse that she will "look up treatment options on the Internet and take care of the child." What would be the best action of the school nurse in this situation?
Provide the mother with a list of credible websites related to the treatment of lice Explanation: Providing the mother with a list of previewed websites related to treating lice gives the mother trustworthy, credible, and timely information related to treatment options. Although assessing and treating the other children in the home is indicated, it is more important to direct the mother to accurate information related to the treatment of lice. The nurse should perform routine hand hygiene; washing the classroom is not indicated. The presence of lice does not warrant a referral to the social worker or child protective services.
Normal aging results in changes in cognition. Therefore, when teaching an elderly patient how to administer insulin, the nurse should:
Repeat the information frequently for reinforcement. Explanation: Effective teaching strategies, especially for an older patient, should include a slow-paced presentation of small amounts of material; frequent repetition of information; and the use of reinforcement techniques, such as audiovisual and written materials and repeated practice sessions. Teaching strategies to accommodate decreased visual acuity include large-print and easy-to-read materials printed on non-glare paper. Teaching strategies to maximize hearing include speaking distinctly with a normal or lowered pitch and facing the person so that speech reading can occur as needed.
The nurse establishes a learning contract with an overweight client. The contract is best if it
includes an incremental goal of 1-2 pound weight loss this week Explanation: The learning contract is recorded in writing. It is to be clear and describe what is to be achieved. A well-balanced diet is too vague. The nurse provides frequent and positive reinforcement as the client moves from one goal to the next. It is easier for the client to achieve a smaller, obtainable goal, such as 1-2 pound weight loss in one week, versus 30 pounds in 6 months.
Select the nursing action that is least likely to motivate a person to learn.
Emphasis on negative outcomes as a method to prevent learning incorrect practices Explanation: Successful learning is associated with positive encouragement and feedback, a comfortable learning environment, and realistic learning outcomes that an individual can understand and embrace.
Choose the nursing statement that would best reflect the final component of the "Ask-Tell-Ask-Close" technique of communication and demonstration.
"Can you repeat for me the information I just reviewed about weighing food portions?" Explanation: The last component to the "Ask-Tell-Ask-Close" communication technique is "Close the Loop." This component recommends asking the patient to restate the information as the patient understands it.
A client and his spouse are in the client's hospital room. The spouse says to the nurse, "I looked up one of the new drugs on the Internet, gabapentin. It said it is for seizures. My husband has never had a seizure." Which would be a therapeutic response by the nurse?
"Gabapentin can also be used for leg pain associated with diabetes." Explanation: The therapeutic response by the nurse is to provide education related to the spouse's question. By providing education the nurse is facilitating informed decision making on part of the client and the family. Teaching is an independent function of the nurse. It is certainly within the responsibility of the nurse to discuss the method of action of the client's medications with the spouse. This is part of patient teaching and if the client is aware, it is not a HIPAA violation.
Which statement made by the client indicates understanding of the Centers for Disease Control and Prevention and U.S. Preventive Services Task Force recommendation for prostate screening frequency?
"I will see you next year for my prostate exam." Explanation: Prostate examinations should be done yearly. PSA levels are assessed every 2 years after age 50. Colonoscopy examinations are every 5 years.
A client has been reporting regularly to the health care unit for blood pressure monitoring. The health care provider diagnoses the client with essential hypertension after analyzing the readings over two or more sessions. What options will the nurse use to inform the client about next steps for blood pressure care? Select all that apply.
Advise the client to begin an exercise regimen based on the approval of the health care provider. Ask the client to follow a diet that is low in saturated fats and sodium and high in fiber. Advise the client to purchase a self-monitoring cuff or use an automatic cuff at a local pharmacy. Educate the client about the correct position to measure blood pressure, as the position may affect readings. Explanation: Nurses play a vital role in the management of clients with hypertension. The nurse is an educator and provides the essential tools for the client to manage hypertension to prevent complications. First and foremost, information must be provided to the patient about the importance of lifestyle changes, such as smoking cessation, exercise, diet, stress reduction, and alcohol moderation. Information about the importance and technique of blood pressure monitoring is important but takes place after the nurse informs the patient about lifestyle changes. The client will need more frequent follow-up than once a year.
A home health care nurse who works in a low- income community assesses the risk factors for patients being serviced. What is an example of a community risk factor?
Children are kept inside the home on a sunny summer day because of lack of recreational opportunities. Explanation: A key component of the question is the term community. The most basic definition of a community is a specific population or group of people living in the same geographic area under similar regulations and having common values, interests, and needs. The only option above that addresses community is where children are kept inside the home on a sunny summer day because of lack of recreational opportunities. Each of the other options are focused on individuals which is not the direction of the question.
Which stage of the transtheoretical model occurs when the patient has serious consideration of change, but it is sometime in the future?
Contemplation Explanation: In the contemplation stage, the patient has serious consideration of change, but it is sometime in the future. When the patient is not considering any change in behavior in the next 6 months, he or she is in the precontemplation stage. During the action stage, concrete activities that lead to the desired change have been made for less than 6 months. During the maintenance stage, active efforts to sustain the changes made for more than 6 months.
A community health nurse is preparing learning materials for an upcoming public seminar for adults. What factors will the nurse consider, based on applying concepts of adult learning readiness? Select all that apply.
Culture Personal values Physical status Emotional status Explanation: One of the most significant factors of an adult's ability to learn is the individual's learning readiness. Learning readiness is based on the individual's culture, personal values, physical and emotional status, and previous experiences in learning. Teaching style is important in the learning process; however, it is not what learning readiness is based on.
A nurse is aware of both the importance of health education and the fact that it is an independent function of nursing practice. Under which of the following circumstances should a nurse consider providing health education?
During each contact that the nurse has with a health care consumer Explanation: Every contact an individual nurse has with a health care consumer, whether or not that person is ill, should be considered an opportunity for health teaching. Health education should not be limited to specific orders in care plans, diagnoses that are likely to resolve, or nurses who have advanced practice designations.
Which of the following teaching strategies may be used with a patient diagnosed with a developmental disability? Select all that apply.
Encourage active participation. Use nonverbal cues as needed. Use simple explanations. Demonstrate information followed by return demonstration. Explanation: Those with a developmental disability would benefit from active participation, use of nonverbal cues as needed, simple explanations, and a demonstration of information followed by return demonstration. Information and teaching should be based on developmental age, not chronologic age.
Which step of the nursing process determines whether the client understands the health teaching that is provided?
Evaluation Explanation: Evaluation includes observing the client, asking questions, and then comparing the client's behavioral responses with the expected outcomes. Assessment includes determining the client's readiness regarding learning. Planning includes identification of teaching strategies and writing the teaching plan. Implementation is the step during which the teaching plan is put into action.
A client with a cognitive disability needs discharge instructions prior to leaving the hospital. Which educational strategy will the nurse implement that will best promote learning for this client?
Give clear, written information. Explanation: A client with a cognitive disability should receive clear, written or verbal information. The other answer choices may work for this client; however, they are not specific to clients with cognitive disabilities.
A nurse is evaluating education provided to various clients being discharged to home. The nurse assesses that client most likely to be nonadherent with treatment is the one who
Has tuberculosis and is taking multiple antitubercular medications Explanation: Client adherence is low when the treatment plan is complex or of long duration. The client with tuberculosis will take multiple antitubercular medications for 9 to 10 months. The other clients are experiencing disturbances and treatments of short duration.
The nurse is teaching a client with diabetes how to perform checks of blood glucose level. To optimize learning, it is best for the nurse to
Have the client return demonstrate. Explanation: All the options will be included in a teaching program regarding blood glucose monitoring. The nurse should provide the client ample opportunity for practice. Having the client demonstrate the skill will ensure that the client has learned the procedure.
Which health promotion model does the nurse identify is the reason some people choose actions to foster health and others refuse to participate?
Health Belief Model Explanation: The Health Belief Model was designed to foster understanding of why some healthy people choose actions to prevent illness while others do not. Another model, the Resource Model of Preventive Health Behavior, addresses the ways in which people use resources to promote health (Pender et al., 2011). It is based on social learning theory and emphasizes the importance of motivational factors in acquiring and sustaining health promotion behaviors. The Canadian health promotion initiative, Achieving Health for All, builds on the work of Lalonde (1977), in which four determinants of health—human biology, environment, lifestyle, and the health care delivery system—were identified. Determinants of health were defined as factors and conditions that have an influence on the health of individuals and communities.
There are many goals for health teaching. Which of the following is the primary goal of family and patient education?
Improve patient outcomes Explanation: The primary goal of patient and family education is to achieve, improve, or alter behaviors that directly or indirectly change and improve patient outcomes.
The home health nurse is planning teaching for a client with COPD and a history of noncompliance to the medication regimen. Which factor does the nurse recognize as having the most influence on enabling complete adherence to a health regimen?
Motivation Explanation: The most influential factor that enables complete adherence to a health regimen is client motivation. The client's self-esteem, the cost of medication, and the client's level of education may influence a client's motivation, but these are not the most influential.
A nursing student observes the home care nurse provide education to a client with congestive heart failure (CHF). The nurse teaches the client how to read food labels and calculate sodium content. The nursing student recognizes that the home care nurse is aware of which basic principle of patient education?
Patient instruction related to self-care activities promotes patient independence Explanation: Teaching is a function of nursing to assist patients to alter lifestyle patterns that increase health risk. By teaching the client how to calculate sodium content of foods the nurse is facilitating independence in nutrition disease management. Patients have the right to decide whether or not to learn. Teaching is an independent function of nursing and does not require a physician's order. Teaching related to food labels in the patient home is an appropriate environment for this client. The nurse can use actual foods from the patient's kitchen.
A hospitalized client reports right lower quadrant abdominal pain at a level of 8 on a 0 to 10 scale. The client is scheduled for an appendectomy. The nurse is teaching the client about use of the incentive spirometer postoperatively verbally and by demonstration. The client is on his side, clutching his abdomen. Learning is not occurring. The nurse has primarily failed to consider the client's
Physical readiness Explanation: Physical readiness for learning is when the client is physically capable of learning. A client in acute pain cannot concentrate on learning. Insufficient data are in the stem to select emotional readiness, learning environment, or experiential readiness.
The home health nurse reviews a medication administration calendar with an elderly patient. In order to consider sensory changes that occur with aging, how should the nurse proceed?
Print directions in large, bold type, preferably using black ink. Explanation: Older adults frequently have one or more chronic illnesses that are managed with numerous medications and complicated by periodic acute episodes. Older adults may also have other problems that affect adherence to therapeutic regimens, such as increased sensitivity to medications and their side effects, difficulty in adjusting to change and stress, financial constraints, forgetfulness, inadequate support systems, lifetime habits of self-treatment with over-the-counter medications, visual and hearing impairments, and mobility limitations. To promote adherence among older adults, all variables that may affect health behavior should be assessed (Fig. 4-1).
Since normal aging results in changes in cognition, how should the nurse teach an elderly patient to administer insulin?
Repeat the information frequently for reinforcement. Explanation: Nurses must also consider that cognitive impairment may be manifested by the older adult's inability to draw inferences, apply information, or understand the major teaching points. It is important to allow ample time to learn and provide reinforcement. Follow-up sessions are imperative to promote the learner's confidence in his or her abilities and to plan for additional teaching sessions.
Based on the nurse's knowledge of nonadherence to therapeutic regimens, which nurse needs to place extra emphasis on adherence to the treatment plan?
The client with pneumonia who requires 1 week of oral antibiotics Explanation: Rates of adherence are generally low, especially when the regimens are complex or of long duration. One week of oral antibiotics has a higher likelihood of patient compliance. Nutritional education and compliance is long term and complex in nature; therefore, it entails a high risk for noncompliance. The 9-month duration of isoniazid therapy places this client in the high-risk category for noncompliance. Hemodialysis is long term and complex in nature; therefore, the client is at a high risk for noncompliance.
A nurse is teaching an older adult about a medication that the client will take at home. The nurse assesses which of the following factors as promoting adherence to the medication regimen?
The client's daughter is present and provides care to the client at home. Explanation: Older adults may have problems that affect adherence to medication regimens. An adequate support system, such as involvement from family members, will assist with adherence. Hearing impairment, lack of financial resources, and forgetfulness are factors that will negatively affect client adherence.
The termination stage of the Transtheoretical Model of Change occurs when:
The person has the ability to resist relapse back to unhealthy behavior. Explanation: The termination stage of the Transtheoretical Model of Change occurs when a person has the ability to resist relapse back to unhealthy behavior. Operationalizing a plan of action, constructing a plan to change behavior, and not thinking about making a change are not parts of the termination stage.
A nurse is planning a smoking-cessation program for a client and incorporates stages from the Transtheoretical Model of Change in the program. For the client to be successful, the client follows the stages in this order from steps 1 to 5:
Thinks about smoking cessation Makes a plan to cease smoking Takes steps to stop smoking Works to prevent relapse of smoking Resists relapsing into smoking Explanation: There are six stages in the Transtheoretical Model of Change, which is also known as the Change Model. The first stage is precontemplative, in which the client is not thinking about making a change. The second stage is contemplative--here, the client is thinking about making a change in the near future. The next stage is decision making, in which the client develops a plan to change behavior. The fourth stage is action. The client initiates the plan of action. The fifth stage is maintenance. The client works to prevent relapse and to sustain the gains made from previous actions taken. The final stage is termination. The client has the ability to resist relapse back to unhealthy behaviors.
