NUR302 - Ch. 4: Health Education and Promotion

According to the American Academy of Family Physicians, prostate examination should be done at what interval?

Yearly Prostate examinations should be done yearly.

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?" 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 middle-aged female client is overweight and sedentary, has slightly elevated blood pressure, and is seeking ways to begin exercise. The client wishes to lose weight and improve her blood pressure. The nurse plans an exercise program in which the client

Walks for 30 minutes three times this week and is re-evaluated Exercise should be individualized, started gradually, and increased slowly based on the client's response. The option in which the client walks for 30 minutes and is re-evaluated best meets these criteria. Exercise needs to be realistic and cost effective. The other options are not realistic for someone who has been sedentary, nor are they cost effective.

Which statement by the client indicates the client's experiential readiness to learn?

"Do you have a video about my disease? I don't like to read." 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.

The termination stage of the Transtheoretical Model of Change occurs when:

the person has the ability to resist relapsing back to unhealthy behavior. 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.

A client has been reporting regularly to the health care unit for blood pressure monitoring. The physician diagnoses the client with essential hypertension after analyzing the readings over two or more sessions. Which options would the nurse use first to inform the patient about next steps? Select all that apply.

- Advise the client to begin an exercise regimen based on the approval of the physician. - Inform the client about the various methods that are available to assist with smoking cessation. - Ask the client to follow a diet that is low in saturated fats and sodium and high in fiber. Nurses play a vital role in the management of patients with hypertension. The nurse is an educator and provides the essential tools for the patient 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.

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. 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.

The nurse is teaching a client how to self-administer insulin. The client inserts the needle into the abdomen, aspirates, and injects the insulin. What action will the nurse take? Select all answers that apply.

- Redemonstrate the correct technique. - Acknowledge positive aspects of the technique. Feedback to the client should be positive when the client is successful. The nurse should offer constructive suggestions for improvement when the cient is unsuccessful. The nurse redemonstrates the skill and acknowledges positive aspects, because the client did perform part of the skill correctly. The client is not ready to perform the skill independently. The nurse does not point out only negative aspects.

Which is an example of a direct measurement technique used to evaluate the teaching-learning process?

Behavioral observation 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 planning component of the teaching-learning process is organized in a sequential manner. Which of the following is the first step for the nurse?

Develop the planned goals for the learning outcome. The first step is to develop the plan and goals. This is necessary to identify specific teaching strategies. The third step would be to specify outcomes followed by documentation.

What does the nurse understand is the single most important factor in determining health status and longevity?

Good nutrition It has been suggested that good nutrition is the single most significant factor in determining health status, longevity, and weight control.

The nurse is preparing to teach a client about a newly prescribed medication. The client lacks insurance. The medication costs approximately $100 per month. The client states, "I can't afford it." The nurse assesses a variable to successful education and health promotion for this client based on the Health Belief Model is

Resources The Health Belief Model is based on the premise that four variables influence health promotion behaviors. Resources address finanical and social behaviors. Demographics and disease factors include client age, gender, education, employment, severity of illness or disability, and length of illness. Barriers are factors that lead to unavailability or difficulty in gaining access to a health promotion alternative. Perceptual factors are how a client views his health status, self-efficacy, and the perceived demands of the illness.

When providing discharge instructions, the nurse recognizes that which client is most likely to comply with the therapeutic treatment regimen?

The client with pneumonia who requires 1 week of oral antibiotics 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.

The termination stage of the Transtheoretical Model of Change begins when which action occurs?

The person has the ability to resist relapsing back to unhealthy behavior 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

Which is an example of a behavior that facilitates health?

Self-monitoring for signs and symptoms of illness Common examples of behaviors facilitating health include self-monitoring for signs and symptoms of illness, increased daily activities and exercise, and taking prescribed medications.

A 35-year-old client with a developmental age of 10 years is being taught to take medication every morning. The nurse assesses that the client brushes his teeth every morning. For learning to occur, which of the following techniques should the nurse employ? Select all answers that apply.

- Use simple explanations. - Repeat information frequently. - Encourage the client to take the medication after brushing his teeth. - Look directly at the client when speaking. Teaching is to be at the client's developmental level. The nurse uses simple explanations, repeats information often, and looks at the client during teaching. The nurse instructs the client to have a cue (eg, brushing the teeth) to take his medication. Written material at the 8th-grade reading level is too high a level for this client.

Which of the following is the goal of patient and family education?

Improvement of patient outcomes The goal of patient and family education is to improve patient outcomes. Teaching is an integral tool that all nurses use to assist patients and families in developing effective health behaviors and in altering lifestyle patterns that predispose people to health risks.

Which of the following is a nursing diagnosis related to health education?

Ineffective health maintenance Diagnoses related to health education may include ineffective health maintenance, health-seeking behaviors, deficient knowledge, and readiness for enhanced knowledge. The other nursing diagnoses do not related to health education.

The nurse develops a program of increased ambulation for a patient with an orthopedic disorder. This is an example of what component of the nursing process?

Planning The entire planning phase concludes with the formulation of the teaching plan.

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 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.

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 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.

A patient with a visual impairment would benefit from which of the following teaching strategies?

Magnifying lenses 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.

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. 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.

A nurse is teaching a client taking digoxin about checking the pulse rate daily. The client counts her radial pulse as 64 beats/min. The nurse counts at the same time and assesses the rate as 58 beats/min. When evaluating response to treatment, the nurse would chart that the client

Requires another opportunity for practice The nurse needs to provide the client with ample opportunity for practice. Only one option represents this answer. The client did not demonstrate adequate knowledge in counting the radial pulse. She would have taken digoxin based on the pulse rate she counted. Insufficient data support that the client cannot learn the skill. Having a family member perform the skill does not ensure it will be done correctly.

Health education is an important part of nursing practice. When challenged with the many needs of patients, families, and communities, the nurse should always remember that the most important nursing responsibility is to:

Stimulate the person's desire to learn. An individual must be motivated to learn, otherwise it makes no difference what is taught, at what time, or where. Without learner receptivity, health teaching cannot be effective.

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 nurse planning to teach adults aged 65 about congestive heart failure management Eighty percent of people older than 65 years of age have one or more chronic illness, and many have limited activity. These chronic illnesses may be managed with numerous medications and complicated by periodic acute episodes, making adherence to a regimen difficult. Problems of teenagers generally are time-limited and specific and require promoting adherence to treatment in order to return to health. In general, the compliance of children to a regimen depends on the compliance of their parents. Middle-aged adults, in general, have fewer health problems, thus promoting adherence to a regimen.

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. 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.

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." Prostate examinations should be done yearly. PSA levels are assessed every 2 years after age 50. Colonoscopy examinations are every 5 years.

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 Once assessment data are collected, the next step is to plan the teaching intervention, which begins with specifying immediate, intermediate, and long-term goals.

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 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.

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. The best action of the nurse is to

Use a model of the hip. For those people who have a hearing impairment, teaching strategies include using visual aids, such as models. The nurse is to use normal or lower pitch to the voice and position himself or herself so that the clients can see mouth movement.

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 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.

The nurse is performing discharge teaching for an elderly client with mild visual impairment. The nurse provides written instructions with large print and highlighted parts. The nurse also sits near the client, faces the client, and speaks in a lower-pitched voice. When the client arrives home, the client has difficulty following instructions. The nurse erred in teaching by

Providing written instructions that are highlighted The client is experiencing mild visual impairment, which may include difficulty with color discrimination. Highlighting material may not be effective for the client. The other actions by the nurse (providing written instructions in large print, sitting near the client, facing the client, and speaking in a lower-pitched voice) are appropriate interventions that would enhance learning.

Which stage of the transtheoretical model occurs when the patient has serious consideration of change, but it is sometime in the future?

Contemplation 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.

Which action by the nurse can negatively affect the patient's ability to learn?

Negative criticism when the patient is unsuccessful so that inappropriate behavior patterns will not be learned A well-designed learning contract is realistic and positive. In a typical learning contract, a series of measurable goals is established, beginning with small, easily attainable objectives and progressing to more advanced goals. Frequent, positive reinforcement is provided as the person moves from one goal to the next. For example, incremental goals such as weight loss of 1 to 2 pounds (0.45 to 0.9 kg) per week are more appropriate in a weight reduction program than a general goal such as a 30-pound (13.6 kg) weight loss.

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. 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.

Therapeutic touch should be used in which situation?

When a client is sensory deprived A nurse uses affective touch therapeutically in many situations, including when a client is sensory deprived. One of the therapeutic uses of silence is to encourage a patient's verbal communication. Other therapeutic uses of silence include providing a personal presence and a brief period during which patients can process information.

A current trend in health education that significantly influences nursing practice is:

Increased emphasis on patient involvement in their own care. 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 educating the client about management of diabetes. An inappropriate statement by the nurse is

"Checks of blood glucose level are to be done ac and hs." When providing education, the nurse is to give clear information and avoid the use of medical terminology or "jargon" as in ac and hs.

Which item is considered the single most important factor in assisting the health professional in arriving at a diagnosis or determining the client's needs?

History of present illness The history of the present illness is the single most important factor in assisting the health professional in arriving at a diagnosis or determining the client's needs. The physical examination is helpful but often only validates the information obtained from the history. Diagnostic test results can be helpful, but they often only verify rather than establish the diagnosis. Biographical information puts the health history in context but does not focus the diagnosis.

Which of the following would be incorporated as a teaching strategy for a hearing-impaired person?

Use slow, directed, and deliberate speech When teaching persons with a hearing impairment, the nurse should use slow, directed, and deliberate speech. Use of large print materials, arrangement of materials in a clockwise position would be used for persons with a visual impairment. Demonstrating information and having the person perform a return demonstration would be appropriate for a person with a developmental disability.

A 42-year-old client displays symptoms that indicate a risk for developing hypertension. Which immediate measures would the nurse recommend?

Routine screening and follow-up appointments Because the client is at a risk for developing hypertension, routine screening is important for early detection. Follow-up appointments should be made if the client has an initial elevation in blood pressure in the physician's office. Lifestyle modifications for clients with newly diagnosed primary hypertension are recommended. If the client is diagnosed with hypertension, drug therapy can be administered, in addition to client teaching.

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? 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.

The nurse is preparing to educate a patient about the home care of an abdominal wound. What patient behaviors does the nurse notice that demonstrate readiness to learn? (Select all that apply.)

- The patient shows the motivation to learn. - The patient has accepted the therapeutic regimen. - The patient requests a contact number if there are questions. One of the most significant factors influencing learning is a person's learning readiness. For adults, readiness is based on culture, personal values, physical and emotional status, and past experiences in learning (Schumacher, 2011). The "teachable moment" occurs when the content and skills being taught are congruent with the task to be accomplished (Miller & Stoeckel, 2011).

Health education of a client by the nurse

is an independent function of nursing practice. Health education is an independent function of nursing practice and is included in all state nurse practice acts. Teaching, as a function of nursing, is included in all state nurse practice acts. Health education is a primary responsibility of the nursing profession. Health education by the nurse focuses on: promoting, maintaining, and restoring health; preventing illness; and assisting people to adapt to the residual effects of illness.

An example of a behavior that facilitates health includes

self-monitoring for signs and symptoms of illness. Common examples of behaviors facilitating health include self-monitoring for signs and symptoms of illness, increased daily activities and exercise, and taking prescribed medications.

Which factor refers to a client's experiential readiness to learn?

Educational history and life experience 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 a leading health indicator to be used to measure the health of the nation?

Overweight and obesity Leading health indicators to be 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 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." 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 phase of the nursing process of patient teaching ends when the strategies have been completed and when the patient's responses to the actions have been recorded?

Implementation The implementation phase ends when the teaching strategies have been completed and when the patient's responses to the actions have been recorded. Assessment in the teaching--learning process is directed toward the systematic collection of data about the person's learning needs and readiness to learn, as well as the family's learning needs. Planning has to do with specifying the expected outcomes and assigning priorities to the diagnoses. Evaluation determines how effectively the patient has responded to teaching and to what extent the goals have been achieved.

The nurse is administering a new medication to an elderly male client and begins instruction about the medication. The client states, "Tell my wife. She takes care of all this kind of stuff." The nurse replies

"When your wife comes in to visit, I will return and provide the information to both of you." Family members should be involved in teaching sessions when possible and appropriate. The client is giving permission with his statement to include his spouse. The statements by the nurse in Option a and Option d are nontherapeutic. Option c does not ensure learning about the new medication will occur.

A school nurse is developing a program about positive health practices for adolescents. The nurse includes information about

Self-esteem Programs to promote good health habits for adolescents include issues about self-esteem. Programs relating to blood pressure control, chronic diseases, and prenatal health are more appropriate for other age groups.

Through which action does the nurse demonstrate the step of the nursing process that determines whether the client understands the health teaching that is provided?

Watching a return demonstration of insulin administration from a client newly diagnosed with diabetes Evaluation includes observing the patient, asking questions, and then comparing the patient's behavioral responses with the expected outcomes. Observation of a return demonstration is a form of evaluation. Assessment includes determining the patient's readiness regarding learning. Planning includes identification of teaching strategies, writing the teaching plan, and setting goals of the teaching strategies. Implementation is the step during which the teaching plan is put into action.

Which of the following is an example of a direct measurement technique for evaluation of the teaching--learning process?

Behavioral observation 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.

Which of the following teaching strategies would benefit a patient with an output disability?

Use of hand gestures Teaching strategies for a patient with an output learning disability would benefit from the use of hand gestures and motions. Those with input disabilities may have success using audiotapes, computers, and modeling.

What percentage of people older than 65 years have one or more chronic disease(s)?

80 80% of people older than 65 years have one or more chronic illness, and many are limited in their activity.

What percentage of people older than 65 years of age has one or more chronic disease?

80 Eighty percent of people older than 65 years of age have one or more chronic illness, and many are limited in their activity.

What is the priority responsibility for the nurse providing patient teaching? (Select all that apply.)

- Determining individual needs for teaching - Motivating each person to learn - Presenting information at the level of the learner Nurses in their role as teachers are challenged to focus on the educational needs of communities and to provide specific patient and family education. Every contact a nurse has with a health care consumer, whether or not that person is ill or has a disability, should be considered an opportunity for health education. Although people have a right to decide whether or not to learn, nurses have the responsibility to present information that motivates people to recognize the need to learn. Therefore, nurses must use opportunities in all health care settings to promote wellness.

There are many goals for health teaching. Which of the following is the primary goal of family and patient education?

Improve patient outcomes The primary goal of patient and family education is to achieve, improve, or alter behaviors that directly or indirectly change and improve patient outcomes.

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 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.

Which of the following variables significantly influence non-adherence to a prescribed regimen? Select all that apply.

- Personal attitudes - Self-concept - Social support - Emotional make-up 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.

Which patient is most in need of health education by the nurse?

A 62-year-old male with chronic kidney injury People with chronic illnesses and disabilities are among those most in need of health education. As the lifespan of the population increases, the number of people with such illnesses also increases. Health information targeted at identifying and managing the exacerbations or issues commonly associated with having a chronic illness or disability is a major focus of health education. People with chronic illness need health care information to participate actively in and assume responsibility for self-care. Health education can help those with chronic illness adapt to their illness, prevent complications, carry out prescribed therapy, and solve problems when confronted with new situations. It can also help to prevent crisis situations and reduce the potential for rehospitalization resulting from inadequate information about self-care.

The nurse identifies a patient's inability to pour a liquid medication into a measuring spoon. This is an example of what part of the nursing process?

Assessment Assessment in the teaching-learning process is directed toward the systematic collection of data about the person and family's learning needs and readiness to learn. The nurse identifies all internal and external variables that affect the patient's readiness to learn. There are learning assessment guides available. Some guides are directed toward the collection of general health information (e.g., healthy eating), whereas others are specific to medication regimens or disease processes (e.g., stroke risk assessments). Such guides facilitate assessment but must be adapted to the responses, problems, and needs of each person. The nurse organizes, analyzes, synthesizes, and summarizes the assessment data collected and determines the patient's need for teaching.

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 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 step of the nursing process determines whether the client understands the health teaching that is provided?

Evaluation 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.

The nurse is teaching a 72-year-old client about heart failure. To enhance learning, the nurse

Frequently repeats the provided information Effective teaching strategies for older adults include frequent repetition information. Giving small amounts of information is more effective for learning rather than providing information in one teaching session. The nurse needs to look at the client rather than notes. This assists with speech reading. The nurse sits near the client so the client can hear the nurse.

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 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. 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 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.

A nurse is aware of the fact that nonadherence to prescribed therapy is both common and harmful. How can a nurse best promote adherence to therapeutic regimens among patients?

Help individuals be aware of the benefits of adhering to their prescribed therapy There are numerous strategies and variables involved in promoting adherence. However, helping individuals be cognizant of the specific benefits of adherence is likely to achieve this goal. Negative examples and punitive measures are less effective, and ethically questionable. It is neither practical nor possible to make adherence a precondition for care.

When a client who has successfully completed a smoking cessation program removes ashtrays from their home and takes a short walk after work instead of joining the usual group of coworkers at the local hangout, which stage of the Transtheoretical Model of Change is the patient portraying?

Maintenance A person is in the maintenance stage of the Transtheoretical Model of Change when they work to prevent relapse and to sustain the gains made from the actions taken. Removing the ashtrays and not keeping the usual after-work routine assist the client to maintain gains made from the smoking cessation program.

The nurse is developing a health-promotion program at a company in which many employees are women in their 20s and 30s. For this population, the nurse plans to include information about

Parenting issues Young adults in their reproductive years want information about parenting issues. Values training is geared more for adolescents. Information about bone-density screening and mammography are for older women.

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 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.

Health education is important for all patients and families. Of the four groups listed below, which group is most in need of health teaching?

Patients with chronic illnesses, because life-long interventions and adjustments can improve the quality of life People with chronic illnesses and disabilities are among those most in need of health education. Health education can favorably change a patient's behavior and increase his ability to cope with and manage his health, and improve his understanding of the options, risks, and benefits of care, treatment, and services.

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 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.

Which phase of the nursing process encompasses the establishment of expected outcomes?

Planning 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.

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. 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.

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 patient teaching would the nurse use with this client?

Suggest the client purchase a self-monitoring cuff Because this client finds it time consuming to visit the doctor 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 patient education in managing hypertension.

Outcome criteria are expressed as specific outcomes of patient behavior resulting from teaching strategies. Which of the following is an example of outcome criteria?

The ability to climb a flight of stairs without experiencing difficulty in breathing Outcome criteria need to be precise and measurable, not general; otherwise, measurement could be generalized.

Which action would be incorporated in a teaching strategy for a hearing-impaired client?

Use of slow, directed, and deliberate speech 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.

Which of the following is accurate regarding wellness? Select all that apply.

- One tries to maximize one's own health. - It requires a conscious commitment. - It is the result of adopting lifestyle behaviors for the attainment of one's highest potential. Wellness, as a reflection of health, involves a conscious and deliberate attempt to maximize one's health. Wellness does not just happen; it requires planning and conscious commitment and is the result of adopting lifestyle behaviors for the purpose of attaining one's highest potential for well-being. Wellness is not the same for every person.

The practice of nursing care is multifaceted in its scope and delivery. Which of the following activities describe the role of nursing? Select all that apply.

- Promoting health - Preventing illness - Health education and maintenance Nursing responsibilities are expanding continuously with increasing numbers of advanced practice nurses and changing state nurse practice acts. However, nurses cannot alter a medical plan of care or change health care provider prescribed treatment protocols.

Which of the following are effective teaching strategies for elderly persons? Select all that apply.

- Slow-paced presentation - Frequent repetition - Use of reinforcement techniques - Use of written materials Effective teaching strategies include a slow-paced presentation of small amount of material at a time; frequent repetition of information; and the use of reinforcement techniques, such as audiovisual and written materials. Distracting stimuli should be minimized as much as possible in the teaching environment.

Place the following nursing actions in sequence in the nursing process. - Establishing expected outcomes - Identifying alterations that need to be made to the teaching plan - Determining what the patient wants to learn - Putting the teaching plan into action - Identifying learning needs and etiology

1) Determining what the patient wants to learn 2) Identifying learning needs and etiology 3) Establishing expected outcomes 4) Putting the teaching plan into action 5) Identifying alterations that need to be made to the teaching plan The steps of the teaching/nursing process are assessment, diagnosis, planning, implementation, and evaluation. Assessment in the teaching-learning process is directed toward the systematic collection of data about the person and family's learning needs and readiness to learn. A nursing diagnosis that relates specifically to a patient's and family's learning needs serves as a guide in the development of the teaching plan. The expected outcomes, which identify the desired behavioral responses of the learner, are completed during the planning phase of the nursing process. The implementation phase of the teaching-learning process, the patient, the family, and other members of the nursing and health care team carry out the activities outlined in the teaching plan. The evaluation phase of the teaching-learning process is used to determine what was effective and what needs to be changed.

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:

1) Thinks about smoking cessation 2) Makes a plan to cease smoking 3) Takes steps to stop smoking 4) Works to prevent relapse of smoking 5) Resists relapsing into smoking 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.

A recommended approach to planning health teaching is applying the trans-theoretical model, which considers the stages of behavioral change. The stage in which the patient engages in calorie counting to reduce weight is called:

Action Individuals in the action stage of the trans-theoretical model would be expected to endorse the need for change and engage in specific behaviors that lead to change in the problem behavior. Engagement in educational activities would be expected at this stage.

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 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 phase of the process of patient teaching ends when the strategies have been completed and when the client's responses to the actions have been recorded?

Implementation The implementation phase ends when the teaching strategies have been completed and when the patient's responses to the actions have been recorded. Assessment in the teaching-learning process is directed toward the systematic collection of data about the client's learning needs and readiness to learn, as well as the family's learning needs. Planning has to do with specifying the expected outcomes and assigning priorities to the diagnoses. Evaluation determines how effectively the client has responded to teaching and to what extent the goals have been achieved.

Nonadherence to therapeutic regimens is a significant problem, especially in the elderly population. Nonadherence can lead to which outcome?

Increased cost of treatment 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.

The client is a Jehovah's Witness with severe anemia and is prescribed 2 units of packed red blood cells. The nurse begins to teach the client about the blood transfusion. The client refuses to sign the consent form for blood administration. The nurse failed to assess the client's

Cultural beliefs Clients may not accept health teaching because it conflicts with the values of their culture. Jehovah's Witnesses may not accept blood transfusions.

In many situations, measurement of which of the following is the most accurate measurement technique to identify changes in patient behavior?

Direct observation of behavior In many situations, measurement of actual behavior is the most accurate and appropriate technique. A variety of measurement techniques can be used to identify changes in patient behavior as evidence that learning has taken place. These techniques include directly observing the behavior; using rating scales, checklist, or anecdotal notes to document the behavior; and indirectly measuring results using oral questioning and written tests.

A weight-loss and exercise program is recommended for a client with type 2 diabetes. When teaching the client about lifestyle changes, what type of assessment would the nurse prioritize?

Individual cultural assessment Because people with different cultural backgrounds have different values and lifestyles, choices about health care vary. Before beginning health teaching, nurses must conduct an individual cultural assessment instead of relying only on generalized assumptions about a particular culture. A patient's social and cultural patterns must be appropriately incorporated into the teaching-learning interaction. A physical assessment is appropriate for this patient; however, the information gathered does not focus on education directed at a change in lifestyle. BMI assessment is an appropriate assessment for this client but does not address specific lifestyle changes. The Braden scale is used to assess risk factors related to skin breakdown.

During a teaching session with a client with a new walker, the nurse provides frequent reinforcement to the client to get up from a chair that has arms by holding the top of the chair arm with one hand. Once standing and stable, the client can grasp either the other side of the walker or both sides of the walker. The nurse knows that this educational strategy is most effective with which type of disability?

Input disability Reinforcement is an appropriate educational strategy with clients experiencing input disabilities. It is important to allow ample time to learn and to provide reinforcement. Individuals with output disabilities benefit from review of information. Individuals with developmental disabilities benefit from repetition of simple explanations. Individuals with perceptual disabilities benefit from highlighting significant information for easy reference.

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. 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).

A nurse knows that the use of a learning contract increases motivation and increases the likelihood of patient compliance with the treatment regimen. Which client goal best exemplifies a well-designed learning contract?

The client who wishes to stop smoking agrees to cut back on one cigarette a day for the first week of treatment and then decrease smoking by two cigarettes the following week of treatment. A well-designed learning contract is realistic and positive. In a typical learning contract, a series of measurable goals is established, beginning with small, easily attainable objectives and progressing to more advanced goals. By reducing a specific number of cigarettes each week, the client is more likely to meet the smaller attainable goals and remain motivated to stop smoking. Learning contracts need to be specific and incremental; therefore smaller measurable goals related to the reduction of alcohol intake would be more realistic. For the client who wants to lose weight, a better statement would be to lose 1 kg the first week and gradually increase weight loss over time. The client wishing to begin an exercise program would benefit from and be more likely to remain motivated by smaller goals of walking for 20 minutes three times per week for the first week and gradually increasing exercise intensity, duration, and frequency.