Chapter 21, Teacher and Counselor

A male client age 61 years has been admitted to a medical unit with a diagnosis of pancreatitis secondary to alcohol use. Which of the client's following statements suggests that nurses' education has resulted in affective learning? A) "I'm starting to see how my lifestyle has caused me to end up here." B) "I understand why they're not letting me eat anything for the time being." C) "My intravenous drip will keep me from getting dehydrated right now." D) "I can see how things could have been much worse if I hadn't gotten to the hospital when I did."

"I'm starting to see how my lifestyle has caused me to end up here." Feedback: The client's understanding of his contribution to his problem demonstrates a shift in attitude and feelings that is characteristic of affective learning. Understanding the treatment, course, and prognosis of his illness are aspects of cognitive learning.

6. A nursing faculty member is teaching a class of second-degree students who have an average age of 32. What is important to remember when teaching adult learners? A) A focus on the immediate application of new material B) A need for support to reduce anxiety about new learning C) Older students may feel inferior in terms of new learning D) All students, regardless of age, learn the same

A focus on the immediate application of new material Feedback: Adults need to be taught differently. Andragogy, the study of teaching adults, is based on several principles. One of those is that most adults' orientation to learning is that new material should be immediately applicable.

2. The nurse has been working with a client for several days during the client's recovery from a femoral head fracture. How should a nurse best evaluate whether client education regarding the prevention of falls in the home has been effective? A) "What changes will you make around your house to reduce the chance of future falls?" B) "Do you have any questions about the fall prevention measures that we've talked about?" C) "In light of what we've talked about, why is it important that you remove the throw rugs in your house?" D) "Do you think that the safety measures I taught you are clear and realistic?"

A) "What changes will you make around your house to reduce the chance of future falls?" Feedback: An open-ended question that requires the client to apply the information that has been taught is often the most accurate way to evaluate the effectiveness of client education. Yes/no questions are much less effective ("Do you have any questions?"; "Do you think that the safety measures I taught you are clear and realistic?"). Asking the client about the importance of preventing falls does not directly assess what the client will actually do to prevent falls.

3. A diabetes nurse educator is teaching a client, newly diagnosed with diabetes, about his disease process, diet, exercise, and medications. What is the goal of this education? A) To help the client develop self-care abilities B) To ensure the client will return for follow-up care C) To facilitate complete recovery from the disease D) To implement ordered teaching and counseling

A) To help the client develop self-care abilities Feedback: The basic purpose of educating and counseling is to help clients and families develop the self-care abilities (knowledge, attitude, skills) needed to maintain and improve health.

28. A nurse is writing learning outcomes for a client recovering from severe burns. Which of the following verbs would be good choices to use when preparing outcomes related to learning how to change dressings? Select all that apply. A) Assembles B) Demonstrates C) Gives examples D) Identifies E) Chooses

Assembles Demonstrates Feedback: Changing dressings falls into the psychomotor domain. "Assembles" and "demonstrates" are appropriate verbs for outcomes. "Gives examples" and "identifies" are verbs best used for the cognitive domain. "Chooses" and "values" relate to the affective domain.

22. When caring for a client, the nurse gives day-to-day examples to explain certain points of the health education. The nurse also notes the client's concentration level and educates when the client is active. Which category does the client fall into? A) Motivation B) Attention and concentration C) Learning readiness D) Learning needs

Attention and concentration Feedback: The client's attention and concentration affect the duration, delivery, and education methods employed. It is helpful to observe the client and implement health education when he or she is most alert and comfortable. This also means involving the client in an active way by providing examples of day-to-day activities. Learning is optimal when a person has a purpose for acquiring new information. The client needs to be motivated to learn new things. Readiness refers to the client's physical and psychological well-being. The best education and learning take place when both are individualized. To be most efficient and personalized, the nurse must gather pertinent information from the client and determine the client's needs when learning.

26. The parents of an infant suffering from apnea need to be educated on the apnea monitor and cardiopulmonary resuscitation. What should the nurse assess first regarding the parents? A) Educational levels B) Home environment C) Infant bonding D) Baseline knowledge of these concepts

Baseline knowledge of these concepts Feedback: Before educating parents on the apnea monitor and cardiopulmonary resuscitation, the nurse should determine the parents' baseline knowledge so that the nurse knows where to begin. Educational level would be the next assessment in order to plan the appropriate teaching delivery method.

5. Which of the following is an essential component of the definition of learning? A) Increases self-esteem B) Decreases stress C) Can be measured D) Cannot be measured

Can be measured Feedback: Learning is the process by which a person acquires or increases knowledge, or changes behavior in a measurable way, as a result of an experience.

17. What word or phrase best describes an effective counselor? A) Technically skilled B) Knowledgeable C) Practical D) Caring

Caring Feedback: An effective counselor needs to be a caring individual with the interpersonal skills of warmth, friendliness, openness, and empathy.

24. To meet accreditation standards regarding client care, a health care facility must show evidence of what? A) Employee satisfaction surveys B) Financial accounts and statements C) Documentation of indigent care D) Client education documentation

Client education documentation Feedback: The Joint Commission also has established standards for client education that health care agencies must meet to receive accreditation.

31. According to Rosenstock, which of the following are health beliefs critical for client motivation? Select all that apply. A) Clients view themselves as susceptible to the disease in question. B) Clients view the disease as a serious threat. C) Clients believe there are actions they can take to reduce the probability of contracting the disease. D) Clients believe the threat of taking these actions is greater than the disease itself. E) Patients view themselves as victims of the disease in question.

Clients view themselves as susceptible to the disease in question. Clients view the disease as a serious threat. Clients believe there are actions they can take to reduce the probability of contracting the disease. Feedback: A client's health beliefs can have great influence on motivation. The health belief model identifies several health beliefs as critical for client motivation (Rosenstock, 1974). Motivation is enhanced when clients view themselves as susceptible to the disease in question; when clients view the disease as a serious threat; when clients believe there are actions they can take to reduce the probability of contracting the disease; when clients believe the threat of taking these actions is not as great as the disease itself.

13. A nurse instructs a client to tell her about the side effects of a medication. What learning domain is the nurse evaluating? A) Affective B) Cognitive C) Psychomotor D) Emotional

Cognitive Feedback: Cognitive learning involves storing and recalling new knowledge in the brain. Cognitive learning may be evaluated through oral questioning.

27. When the newly diagnosed, insulin-dependent diabetic client tells the nurse that he has never received instruction on the administration of injections, an appropriately stated nursing diagnosis for the client is what? A) Self-care deficit related to lack of knowledge about injections B) Knowledge deficit related to lack of knowledge about injections C) Deficient knowledge of injection administration as verbalized by the client, related to the lack of instruction and experience D) Ineffective health care maintenance related to diabetic instructions

Deficient knowledge of injection administration as verbalized by the client, related to the lack of instruction and experience Feedback: Many factors can contribute to deficient knowledge, such as a lack of exposure, lack of recall, information misinterpretation, cognitive limitations, lack of interest in learning, and unfamiliarity with information resources.

12. A mother of a toddler wants to learn how to do CPR. What education strategy would be most effective in helping her learn? A) Lecture B) Discussion C) Demonstration D) Discovery

Demonstration Feedback: When a client wants to learn a specific skill, such as CPR, demonstration is an effective strategy. The client's learning can be evaluated by return demonstration. Lecture, discussion, and discovery are not as effective in teaching a skill.

35. A nurse is working with an older adult client, educating the client on how to ambulate with the aid of a walker. The nurse notes that the client appears to lack the motivation to learn how to use device. The client states, "I'm just too old to learn." Which of the following would be most appropriate for the nurse to do to motivate this client? A) Tell the client how to move the walker as he ambulates. B) Explain how the walker supports the client's lower extremities C) Fully discuss the rationale for using the walker. D) Describe how the walker can improve the client's quality of life.

Describe how the walker can improve the client's quality of life. Feedback: Motivating the older adult client can be done by showing the client how the new knowledge will improve his quality of life, regardless of how long that may be. It will also demonstrate how the new knowledge could improve the client's level of independence. Although demonstrating the use of the walker and explaining how the walker assists with ambulation (and the rationale for its use) can be used to educate the client, these actions would not promote motivation for the client to learn.

7. A nurse is designing a teaching program for individuals who have recently immigrated to the United States from Iraq. Which of the following considerations is necessary for culturally competent client teaching? A) Use materials developed previously for U.S. citizens. B) Use all visual materials when teaching content. C) Use a lecture format to teach content with few questions. D) Develop written materials in the client's native language.

Develop written materials in the client's native language. Feedback: With changes in society, nurses are faced with the challenge of teaching clients from different cultural and ethnic backgrounds. One of the strategies is to develop written materials in the native language of the client.

29. A nurse educating a new mother on how to bathe her infant uses the acronym TEACH to maximize the effectiveness of the education plan. Which of the following are guidelines based on this acronym? Select all that apply. A) Tune out the individual client. B) Edit client information. C) Act on every teaching moment. D) Always refer a client to counseling. E) Clarify often.

Edit client information. Act on every teaching moment. Clarify often. Feedback: To maximize the effectiveness of patient education, the nurse should use the acronym TEACH — T: tune into the client, E: edit client information, A: act on every teaching moment, C: clarify often, H: honor the client as a partner in the education process.

23. A nurse notices that a toddler is constantly snatching toys from the hands of other preschool children at the health care facility, placing the toddler and other children at risk for injury. Which of the following would be a most effective method for teaching the toddler not to snatch toys? A) Ask the children to play another game. B) Tell the toddler that God punishes children who snatch. C) Give the toddler another toy with which to play. D) Enlist the aid of the toddler's parents in education.

Enlist the aid of the toddler's parents in education. Feedback: The nurse should inform the toddler's parents as to his or her behavior. Since toddlers and preschoolers are accustomed to learning from and communicating with their parents, the parents are usually the most effective teachers. Children learn through play, so using dolls or toys as models can enhance learning. Giving another toy to the toddler or asking the children to play another game may not solve the problem, as the toddler would still want someone else's toys. Telling the toddler that God punishes children who snatch is not correct because the nurse is indirectly trying to scare and threaten the toddler.

16. What is the most critical element of documentation of education? A) A summary of the education plan B) The implementation of the education plan C) the client's need for learning D) Evidence that learning has occurred

Evidence that learning has occurred Feedback: Documentation of the education-learning process includes a summary of the learning need, the plan, the implementation of the plan, and the evaluation results. The evaluative statement is crucial and must show concrete evidence that demonstrates that learning has occurred. If the desired learning has not occurred, the notes should indicate how the problem was resolved. It is insufficient to document only what was taught; the charting must show evidence that the client or significant other has actually learned the material taught.

4. A nurse refers a client with a new colostomy to a support group. This nurse is practicing which of the following aims of nursing? A) Promoting health B) Preventing illness C) Restoring health D) Facilitating coping

Facilitating coping Feedback: Not all clients fully recover from their illness or injury; many clients will need to learn to cope with permanent health alterations.

10. Developing an education plan is comparable to what other nursing activity? A) Documenting in the nurses notes B) Formulating a nursing care plan C) Performing a complex technical skill D) Using a standardized form or format

Formulating a nursing care plan Feedback: Planning for learning involves the development of an education plan. Both education plans and nursing care plans follow the steps of the nursing process.

32. A nurse is educating an elderly client with diabetes and his family members about the importance of a nutritious diet. The nurse knows that client education promotes which of the following purposes? Select all that apply. A) Helps the nurse to restore optimal health in the client B) Helps the client to cope with alterations in health status C) Helps the nurse to be more aware of the client's health D) Helps the nurse to diagnose the client's illness early E) Helps the nurse to be well-informed about the client's care

Helps the nurse to restore optimal health in the client Helps the client to cope with alterations in health status Feedback: Nurses are involved in client education to promote wellness (primary prevention), prevent or diagnose illness early (secondary prevention), restore optimal health and function if illness has occurred (tertiary prevention), and assist clients and families to cope with alterations in health status. Simply being knowledgeable about the client's health status and care is not enough. Nurses must know the education and learning process and know how best to include the client's family in the process.

15. A male client age 42 years recovering from a MI is having difficulty following the care plan to stop smoking and exercise. What is the nurse's best response to this client? A) Praise him for trying. B) Tell him that he will have another MI and it will be his own fault. C) Tell him that his cigarettes will be taken away if he smokes again. D) Ignore the behavior and recommend a behavior modification program.

Ignore the behavior and recommend a behavior modification program. Feedback: Negative reinforcement (criticism or punishment) is generally ineffective; undesirable behavior is usually best ignored. Behavior modification programs that reward desired behaviors and ignore undesired behaviors might be best for this client.

14. When is the best time to evaluate one's own teaching effectiveness? A) During the education session B) Immediately after an education session C) 1 week after the education session D) 1 month after the education session

Immediately after an education session Feedback: It is best to evaluate one's own teaching effectiveness immediately after an education session by quickly reviewing how one feels the plan was implemented; noting both strengths and weaknesses helps plan for subsequent sessions.

25. When providing client education it is essential for the nurse to incorporate what action so that learning can be optimized? A) Have the clients read material after client education B) Be sure that clients are formally engaged C) Include educational strategies that encourage clients to be active participants D) Administer tests to evaluate learning

Include educational strategies that encourage clients to be active participants Feedback: The teaching-learning relationship is a dynamic, interactive process that involves active participation from the nurse and client.

8. Which of the following strategies might a nurse use to increase compliance with education? A) Include the client and family as partners. B) Use short, simple sentences for all ages. C) Provide verbal instruction at all times. D) Maintain clear role as the authority.

Include the client and family as partners. Feedback: Compliance is facilitated by including the client and family in the education-learning process. Other strategies include making sure instructions are understandable, using interactive education methods, and having a strong interpersonal relationship with clients and their families.

34. What client characteristic is important to assess when using the health belief model as the framework for teaching? A) Developmental level B) Source of information C) Motivation to learn D) Family support

Motivation to learn Feedback: When assessing a client's learning readiness, it is important to consider his or her motivation. Motivation is influenced by an individual's health beliefs and plays a key role in the health belief model. Motivation encourages the client to adopt health promotion and disease prevention actions.

33. A nurse in a neighborhood clinic is conducting educational sessions on weight loss. What aim of nursing is met by these educational programs? A) Practicing advocacy B) Preventing illness C) Restoring health D) Facilitating coping E) Maintaining and promoting health

Preventing illness Restoring health Maintaining and promoting health Feedback: If this education is directed toward those who are healthy, weight loss information can help maintain health and prevent illness. If this education is used in those already ill (hypertension, diabetes), weight loss can restore health. The nurse is not practicing advocacy or facilitating coping by providing weight loss education.

20. At completion of the health education for a client, the nurse documents the details of the health education in the client's medical record. What can be determined by this documentation? A) Proof of compliance with education standards B) Client's response to the health education C) Self-administration of medications D) Dietary instructions for the client

Proof of compliance with education standards Feedback: The information about who was taught, what was taught, the education method, and the evidence of learning is the best proof of compliance with education standards. These are entered in the client's medical record. The client's response to the health education cannot be determined by this document. Self-administration of medications and dietary instructions for the client are not implied from who was taught, what was taught, the education method, and the evidence of learning.

21. A client 36 years of age is able to understand the health education when she is given the opportunity to put the education into practice. The nurse helps the client to self-administer the medication dosage before the client is discharged from the health care facility. Which domain correctly identifies the client's learning style? A) Cognitive domain B) Affective domain C) Psychomotor domain D) Interpersonal domain

Psychomotor domain Feedback: The client's learning style falls into the psychomotor domain, which is a style of processing that focuses on learning by performing what has been learned. The cognitive domain is a style of processing information by listening or reading facts and descriptions. The affective domain is a style of processing, which appeals to a person's feelings, beliefs, or values. The interpersonal domain is a style of processing that focuses on learning through social relationships.

9. A young mother asks the nurse in a pediatric office for information about safety, diet, and immunizations for her baby. Which nursing diagnosis would be appropriate for this client? A) Knowledge Deficit: Infant care B) Impaired Health Maintenance C) Readiness for Enhanced Parenting D) Readiness for Enhanced Coping

Readiness for Enhanced Parenting Feedback: A client who requests information is demonstrating motivation and readiness to learn. The appropriate nursing diagnosis would be Readiness for Enhanced Parenting.

11. A student is developing an education plan for her assigned client. The student wants to educate the client on what symptoms to report after chemotherapy. What would the student need to do first? A) Ask other students what should be included in content. B) Ask the client what he or she wants to know. C) Tell the instructor that this topic hasn't been covered yet. D) Review information available in writing and on the Internet.

Review information available in writing and on the Internet. Feedback: New nurses (and students) usually need to research the subject to be taught to determine what information exists on the topic. Books, journals, manuals, and Web-based sources may be used to find information.

18. An older adult client is very stressed about who will care for his pets while he is hospitalized for a fall that caused a fractured hip. What type of counseling would the nurse conduct? A) None B) Long-term C) Short-term D) Motivational

Short-term Feedback: Short-term counseling focuses on an immediate problem or concern of the client or family. Even if it is a relatively minor concern, it needs immediate attention.

19. A nurse is using motivational interviewing to find out why a client refuses to participate in the recommended rehabilitation program. Which of the following is an example of using the skill of reflective listening to help motivate this client? A) So, you feel that you are not ready to start a program this week...? B) Why do you feel that you are not ready to start rehabilitation? C) I understand that you are afraid to start rehabilitation; where do you see yourself in a week? D) Remember we discussed what needs to be done to get you back on your feet...How do you feel about getting started?

So, you feel that you are not ready to start a program this week...? Feedback: Four skills have proved effective in motivational interviewing. These include: (answer A) reflective listening (restates the client's response back to him or her), (answer B) asking open questions (encourages discussion of the reason for making desired changes), (answer C) affirming (supports the client's efforts and encourages further exploration), and (answer D) summarizing (links and reinforces material that has been discussed).

30. The National Patient Safety Foundation recently collaborated with the Partnership for Clear Health Communication (2007) to create awareness of the need for improved health literacy and developed the Ask Me 3 tool. Which of the following is an Ask Me 3 question? Select all that apply. A) Who will be my health care provider? B) What is my main problem? C) What do I need to do? D) Where will I get help? E) Why is it important for me to do this?

What is my main problem? What do I need to do? Why is it important for me to do this? Feedback: Ask Me 3 questions are: What is my main problem? What do I need to do? Why is it important for me to do this?