chapter 26 patient education

The nurse established the following objective for the client who was unable to void: The clients intake will be at least 1000 mL between 7 AM and 3:30 PM. Feedback showing success is indicated by the client: a. Voiding at least 1000 mL during the shift b. Verbalizing abdominal comfort without pressure c. Having adequate fluid intake and urinary output d. Drinking 240 mL of fluid five or six times during the shift

ANS: 4 The nurse evaluates success by observing the clients performance of each expected behavior. Feedback indicating success in this situation is the client drinking 240 mL of fluid five or six times during the shift. This would be a fluid intake of 1200-1440 mL, meeting the objective of at least 1000 mL during the designated time period. Voiding at least 1000 mL is not the objective. The objective is to have the client drink at least 1000 mL. Verbalizing abdominal comfort without pressure is not an evaluation of the objective regarding specific fluid intake. Having adequate intake and output is not accurate feedback indicating success. The term adequate is not quantified.

While teaching the client about management of his heart disease, a nurse might use a strategy that is implemented to promote learning in the affective domain such as: a. Asking the client what he believes he needs to know about the diagnosis b. providing brochures both on current exercises and on nutrition guideline c. Encouraging the client to personally discuss his feelings about his health status d. Having the client return-demonstrate self-measurement of his own blood pressure

ANS: C An intervention to promote learning in the affective domain would be encouraging the client to discuss his feelings about his health status. Asking the client what he believes he needs to know about the diagnosis would be an intervention to promote learning in the cognitive domain. Providing brochures on current exercises and nutrition guidelines would be an intervention to promote learning in the cognitive domain. Having the client return-demonstrate self measurement of his blood pressure would be an intervention to promote learning in the psychomotor domain.

Which of the following statement best reflects the nurses appropriate attention to a clients need for self-efficacy? a. What can I do to help you lose the weight? b. Are you really ready to start a regular exercise regimen? c. After you watch me demonstrate this inhaler, you will have no problems using it at all. d. Come on; with all the self-help products out there, you will be able to stop smoking.

ANS: C Self-efficacy refers to a persons perceived ability to successfully complete a task. When people believe that they are able to execute a particular behavior, they are more likely to actually perform the behavior consistently and correctly. Although the other options are related to behavioral change to achieve a goal, they do not support the client by both encouragement and providing the skills necessary to be successful.

When a client newly diagnosed with type 2 diabetes mellitus selects a lunch menu that correlates with the number of carbohydrates he is allowed for that meal, this is an example of: a. Cognitive learning b. Affective learning c. Impaired learning d. Psychomotor learning

ANS: a Cognitive learning includes all intellectual behaviors and requires thinking. The remaining options are involved with expression of feelings and acceptance of attitudes, opinions, or values or acquiring skills that require the integration of mental and muscular activity. Impairing learning involves alteration to the normal learning process that requires alterations in methods and techniques.

In planning to teach an older adult client, the nurse should incorporate which teaching method or principle into the plan? a. Keep teaching sessions short. b. Teach in the early morning or late evening. c. Put as much as possible into each teaching session. d. Focus on teaching a family member or caregiver instead.

ANS: a Keeping teaching sessions short is an appropriate method when teaching an older adult client. The older adult should be taught when the client is alert and rested, not early morning or late evening. The teaching session should not be filled with numerous topics. The older adult client is capable of learning and should be the focus. A family member or caregiver may be included in teaching, but the older adult client should not be excluded

Which of the following actions is the primary nursing responsibility regarding client education? a. Providing accurate, current, relevant information b. Answering the clients questions regarding health-related issues c. Assessing the individual clients readiness and motivation to learn d. Identifying areas where clients are in need of educational information

ANS: a Nurses have an ethical responsibility to teach their clients (Redman, 2005, 2007). The information needs to be accurate, complete, and relevant to the clients needs. The remaining options are factors that affect learning and so require the nurses attention but are not as primary as providing information that is accurate, current, and relevant to the clients needs.

Which of the following teaching topics is an example of health maintenance and promotion and illness prevention? a. Glucose monitoring at home b. Living with rheumatoid arthritis c. Stress managements impact on depression d. What to expect after hip replacement surgery

ANS: a Promoting healthy behavior through education allows clients to assume more responsibility for their health. Greater knowledge results in better health maintenance habits. When clients become more health conscious, they are more likely to seek early diagnosis of health problems. The remaining options address restoration of health and coping with impaired functioning, whereas stress management is a topic that relates to the promotion of health and the prevention of illness.

22. The nurse recognizes that the clients teaching plan is most directly driven by: a. The clients identified learning needs b. The complexity of the clients health needs c. The clients readiness and motivation to learn d. The presence of cultural or physical barriers

ANS: a Teaching is most effective when it responds to the learners needs. While assessing and diagnosing a clients health care problems, the nurse identifies the need for education that in turn generates the teaching plan. The remaining options reflect factors that will affect both the teaching plan and the clients learning.

12. The nurse is evaluating the responses of clients to teaching sessions. An example of an evaluation of a clients attainment of a cognitive skill is: a. Client explains that the medication should be taken with meals b. Client looks at the surgical incision without requiring prompting c. Client uses crutches appropriately to move both up and down stairs d. Client independently capable of dressing self after eating breakfast

ANS: a The client who is able to explain that the medication should be taken with meals is demonstrating attainment of a cognitive skill. The client who is able to look at the surgical incision without prompting is demonstrating attainment of affective learning. The client who uses crutches appropriately is demonstrating attainment of a psychomotor skill. The client who dresses self after breakfast is most likely demonstrating attainment of psychomotor learning.

A client, after being taught of the clinical manifestations of inflammation to enable early detection of a complication of a surgical wound states, I will look at the wound four times a day and tell my surgeon if it looks red or swollen. Her statement is an example of: a. Attitudes b. Application c. Analysis d. Evaluation

ANS: b Application involves using abstract, newly learned ideas in a concrete situation. The client who is taught the clinical manifestations of inflammation and who will assess for signs such as redness or edema is using newly learned information in a concrete manner. Attitude has to do with affective learning. The client is not expressing an attitude, but is applying new knowledge in a concrete way. Analysis involves breaking down information into organized parts. The client is not demonstrating analysis. Evaluation is a judgment of the worth of a body of information for a given purpose. The client is not expressing judgment.

There are many factors are assessed before teaching the client to learn insulin injection sites, but the most important factor for the nurse to assess first is the: a. Previous knowledge level of the client b. Willingness of the client to want to learn the injection sites c. Financial resources available to the client for the equipment d. Intelligence and developmental level of the individual client

ANS: b If a person does not want to learn, it is unlikely that learning will occur. Motivation is the first factor the nurse should assess before teaching. To determine learning needs, the nurse should assess the clients previous knowledge level. However, this would not be the most important factor for the nurse to assess first. Assessing the financial resources available to the client for obtaining equipment is important; however, it is not the most important factor for the nurse to assess first. Assessing the clients physical and cognitive ability to learn is important. However, it is not the most important factor for the nurse to assess first.

21. The nurse is preparing the discharge teaching materials on newly prescribed drugs to a client diagnosed to be in the early stage of Alzheimers disease. The nurse best deals with the clients cognitive deficits by: a. Providing written material to supplement the discussion b. Arranging for family to be present during the discussion c. Presenting the material in two short but focused sessions d. Requiring the client to restate the information in her own words

ANS: b The clients family needs to understand and accept many changes in the patients physical and/or cognitive capabilities. The familys ability to provide support results in part from education, which begins as soon as the nurse identifies the clients needs and the family displays a willingness to help. The remaining options may support retention of material but not as effectively as including family in the educational sharing.

There are a variety of teaching methodologies that may be utilized to meet the clients needs. Which teaching method is best applied to a cognitive learning need? a. Modeling of behavior b. Discussion of feelings c. Computer-assisted instruction d. Demonstration of a procedure

ANS: c An independent project such as computer-assisted instruction is an appropriate teaching method for cognitive learning. Modeling of behavior is an appropriate teaching method for psychomotor learning. Discussion of feelings is an appropriate teaching method for affective learning. Demonstration is an appropriate teaching method for psychomotor learning.

The nurse evaluates which of the following statements as an indication that the client is not ready to learn at this time? a. I need to understand more about the reason for the colostomy. b. I will find out more about that when the support group meets. c. Theres no sense in showing me that now. Im too sick right now. d. Please be sure to tell me if I am completing all the steps correctly.

ANS: c Readiness to learn is related to the stage of grieving. This response by the client is demonstrating anger. The client is unwilling to learn at this time. The client has not yet reached the acceptance state of grieving in which learning can occur. This statement indicates the client is ready to learn and desires to find out more to gain understanding. This statement indicates the client is willing to learn. The client who requests feedback is expressing readiness to learn.

17. For a functionally illiterate client, the nurse particularly focuses on: a. Using intricate analogies and examples b. Avoiding lengthy return demonstrations c. Incorporating familiar nonmedical terminology d. Providing longer learning sessions with the client

ANS: c When teaching a functionally illiterate client, the nurse should use simple terminology, avoiding medical jargon. The nurse should incorporate familiar terminology to enhance the clients understanding. The nurse should use simple analogies and real life examples. The nurse should ask for return demonstrations as this provides the opportunity to clarify instructions and time to review procedures. Although teaching sessions may be kept short, they should be scheduled at more frequent intervals.

7. The client continues to ask questions about a surgical wound. The client states, I think I would like help the first time I look at my wound. This is an example of: a. Adaptation b. Perception c. Organizing d. Guided response

ANS: d A guided response is the performance of an act under the guidance of an instructor. The client who is seeking help is demonstrating a guided response. Adaptation occurs when a person is able to change a motor response when unexpected problems arise. The client is not exhibiting adaptation. Perception is being aware of objects or qualities through the use of sense organs. This situation is not an example of perception. Organizing is developing a value system by identifying and organizing values and resolving conflicts. This situation is not an example of organizing.

23. The nurse recognizes that the primary goal of a clients teaching plan is to: a. Facilitate a knowledge-based client decision-making process b. Provide information that brings about informed client consent c. Enhance the clients sense of personal control regarding his or her health care d. Therapeutically affect the clients health, wellness, and independence

ANS: d Creating a well-designed, comprehensive teaching plan that fits a clients unique learning needs ultimately helps clients make informed decisions about their care and results in clients becoming healthier and more independent. The remaining options affect the primary goal by enhancing decision making, providing for informed consent, and bringing about a sense of personal control.

Clients give various responses to teaching sessions. For the nurse, an example of an evaluation of a psychomotor skill is: a. Client states side effects of a medication b. Client responds appropriately to eye contact c. Client independently plans an exercise program d. Client demonstrates the proper use of a walking cane

ANS: d Determining whether the client is able to demonstrate a newly learned skill is an example of an evaluation of a psychomotor skill. Psychomotor learning involves acquiring skills that require the integration of mental and muscular activity, such as walking with a cane. Having the client state side effects of a medication is an example of an evaluation of cognitive learning. Determining whether a client responds appropriately to eye contact is an example of evaluation of affective learning. The client who planned an exercise program is demonstrating cognitive learning.

4. There are a variety of teaching methodologies from a nurse to choose from to use with clients. For a toddler, the nurse should use: a. Role-playing b. Problem-solving c. Independent learning d. Simple explanations and pictures

ANS: d Effective teaching methodologies for the toddler include simple explanations and picture books that describe a story of children in a hospital or clinic. Role-playing is an appropriate teaching methodology for the preschooler. Problem-solving is an appropriate teaching methodology for the adolescent. Independent learning is best used as a teaching methodology for the young or middle adult.

Which of the following teaching topics is an example of restoration of health? a. Glucose monitoring at home b. Living with rheumatoid arthritis c. Stress managements impact on depression d. What to expect after hip replacement surgery

ANS: d Injured or ill clients need information and skills to help them regain or maintain their levels of health. The remaining options address health maintenance and promotion and illness prevention and coping with impaired functioning while what to expect after hip replacement surgery is a topic that relates to the restoration of health and function.

When a client newly diagnosed with type 2 diabetes mellitus assumes responsibility for checking her blood glucose level four times a day, this is an example of: a. Cognitive learning b. Affective learning c. Impaired learning d. Psychomotor learning

ANS: d Psychomotor learning involves acquiring skills that require the integration of mental and muscular activity. The remaining options are involved with expression of feelings and acceptance of attitudes, opinions, or values or the acquisition of knowledge. Impaired learning involves alteration to the normal learning process that requires alterations in methods and techniques.

The nurse has completed an assessment on the client and identified the following nursing diagnoses. Which one of the following nursing diagnoses indicates a need to postpone teaching that was planned? a. Activity intolerance related to pain b. Ineffective management of treatment regimen c. Noncompliance with prescribed exercise plan d. Knowledge deficit regarding impending surgery

ANS:A Pain, fatigue, or anxiety can interfere with the ability to pay attention and participate. The nursing diagnosis of activity intolerance related to pain indicates a need to postpone teaching. Teaching may be delayed until the nursing diagnosis is resolved or the health problem is controlled. Ineffective management of treatment regimen does not indicate a need to postpone teaching. Ineffective management of treatment regimen reinforces the need for teaching. Noncompliance with prescribed exercise plan does not indicate a need to postpone teaching. The client who is noncompliant may require further teaching. Knowledge deficit regarding