Fundamental Chapter 9: Teaching and Counseling
A nurse is reviewing the teaching plan about heart failure with a client. The nurse determines that learning in the affective domain has been achieved based on which client statement? A) "I realize now just how important it is to watch how much salt I use." B) "I can identify the signs or symptoms of heart failure." C) "I understand why I need to take a water pill." D) "I know to call my provider if my ankles swell."
A) "I realize now just how important it is to watch how much salt I use." Explanation: Affective learning includes changes in attitudes, values, and feelings, as evidenced by the client's statement about realizing the importance of watching salt intake. Statements about signs and symptoms, taking a water pill, and calling the provider reflect learning in the cognitive domain.
The nurse is educating a client regarding a new skill. When evaluating the client's knowledge about the topic covered, which best represents that the client has learned a new skill? A) The client states understanding and passes a written test. B) The client organizes materials needed and gives return demonstration. C) The client verbalizes items needed and how to perform the skill. D) The client nods when asked about process and assists with cleanup.
B) The client organizes materials needed and gives return demonstration. Explanation: Confirmation that a client has learned a skill requires more than the client verbalizing understanding, passing a written test, nodding, or assisting with cleanup. Being able to gather all equipment needed for a skill and then perform it demonstrates proficiency.
When a nurse is planning for learning, who must decide who should be included in the learning sessions? A) The health care team B) The doctor and nurse C) The nurse and the client D) The client and the client's family
C) The nurse and the client Explanation: The nurse and the client should be the individuals who decide who should be included in the learning sessions. The nurse cannot assume that family members are wanted by the client to be included. The client must always be included in the learning session.
The client has Alzheimer disease and is a new admission to the nursing home. The client was transferred from the hospital. When first meeting the client, what technique(s) will the nurse use to facilitate communication with this client? Select all that apply. A) Approach the client from the front of the client. B) Call the client by the client's preferred name. C) Use simple words and short sentences when talking with the client. D) Correct the client when the client communicates erroneous information. E) Fill in information when the client has difficulty answering questions.
A) Approach the client from the front of the client. B) Call the client by the client's preferred name. C) Use simple words and short sentences when talking with the client. Explanation: When communicating with a client who has Alzheimer disease, the nurse must use techniques that will facilitate communication. The nurse will approach from the front of the client to obtain the attention of the client. Coming from the side or the back of the client may startle or agitate the client. Using the client's preferred name will also gain the client's attention. The nurse will use simple words and short sentences to allow the client to understand the nurse. The nurse must show patience and allow the client time to respond. The client may have difficulty finding the correct words or expressing thoughts. Correcting the client or providing information may confuse or agitate the client even more.
When caring for a client at the health care facility, the nurse observes that the client is having difficulty understanding the health education. Which action is most appropriate? A) Assess for cultural differences. B) Boost the morale of the client. C) Delegate the health education to a colleague. D) Replace one-on-one teaching with written materials.
A) Assess for cultural differences. Explanation: When the client is having difficulty learning, it may be possible that the client does not understand the language that the nurse speaks. In such a case, the nurse should take the necessary steps to break the cultural barrier and then proceed with the education. Written materials can enhance many clients' learning, but will not necessarily overcome many of the common barriers to understanding, including cultural and linguistic factors. The nurse should take action to overcome any barriers to the learning process before delegating to a colleague. The client's morale is not pertinent to the client's difficulty understanding the teaching. Reference:
A client informs the nurse about being committed to quitting smoking to improve health. During discussion, the nurse asks the client "on a scale of 0 to 10, how likely are you to attend a support group?" Which strategy of motivational interviewing is the nurse using with the client? A) Assessing importance B) Elicit-provide-elicit C) Evoking change talk D) Prioritizing
A) Assessing importance Explanation: Using the 0 to 10 scale is a key aspect of assessing importance with motivational interviewing. It helps the nurse to understand the client's feelings toward the recommended activity and can help start a conversation about why the client chose that rating number-and what the nurse could do to increase the number. In the elicit-provide-elicit strategy, the nurse elicits information from the client about a topic, provides teaching on the topic, and then further elicits information from the client. Evoking change talk is when the nurse presents a potential change to the client for consideration. Prioritizing is helping a client determine how to order one's priorities.
A nurse is educating a 4-year-old client about cast care following a tibia-fibula fracture. Which action is not developmentally appropriate to include in the nurse's teaching? A) Blocking 30 minutes of time for skill teaching B) Using dolls to demonstrate psychomotor skills C) Ensuring the client's parents are present D) Giving stickers as a reward for task completion
A) Blocking 30 minutes of time for skill teaching Explanation: Preschool age children (2 to 5 years) have short attention spans. Five- to ten-minute blocks of time are age appropriate. A 30-minute block is more appropriate for an older client. The other answers are developmentally appropriate for a 4-year-old.
When caring for a client, the nurse observes that the client enjoys reading books and magazines. In which learning domain does the client's learning style fall? A) Cognitive B) Affective C) Psychomotor D) Interpersonal
A) Cognitive Explanation: As the client enjoys reading books and magazines, the client's learning style would fall in the cognitive domain, where information is processed by listening or reading facts and descriptions. The affective domain is a style of processing that appeals to a person's feelings, beliefs, or values. The psychomotor domain is a style of processing that focuses on learning by doing. The interpersonal domain is a style of processing that focuses on learning through social relationships.
A client reads the nutritional chart and follows it accurately. The nurse also notes that the client understands the need for a balanced diet and its relationship with a quick recovery. In which domain is the client demonstrating successful learning? A) Cognitive B) Affective C) Psychomotor D) Interpersonal
A) Cognitive Explanation: As the client is able to understand the need for a balanced diet after the session and follows the nutritional chart accurately, the client is demonstrating successful learning in the cognitive domain. Learning in the cognitive domain involves processing information by listening to or reading facts and descriptions. Learning in the affective domain involves appealing to a person's feelings, beliefs, or values. Learning in the psychomotor domain involves learning by doing. Interpersonal is not a domain of learning but a type of communication in which ideas are exchanged between two or more people.
The nurse is completing documentation after an education session with a client. Which statement best demonstrates detailed documentation of an effective teaching plan? A) Demonstrated cord care to mother, who stated understanding and performed return demonstration using correct technique. B) Discussed wet-to-dry dressing changes, and client stated understanding. C) Spouse taught to flush feeding tube before and after medication. Denied further instruction needed. D) Lecture provided about infection, and client stated understanding what infection is.
A) Demonstrated cord care to mother, who stated understanding and performed return demonstration using correct technique. Explanation: Documentation of teaching must include who was taught, the topic taught, and some indication of the success of the learning plan beyond a simple verbal statement by the client. Only the answer with a mother being taught cord care and then performing return demonstration is complete.
A client diagnosed with type 2 diabetes has been prescribed insulin therapy in conjunction with an oral agent because the client has been experiencing difficulty controlling blood sugar levels with an oral agent alone. The nurse is preparing a teaching plan for this client. Which intervention would the nurse include in the teaching plan to address the psychomotor domain? A) Demonstrating the technique for insulin self-injection B) Describing the signs and symptoms of low blood sugar C) Explaining what to do if hypoglycemia occurs D) Reviewing with the client appropriate foods to eat
A) Demonstrating the technique for insulin self-injection Explanation: The psychomotor domain involves skill performance. In this case, demonstrating the insulin self-injection technique would apply. Describing signs and symptoms, explaining what to do if hypoglycemia occurs, and reviewing appropriate food choices are appropriate for the cognitive domain.
A nurse is preparing to teach a 6-year-old client with a broken arm and the client's mother about caring for the child's cast. Which statement reflects the best education plan for these clients? A) Include the child in the education; ask questions of both the mother and the child. B) Focus mainly on the mother; ask the child a couple of simple questions. C) Provide the mother with written materials; teach the child about keeping the cast dry. D) Separate the mother and the child; teach the mother and then let the mother teach the child.
A) Include the child in the education; ask questions of both the mother and the child. Explanation: School-age children are able to make decisions and provide care for themselves. Focusing mainly or only on the mother fails to validate the child's abilities, and teaching the mother and the child separately does not make good use of time.
Which developmental consideration is a nurse assessing when determining that an 8-year-old child is not equipped to understand the scientific explanation of the child's disease? A) Intellectual development B) Motor development C) Emotional maturity D) Psychosocial development
A) Intellectual development Explanation: Piaget's theory of intellectual development is a major learning theory. By understanding how children and adolescents develop learning abilities, the nurse can use this knowledge when teaching clients. School-age children are capable of logical reasoning and should be included in the teaching-learning process whenever possible. Teaching strategies that include clear explanations and reasons for procedures, stated in a simple and logical manner, are most successful. These children are open to new learning experiences but need learning to be reinforced by either a parent or health care personnel as they become more involved with their friends and school activities. Motor development would be focused on a hands-on skill for example, not the scientific explanation of the disease. Psychosocial development looks at stages of development and goals or tasks for different stages.
A nurse is forming an education plan for a client who is being discharged from the nursing unit after cardiac catheterization. Which diagnosis and intervention are most appropriate for this client? A) Knowledge Deficient: Risk for altered perfusion secondary to re-occlusion B) Knowledge Deficient: Altered urinary output related to catheterization C) Knowledge Deficient: Impaired mobility related to lying flat for 8 hours D) Knowledge Deficient: Risk for ineffective breathing pattern related to incisional pain
A) Knowledge Deficient: Risk for altered perfusion secondary to re-occlusion Explanation: Urinary output should not be changed from a cardiac catheterization. The incision for this procedure may require 8 hours of lying flat, but mobility returns to baseline before discharge home. The risk for ineffective breathing pattern would not be due to incisional pain, which would be in the groin or elbow. Educating the client to be aware for the safety issue of chest pain resulting from the newly opened coronary arteries becoming re-occluded and blocking blood flow to the heart is the highest priority focus.
A nurse is using the teaching-learning process to teach new parents how to care for their infants. Which nursing actions reflect recommended steps of this process? Select all that apply. A) The nurse assesses the learning needs and readiness of the parents. B) The nurse identifies general long-term goals for client learning when developing learning objectives. C) The nurse includes group teaching and formal teaching in every education plan. D) The nurse does not allow time constraints, schedules, and the physical environment to influence the choice of education strategies. E) The nurse formulates a verbal or written contract with clients. F) The nurse relates new learning material to clients' past life experiences to help them to assimilate new knowledge.
A) The nurse assesses the learning needs and readiness of the parents. E) The nurse formulates a verbal or written contract with clients. F) The nurse relates new learning material to clients' past life experiences to help them to assimilate new knowledge. Explanation: The nurse would use critical thinking skills to assess the learning needs and learning readiness of the parents. The nurse would formulate a verbal or written contract with the clients. The nurse would relate new learning material to the clients' past life experiences to help them assimilate new knowledge, which is an adult learning principle. Goals should be specific, not general in focus. The nurse would not have to include group teaching and formal teaching in every education plan. The nurse must allow time constraints, schedules, and the physical environment to influence the choice of teaching strategies.
The nurse is planning client education based on the developmental stage of the client. Which nursing actions best reflect this consideration? Select all that apply. A) The nurse directs the health education for a 3-year-old to the parents. B) The nurse provides lengthy explanations of a procedure to a preschool child. C) The nurse includes a school-age child in the teaching and learning process. D) The nurse determines the learning needs of the client. E) The nurse avoids relating education for an adult to a social role. F) The nurse provides material that is useful immediately to adult clients.
A) The nurse directs the health education for a 3-year-old to the parents. C) The nurse includes a school-age child in the teaching and learning process. D) The nurse determines the learning needs of the client. F) The nurse provides material that is useful immediately to adult clients. Explanation: Looking at clients' development stages, the nurse would develop and carry out actions based on the individual client needs. The nurse would direct the health education for a 3-year-old to the parents. The nurse would include a school-age child in the teaching-learning process. The nurse would use the same learning strategies for an adolescent as for an adult. The nurse would provide material that is useful immediately to adult clients. The nurse would not provide lengthy explanations for a procedure to a preschool child because of the client's development stage. The nurse would not avoid relating education for an adult to a social role.
A nurse is providing teaching to clients in a short-term rehabilitation facility. Which examples are common teaching mistakes made by health care professionals? Select all that apply. A) The nurse fails to accept that clients have the right to change their minds. B) The nurse negotiates goals with the client. C) The nurse uses medical jargon frequently when discussing the teaching plan. D) The nurse ignores the restrictions of the client's environment. E) The nurse evaluates what the client has learned. F) The nurse reviews educational media when planning learner objectives.
A) The nurse fails to accept that clients have the right to change their minds. C) The nurse uses medical jargon frequently when discussing the teaching plan. D) The nurse ignores the restrictions of the client's environment. Explanation: Common teaching mistakes made by health care professionals would include the following: the nurse failing to accept that clients have the right to change their minds; the nurse using medical jargon frequently when discussing the teaching plan; and the nurse ignoring the restrictions of the client's environment. The nurse does negotiate goals with the client. The nurse would evaluate what the client had learned. The nurse would review educational media when planning learner objectives.
A parish nurse is preparing to provide a health promotion class to a group of adults in the parish. In preparing to meet the learning needs of this group, the nurse recognizes which as a characteristic of an adult learner? A) Their readiness to learn is often related to a developmental task or social role. B) Peer group acceptance is a critical issue for this age group. C) The material presented should focus on future application. D) Previous experiences have little impact on learning.
A) Their readiness to learn is often related to a developmental task or social role. Explanation: An adult's readiness to learn is often related to a developmental task or social role. The previous experience of the adult is a rich resource for learning. Most adults' orientation to learning is that material should be useful immediately. Peer group acceptance is a critical issue for the adolescent group and not adults.
The nurse is conducting a teaching session regarding HIV/AIDS for adult clients in the community. What consideration(s) will the nurse make when teaching this type of session? Select all that apply. A) identifying the length of the session B) beginning with basic concepts about HIV/AIDS C) using proper medical terms when describing treatment D) providing adequate lighting and comfortable temperature E) identifying the time, place, and content for the next teaching session
A) identifying the length of the session B) beginning with basic concepts about HIV/AIDS C) using proper medical terms when describing treatment E) identifying the time, place, and content for the next teaching session Explanation: The nurse should identify the length of the session because it prepares the participants for the demand on time and attention. The nurse should begin with basic concepts about HIV/AIDS, as this allows for the participants to learn from the simple to the complex. The nurse should provide adequate lighting and comfortable temperature, as these will promote an environment for learning. The nurse should identify the time, place, and content for the next teaching session, because it allows participants to plan ahead and prepare for the next session. The nurse should try not to use medical terms or allow time to explain the terms in simple language, as this allows the nurse to accept some accountability for the participants' comprehension.
While the nurse is caring for a hearing impaired client, and a family member of the client states, "What do you think is the best way to communicate?" What is the best response by the nurse? A) "Use words that begin with 'f,' 's,' 'k,' and 'sh' to communicate." B) "Use flash cards and writing pads." C) "Limit communication to avoid frustration." D) "Encourage family members to increase their vocal pitch."
B) "Use flash cards and writing pads." Explanation: Using flash cards and writing pads to communicate is a good substitute for verbal instructions for persons with hearing impairment. Speaking words that begin with "f," "s," "k," and "sh" typically requires forming high-pitched sounds, which are difficult for clients with hearing impairment to discriminate. Do not limit communication, because it will alienate the client from family and friends. Lowering (rather than increasing) the vocal pitch is better, as hearing loss is generally in the higher pitch ranges.
The nurse is caring for a 70-year-old client with a fractured wrist. Which is the best method to determine whether the client has retained the information taught? A) Observe the change in client's behavior for a month. B) Ask the client to recall after approximately 15 minutes. C) Test the client on the health education and information imparted. D) Ask the client to administer the doses of drug himself.
B) Ask the client to recall after approximately 15 minutes. Explanation: Asking a client to recall what has been discussed after approximately 15 minutes helps determine what information the client has actually retained. Observing the change in the client's behavior for a month is not feasible or timely. Testing the client on the health education and information imparted would be time-consuming and unnecessarily involved. Asking the client to self-administer the doses of drug (if even appropriate) would help demonstrate the client's understanding of how to actually administer the drug but not any other aspect of teaching related to a fracture.
During the health education session at the health care facility, the nurse notes that a client is able to recognize, describe to others, and explain the information learned. What is the final learning stage of the client in this case? A) Recall of the information being taught B) Independent use of new learning C) Involvement in the education in an active way D) Repetition of information for memorization
B) Independent use of new learning Explanation: The final learning stage for the client in this case is the independent use of the new learning. The client demonstrates the ability to recall the information being taught by describing it to others. Involvement of the client in the health education in an active way is required to maintain the attention and the concentration of the client. Repetition of information for memorization is a technique to teach illiterate clients.
When a client says, "I don't care if I get better; I have nothing to live for, anyway," which type of counseling would be appropriate? A) Long-term counseling B) Motivational counseling C) Short-term counseling D) Professional counseling
B) Motivational counseling Explanation: The most appropriate counseling for the situation at hand would be motivational counseling. With motivational counseling, the nurse would discuss feelings and incentives with the client. Short-term counseling focuses on the immediate problem or concern of the client or family. It can be a relatively minor concern or a major crisis, but in any case, it needs immediate attention. Long-term counseling extends over a prolonged period. A client might need the counsel of the nurse at daily, weekly, or monthly intervals. A client experiencing a developmental crisis, for example, might need long-term counseling. Professional counseling is a general term.
An active, otherwise healthy, older adult client presents to the clinic with severe osteoarthritis in both knees. The nurse knows this client does not want to be a burden on the family, and the client remains stoic despite reporting the pain as severe. The client avoids the topic of surgery and attends church weekly. The client's family is supportive of any decisions the client makes regarding health. Which of the assessment data is most important to forming an individualized education plan for this client concerning treatment for osteoarthritis? A) Orthopedic surgical history B) Personal perception of health and aging C) Floor plan of the client's dwelling D) Formal religious beliefs
B) Personal perception of health and aging Explanation: Knowing about the client's orthopedic history, religious beliefs, and barriers to mobility in the home are all helpful for an overall plan of care, but do not address individualism. Gaining insight into the client's own perceptions of health and aging, however, will allow the nurse to tailor the plan of care to the client's personal needs.
A nurse assisting a new mother in the act of breastfeeding represents which form of learning? A) Affective B) Psychomotor C) Cognitive D) Simplistic
B) Psychomotor Explanation: Psychomotor refers to the muscular movements learned to perform new skills and procedures, such as breastfeeding. Affective learning involves engagement of the client's emotions. Cognitive learning involves engagement of the client's critical thinking and reason. Simplistic is not a formal type of learning, and assisting a new mother with breastfeeding is not simplistic. Reference:
The nurse has provided teaching for a client with a sinus infection who has been prescribed antibiotics and a decongestant. The client states, "I'm not sure how many days I'm supposed to take this antibiotic." What is the nurse's appropriate response? A) Ask the client to restate the teaching that was provided. B) Reteach the length of time to take the prescription. C) Tell the client to take the antibiotic until symptoms subside. D) Proceed with teaching about the decongestant.
B) Reteach the length of time to take the prescription. Explanation: Client teaching requires a circular approach, specifically if the client has not understood the teaching. The nurse needs to reteach the information that has not been understood. Asking the client to restate the teaching, telling the client to take the antibiotic, and proceeding with teaching about the decongestant are not effective teaching methods.
A client shares with the nurse how much the client appreciates understanding the physiology of breastfeeding. The client states, "I felt very comfortable with what you explained to me, and I feel I will be successful at breastfeeding." In affective learning, this represents the nurse: A) creating an educational opportunity for the future. B) creating an atmosphere for discussion of feelings. C) creating specific learning sessions for new information. D) creating an opportunity for rational thought and learning.
B) creating an atmosphere for discussion of feelings. Explanation: When working with clients to change beliefs, values, and attitudes (i.e., affective learning), the nurse creates an atmosphere in which clients can honestly and freely discuss their feelings and emotions. Creating specific learning sessions for new information and creating an opportunity for rational thought and learning pertain more to cognitive learning, which involves the client's critical thinking and reason. In this scenario, the nurse has provided an educational opportunity in the present, not for the future.
Which statement made by a client who was recently admitted to the medical unit with a diagnosis of pneumonia indicates a physical inability to learn? A) "May I have something to eat?" B) "The pain in my chest has gone." C) "I am having difficulty breathing." D) "Finally, I am getting medical attention."
C) "I am having difficulty breathing." Explanation: The statement "I am having difficulty breathing" indicates that the client is not physically well and that the client is unable to learn effectively until comfort is restored. "The pain in my chest has gone" and "May I have something to eat?" is suggesting that the client is physically well and is ready to learn. "Finally, I am getting medical attention" is suggesting that the client is psychologically ready to learn.
A 56-year-old client meets with the nurse for education about a recently diagnosed atrial fibrillation. The client verbalizes concerns about being away from work too long and doubts about the necessity of having blood tests every week, as the client has no symptoms. Which is the best motivational statement by the nurse for this client? A) "Your doctor wants you to take your warfarin every day, go to the clinic every week to have blood drawn, and then wait for any dosage change. Do you understand?" B) "You have to take your warfarin and go to the clinic every week for a blood draw. It's not the most convenient way to live, but you have to do it." C) "The medicine and blood work can help prevent blood clots, which can lead to strokes. What do you know about warfarin therapy?" D) "Atrial fibrillation is when your upper heart beats ineffectively and blood clots can go to your brain. Would you like some printed information about this?"
C) "The medicine and blood work can help prevent blood clots, which can lead to strokes. What do you know about warfarin therapy?" Explanation: Adults learn best when the information given to them will be used immediately, is presented as important to the client, and when the client's autonomy is preserved. As with all learners, the teaching approach must reflect respect for what the client already knows. By presenting the facts in a way that gives the client control over a health alteration, and by assessing current knowledge, these qualities that are important to forming a learning plan for an adult are met. When education plans take control out of the client's hands (such as stating the doctor wants compliance) or when the lifestyle change is presented as a burden, motivation may be low. If the nurse shows interest in working with and discussing issues with the client, a partnership is formed that can boost motivation.
The nurse is visiting a client who was released from inpatient rehabilitation 6 weeks ago after a 5-month recovery from a motor vehicle accident that left the client immobile. As the nurse enters the home, the client braces hands on the arms of a chair to rise and uses crutches to walk across the room. What is the best response by the nurse? A) "Let me document that you can walk." B) "Those physical therapists work wonders. C) "You have made an amazing recovery." D) "Are you supposed to be out of the wheelchair?"
C) "You have made an amazing recovery." Explanation: Reinforcement of learning shows that the nurse supports and wants to encourage the client. Giving credit where it is due communicates these values. Documenting is necessary, but stating this does not show interest in the client's progress. Crediting the therapists does not encourage the client. Asking about permission to ambulate negates the goal for improving wellness.
Which statement describes the person who is likely the most motivated to learn? A) A 29-year-old male whose significant other is insisting on the client receiving the education B) A 52-year-old male who has been hired to drive the client home from the clinic C) A 70-year-old female who is the client's spouse and is learning the care so the client can come home D) A 25-year-old female who just completed a course of physical therapy
C) A 70-year-old female who is the client's spouse and is learning the care so the client can come home Explanation: Adults learn best when the information given to them is something they need to use immediately, when they are strongly motivated to learn, and when they have an internal motivation to learn the topic. When the adult learner does not see the importance of the topic or has no emotional need to learn (such as the client who appears to be undergoing the education only at the insistence of the client's significant other), motivation is low. Motivation to learn may also be lacking if the adult learner has just reached completion of a major task, such as the client who just completed a course of physical therapy. The adult learner who is seeking knowledge to assist a loved one may be the most motivated. On the other hand, a stranger to the client who has just been hired to bring the client home from the clinic is the least likely to be motivated to learn.
When preparing client teaching materials, how does the nurse best assess a client's preferred learning style? A) Observe the client's behaviors. B) Provide teaching that works for the broadest base of clients. C) Ask the client, "Do you learn best by observing, valuing, or doing?" D) Determine client learning needs based on age and ability to hear effectively.
C) Ask the client, "Do you learn best by observing, valuing, or doing?" Explanation: One way to determine the client's preferred learning style is to ask the client about the client's personal learning preference--whether cognitive, affective, or psychomotor. Simply observing the client's behavior or considering the client's age and hearing ability would not provide as much information about the client's preferred learning style as would directly asking the client. Providing teaching using a broad-based approach would not help determine the client's preferred learning style and would not be as effective as providing teaching that is tailored to the client's preferred learning style.
The nurse has educated the client on the pathophysiology of osteoarthritis and degenerative joint disease. This type of teaching best illustrates which learning theory? A) Adaptive learning theory B) Behavioral learning theory C) Cognitive learning theory D) Developmental learning theory
C) Cognitive learning theory Explanation: Cognitive learning theory is the result of people wanting to make sense of the world around them by assimilating and processing information to gain new understandings and insights. Developmental learning theory focuses on considering the patient's physical maturation and abilities, psychosocial development, and cognitive capacity when providing education. Behavioral learning theory focuses on how one learns and unlearns behaviors. Adaptive learning theory explains how learning is optimized when teaching is adapted to the particular learning style of the learner.
The nurse is preparing to teach a client from Generation X about hypertension. Which teaching approach should the nurse plan to implement? A) Provide brochures about low-sodium foods. B) Ask a family member to do meal planning to alleviate the burden for the client. C) Demonstrate the MyFoodPyramid phone app, to show the best food choices on a lunch tray. D) Have the client repetitively choose appropriate foods from various menus.
C) Demonstrate the MyFoodPyramid phone app, to show the best food choices on a lunch tray. Explanation: Those who represent Generations X, Y, and Z may share many learning characteristics. They are or will be technologically literate, having used or grown up with computers, smart phones, and tablet devices. Therefore, it is most appropriate to teach them using some form of multimedia, such as a phone app. The other teaching approaches are less appropriate for this client population.
A nurse may attempt to help a client solve a situational crisis during what type of counseling session? A) Long-term counseling B) Motivational counseling C) Short-term counseling D) Professional counseling
C) Short-term counseling Explanation: Short-term counseling would help a client solve a situational crisis. A client experiencing a developmental crisis, for example, might need long-term counseling. Motivational counseling is an evidence-based counseling approach that involves discussing feelings and incentives with the client. Professional counseling is a general term.
When establishing a teaching-learning relationship with a client, it is most important for the nurse to remember that effective learning can best be achieved through which concept? A) The nurse is the expert in the teaching-learning environment. B) The nurse must be able to handle criticism during the process. C) The client and the nurse are equal participants. D) Assimilation and application of psychomotor concepts is essential.
C) The client and the nurse are equal participants. Explanation: Effective learning occurs when clients and health care professionals are equal participants in the teaching-learning process, not when the nurse is viewed as the expert. Although it is important for the nurse to be able to handle criticism and to understand and apply psychomotor concepts when teaching, these are not as important as viewing the client and nurse as equal participants.
The nurse is providing instructions to a client about performance of breast self-examination. What learning outcome would be most appropriate regarding this education? A) The client will demonstrate self-efficacy and improved body image. B) The client will have restoration of breast function. C) The client will be able to perform proper breast self-examination for breast cancer detection and prevention. D) The client will demonstrate improved coping skills.
C) The client will be able to perform proper breast self-examination for breast cancer detection and prevention. Explanation: This client education is focused on teaching the client a psychomotor skill for the purpose of early detection of breast cancer. Therefore, an appropriate learning outcome would be that the client is able to perform the skill properly. This client does not have any self-image problems, breast dysfunction, or poor coping skills, so outcomes related to these issues would not be appropriate.
While applying dressings to a client's wound, the nurse teaches the client about wound care. To promote the most effective teaching-learning relationship with this client, what would be most important for the nurse to keep in mind? A) Nurses are experts who generously bestow knowledge upon clients. B) Nurses barter knowledge of medication with the client for compliance. C) The nurse and client relationship is based on mutual sharing and negotiation. D) Nurses have control over the client because of their knowledge and expertise.
C) The nurse and client relationship is based on mutual sharing and negotiation. Explanation: When providing nursing care, the teaching-learning relationship between the nurse and client is special, characterized by mutual sharing, advocacy, and negotiation. Effective learning occurs when clients and health care professionals are equal participants in the teaching-learning process. Unlike some traditional views, nurses are not experts who generously bestow knowledge upon clients, nor do they barter knowledge for compliance. Both images represent the relationship as a power imbalance in which nurses, because of their knowledge and expertise, control the situation.
Which client would be the best candidate for the nurse to engage in motivational interviewing? A) A 38-year-old client training to walk a half marathon B) A 44-year-old client who brought a food log to weight loss counseling C) A 66-year-old client who is showing improvement in range of motion D) A 28-year-old client with elevated blood glucose for 8 months
D) A 28-year-old client with elevated blood glucose for 8 months Explanation: Clients who are working on improving their health and physical condition are already motivated and do not need motivational interviewing, such as the client who is training to walk a half marathon, the client who brings a food log to weight loss counseling, and the client who is showing improvement in range of motion. However, a client who has not shown positive changes in months, such as the client whose blood glucose level has remained elevated for 8 months, may benefit from motivational interviewing. The client's age has no bearing on whether the client would be a good candidate for motivational interviewing.
A nurse is counseling several clients for depression. Four of them do not seem to be improving, which leads the nurse to suggest a referral to a psychiatric nurse practitioner. Which of these clients would be most likely to attend the scheduled appointment? A) A 45-year-old female who is unsure of the benefit of psychiatric care, on a fixed income, and has good family support B) A 51-year-old male who walks to most places because of a lack of transportation, has a low income, and works days C) A 36-year-old male who uses public transportation, is unable to read, and wants to confer with a pastor D) A 28-year-old female who works nights, is willing to try, and asks about insurance coverage of the appointment
D) A 28-year-old female who works nights, is willing to try, and asks about insurance coverage of the appointment Explanation: Cultural issues, a low income, poor family support, and lack of transportation are potential barriers to obtaining needed care. If a client must choose between work and keeping an appointment, scheduling is an important factor. The characteristics of a client who will keep appointments with specialists include those clients who have been well educated about the importance of the referral, understand the benefit to seeing a specialist, and will not have to struggle to keep the appointment. A client who agrees, who has input in scheduling, and shows curiosity or hope about the benefit of the referral is more likely to keep the appointment.
The nurse must instruct a 35-year-old client with Down syndrome about the use of an albuterol rescue inhaler. Which documentation demonstrates appropriate individualization of the education plan for this client? A) Taught lesson at a school-age developmental level in an authoritarian style while the client was at meal time B) Taught lesson at an adult developmental level (age 35) using short sentences and assessed motor skills C) Assessed the client's understanding of health and answered questions on an age-appropriate level while the television was on in the room D) Assessed the client's understanding of illness; assessed motor skills and developmental stage; provided clarification
D) Assessed the client's understanding of illness; assessed motor skills and developmental stage; provided clarification Explanation: Distractions to learning, such as the television being on or the client being at meal time, diminish the effectiveness of any education plan. An authoritarian style of teaching does not honor the client as a partner in the learning process. Age does not necessarily determine developmental stage. Assessing the client's developmental stage and understanding of the health problem, clarifying information that is difficult for the client to understand, and ensuring that the client is physically able to perform the task are all aspects of a well-planned education session for all clients.
The parents of a school-age child are meeting with the nurse for health promotional education for their child. The child has the following assessment data: a 7-year-old male with diabetes mellitus type 1 with a hemoglobin A1C level of 8.3%, a body mass index (BMI) of 31.7, and a BMI percentile of 99. What are the most appropriate learning diagnoses for this first session? A) Deficient Knowledge: Readiness for enhanced nutrition, and risk for disturbed body image. B) Deficient Knowledge: Risk for chronic low self esteem, and risk for unstable blood glucose level. C) Deficient Knowledge: Risk for imbalanced nutrition: more than body requirements, and sedentary lifestyle. D) Deficient Knowledge: Imbalanced nutrition: more than body requirements, and ineffective health maintenance.
D) Deficient Knowledge: Imbalanced nutrition: more than body requirements, and ineffective health maintenance. Explanation: The data present for the nurse to use for planning the educational session do not give enough information to determine the parents' concepts of their child's health. Before making judgments on their readiness to learn, the nurse must assess them. There are not enough data to support sedentary lifestyle. When making a diagnosis, do not address actual problems as risks. With the hemoglobin A1C level of 8.3%, the nurse knows that the client's glucose control is an actual problem, as is a BMI of 31.7 and a BMI percentile of 99. The assessment data on the client do reflect enough data to make the learning diagnoses of imbalanced nutrition and ineffective health maintenance.
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 the device. The client states, "I'm just too old to learn." What would be most appropriate for the nurse to do to motivate this client? A) Tell the client how to move the walker as the client 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.
D) Describe how the walker can improve the client's quality of life. Explanation: Motivating the older adult client can be done by showing the client how the new knowledge will improve the client's 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.
A home health nurse states to her client, "I am very proud of you. You gave your first insulin injection without a problem. You have done wonderfully and are learning fast." What technique is the nurse using to compliment the client's progress? A) Reinforcement B) Motivation C) Health promotion D) Positive feedback
D) Positive feedback Explanation: Important keys to success when evaluating learning are consistent, immediate, and frequent positive reinforcement, and teaching a small number of skills at any one time, thus creating a high possibility that the learner will master them. Positive reinforcement is also known as positive feedback, which is what the nurse is providing in this case. Negative reinforcement or feedback would be attempting to change a client's behavior by pointing out and criticizing or even punishing mistakes or undesirable behaviors. Motivation refers to the client's desire to learn or make a change. Health promotion is a topic that may be covered in client teaching and that pertains to optimizing one's health through maintaining proper nutrition, exercise, and hygiene.
A client is reluctant to learn to do finger sticks for home international normalized ratio (INR) monitoring. What is the best statement by the nurse? A) Are you worried about the pain? B) Why don't you want to do this? C) Most people are afraid of sticking themselves. D) Tell me what you know about these tests.
D) Tell me what you know about these tests. Explanation: Saying something to encourage the client to openly discuss personal issues is the best option. Assessing worry about pain narrows the client's answer to only addressing pain. Asking "why" questions may be considered probing or accusatory and tends to block communication. Generalizing the client's fear is belittling. Assessing the client's perceptions about checking the INR opens up the discussion about the client's barrier to learning to perform this test.
A nurse is writing learner objectives for a client who was recently diagnosed with type 2 diabetes. Which statement best describes the proper method for writing objectives? A) The nurse writes one or two broad objectives rather than several specific objectives. B) The nurse writes general statements for learner objectives that could be accomplished in any amount of time. C) The nurse plans learner objectives with another nurse before obtaining input from the client and family. D) The nurse writes one long-term objective for each diagnosis, followed by several specific objectives.
D) The nurse writes one long-term objective for each diagnosis, followed by several specific objectives. Explanation: The statement that best describes the proper method for writing objectives would be that the nurse writes one long-term objective for each diagnosis, followed by several specific objectives. The nurse would not use general statements that could be accomplished in any amount of time because this action is not addressing the specific needs of the client, and the setting in which the client is in. The nurse would not plan learner objectives with another nurse and would not always obtain input from the family of the client. The objectives need to be specific so the outcomes can be measured in the evaluation phase.
The nurse is caring for a client who demonstrates a health literacy concern. The nurse adjusts client teaching in which way? A) uses medical terminology to help the client feel smarter B) provides general teaching instead of specificity regarding diagnosis C) gives instructions in multiple ways so the client will understand D) uses videos, diagrams, and pictures rather than focusing on verbal teaching
D) uses videos, diagrams, and pictures rather than focusing on verbal teaching Explanation: To address health literacy concerns, the nurse should avoid technical language, limit information to three to five key points, and be specific rather than general. Using medical terminology to help the client feel smarter, providing general teaching instead of specific teaching, and giving instructions in multiple ways are not effective ways to adjust client teaching for those who demonstrate low health literacy.
The nurse is assisting a client 55 years of age to understand the anatomy and physiology of the heart following a heart attack. What type of learning is taking place? A) Andragogy B) Pedagogy C) Psychomotor D) Affective
A) Andragogy Explanation: Andragogy is the art and science of helping adults learn. Pedagogy is the academic discipline that deals with the theory and practice of teaching and how these influence student learning. Psychomotor learning is demonstrated by physical skills such as movement. Affective learning is growth in feelings or emotional areas (attitude or self).
The client reports to the clinic as ordered by the primary care provider for counseling on weight loss to improve overall health. The client received printed information in the mail to review before the session, and reports having read through it before the appointment. Which client statement alerts the nurse to a need for clarification and further education? A) "I can lower my blood pressure by losing weight." B) "Osteoarthritis in my knees may be because of my weight." C) "I can monitor my caloric intake by measuring portions." D) "I will be doing well if I lose between 5 and 10 lb (2.3 and 4.5 kg) per week."
D) "I will be doing well if I lose between 5 and 10 lb (2.3 and 4.5 kg) per week." Explanation: Blood pressure can be reduced with weight loss. Osteoarthritis may be caused by destruction of cartilage from the pressure on the knee joints caused by excessive weight. Measuring portions is essential to understanding caloric intake. Healthy weight loss is generally accepted as 1 to 2 lb (0.45 to 0.90 kg) per week, or a reduction of 500 to 1,000 calories per day, which includes decreased intake of foods and burning calories with exercise.
When teaching a client, the nurse notices the client tends to lose focus easily. The nurse would adapt client teaching in which way? A) Request family members to serve as translators. B) Provide less health teaching because of the language barrier. C) Elongate the teaching session to be sure the client understands. D) Talk with animation and vocal inflection to stimulate the client aurally.
D) Talk with animation and vocal inflection to stimulate the client aurally. Explanation: Talking with animation and vocal inflection to stimulate the client is effective for keeping the client's attention when the client loses focus. It is not appropriate to request family members to serve as translators, provide less teaching due to communication barriers, or elongate the teaching session.
The nurse is conducting a community health promotion class and has developed scenarios that will involve active participation by the class attendees. What type of education strategy is the nurse incorporating into this class? A) Role-playing B) Role modeling C) Programmed instruction D) Panel discussion
A) Role-playing Explanation: Role-playing allows the learner to experience, relive, or anticipate an event. The nurse explains the scenario and then allows the individual to play out the scene. Role modeling involves a nurse's behaviors and the client observing and learning from these behaviors. Programmed instruction incorporates the use of books as the instructor, independent of study with a teacher. A panel discussion involves a presentation of information by two or more people.
A nurse is educating a client with a new diagnosis of diabetes. Which example demonstrates cognitive learning by the client? A) The client describes signs and symptoms of hypoglycemia. B) The client demonstrates proper technique for injecting insulin. C) The client expresses a desire to improve nutritional intake and lose weight. D) The client prepares the skin for the administration of an insulin injection.
A) The client describes signs and symptoms of hypoglycemia. Explanation: The client's ability to describe the signs and symptoms of hypoglycemia demonstrates cognitive learning (the storing and recalling of new knowledge in the brain). Demonstrating a skill, such as insulin injection, is an example of psychomotor learning. Affective learning includes changes in attitudes, values, and feelings (e.g., desire to lose weight).
A nurse evaluates whether a middle-age client with chronic back pain has been performing the different exercises and physiotherapy procedures recommended by the physician. What would the nurse most likely use to evaluate the client? A) Written test B) Oral test C) Return demonstration D) Simulation
C) Return demonstration Explanation: The nurse is evaluating psychomotor skills; thus, a return demonstration, which is a method of testing skill performance, would be the most appropriate method for evaluating the client's learning. Written tests are time-consuming, intimidating, and not always specific to the client. Oral tests can be useful in testing cognitive learning. Simulation evaluates whether the client can apply learning in different situations, but not the ability to perform the exercises.
Which documentation example best reflects the complexity of client teaching by the nurse? A) "Told client to take antibiotic as ordered." B) "Client return demonstrated how to use glucometer." C) "Taught client about peak flows; client verbalized understanding." D) "Client and spouse taught how to use phone app to count carbohydrates; client return demonstrated carb counting for a hypothetical meal."
D) "Client and spouse taught how to use phone app to count carbohydrates; client return demonstrated carb counting for a hypothetical meal." Explanation: The nurse should document who the teaching was provided to, what was taught, the teaching method, and the evidence of learning. The other answer choices are not as comprehensive and, therefore, are not the best examples of teaching.
