Fundamentals HESI Prep-Ch 25-Patient Education and the Nursing Process

The nurse is teaching dietary modifications to a group of people with heart disease. Which action by the nurse would maintain the attention and participation of the class? Select all that apply. One, some, or all responses may be correct.

ANS: (1) Making eye contact (2)Using gestures (4)Asking questions Active participation and attention is essential for learning to happen. The nurse should make eye contact with the listeners to increase their interest. Using gestures and engaging the listeners by asking questions help maintain the attention level of the participants. Being stationary and using a single tone while talking decreases the interest and attention of the listeners.

While teaching a patient, the nurse determines that the patient is not able to read above the fifth-grade level. This describes which inability?

ANS: Functional illiteracy Functional illiteracy is the inability to read above the fifth-grade level and is a major problem in America. Health literacy involves the cognitive and social skills that determine the motivation and ability of individuals to use information to promote good health. Health illiteracy is a lack of health literacy. A learning disability is the inability of an individual to learn new things because of various factors.

Which statement made by the nursing student indicates effective learning regarding learning resources for patient education?

ANS: "I need to determine the availability of teaching tools." Determining the availability of teaching tools helps the nurse assess learning resources during patient education. Assessing the patient's desire to learn helps identify the patient's motivation. The nurse should assess skills needed by the patient to perform self-care while determining learning needs. The patient's cognitive function is assessed to determine his or her ability to learn.

A patient who was on chemotherapy is taking a new medication, which is available in a prefilled syringe and is given subcutaneously. Which statement by the patient helps the nurse individualize the teaching plan?

ANS: "I used to administer subcutaneous injections to my father." The nurse individualizes the teaching plan by building on the patient's previous knowledge and experience with insulin injections. Instructions regarding administration of the medication help the patient use it safely, but do not help individualize the teaching based on previous experience. Knowing the benefits of the medication helps reduce patient anxiety, but this knowledge would not be used to individualize the teaching plan. Patients prescribed the same medications may or may not require the same teaching strategies. Learning about other patients' experiences with the medication would not be considered to individualize the teaching plan.

During which step of the teaching process does the nurse determine the outcomes of teaching and measure a patient's level of achievement of learning objectives?

ANS: Evaluation During the evaluation phase, the nurse can determine the outcomes of teaching and measure a patient's achievements of learning objectives. The nurse can also reinforce information if needed. In the assessment phase, the nurse gathers information about and identifies the patient's learning needs based on data and three domains of learning. In the planning phase, the nurse and the patient collaborate to set a teaching plan. Implementation involves carrying out the teaching methods and actively involving the patient in the teaching process.

During a teaching session, a parent approaches the nurse for advice about managing a child's temper tantrums. The nurse enacts the role of the child to evaluate the parent's response to the child's behavior. The nurse is using which instructional method to teach the parent?

ANS: Role play During role play, people are asked to play themselves or someone else. Patients learn required skills and feel more confident in being able to perform them independently. Analogies supplement verbal instruction with familiar images that make complex information more real and understandable. Simulation is a useful technique for teaching problem solving, application, and independent thinking. During individual or group discussions, the nurse poses a pertinent problem or situation for patients to solve. Demonstration is used when teaching psychomotor skills, such as preparing a syringe, bathing an infant, crutch walking, or taking a pulse.

The nurse is teaching a parenting class to a group of pregnant adolescents. The nurse pretends to be the baby's father, and the adolescent mother is asked to show how she would respond to the father if he gave her a can of beer. Which teaching approach did the nurse use?

ANS: Role play In role play people are asked to play themselves or someone else in a situation to enhance their confidence in handling similar situations in the future. Discovery learning allows a patient to actively apply knowledge in a controlled environment. Analogy learning is when the nurse translates complex concepts into concepts the learner understands. Demonstration occurs when the nurse shows the patient how to do something, such as how to draw up insulin.

Which teaching approach would be effective for informing a patient of an emergency appendectomy and the postoperative recovery he or she will experience?

ANS: Telling The telling approach should be used for teaching when limited information is taught. It is more effective for the patient experiencing anxiety. Participating involves the nurse and patient working together to achieve learning objectives. Entrusting gives the patient the opportunity to manage self-care, and the patient accepts the responsibility. Reinforcement is using some stimulus to increase the probability of a response.

A patient diagnosed with colorectal cancer underwent surgery for removal of the cancerous tissue. The nurse teaches the patient about medications, exercises, and self-care techniques. The patient interrupts the nurse, saying that the teaching seems overwhelming and he needs rest. How would the nurse respond?

ANS: "You should rest now. We can discuss this more in the evening." The patient is an older adult who becomes weak after surgery. The patient's cognitive abilities may be reduced. The nurse should respect this and should stop any further teaching temporarily. Asking the patient to listen for a few more minutes would not be useful, because the patient is tired and will not be able to assimilate information. Because the patient has mentioned needing rest, it is not appropriate for the nurse to talk about some other subject. Telling the patient that nothing has been explained until that time and that the explanation should not be overwhelming is disrespecting the patient and his condition.

The nurse is teaching a patient with literacy problems about the steps to be taken before initiating prescribed hypertensive therapy. Which question asked by the nurse helps evaluate the effectiveness of the teaching? Select all that apply. One, some, or all responses may be correct.

ANS: (1)"Can you verbalize the information taught?" (2)"Are you able to demonstrate the teaching?" (3)"How does your illness affect your current lifestyle?" (4)"What do you know about your illness and your treatment plan?" Asking patients to verbalize understanding of information taught, observing, and evaluating a patient's ability to perform desired behaviors or demonstrate learned procedures help determine the patient's level of understanding. Asking questions about the effects of an illness on lifestyle is a nursing assessment for self-management. It allows the patient to verbalize potential barriers to therapy and thereby helps evaluate the effectiveness of the therapy. Asking about the illness and the treatment plan also helps evaluate the effectiveness of the teaching. Asking the patient about the involvement of his or her family member in the management of an illness and asking about similar past experiences are nursing assessment questions to determine previous learning and identify learning needs and preferences.

Which principle should be followed when using analogies? Select all that apply. One, some, or all responses may be correct.

ANS: (1)Being familiar with the concept (3)Keeping the analogy simple and clear (5)Knowing the patient's background, experience, and culture Using analogies is an instructional method of teaching patients about concepts that are not easily understood by explaining verbally. The principles the nurse should follow when using analogies include being familiar with the concept, keeping the analogy simple and clear, and knowing the patient's background, experience, and culture. The role play technique is an institutional method of teaching that involves rehearsing a desired behavior. Outlining the task that should be performed by the patient with explicit instructions is a general teaching approach, not a principle for using analogies.

Which consideration would the nurse take when teaching self-administration of insulin injections to a group of patients with diabetes? Select all that apply. One, some, or all responses may be correct.

ANS: (1)Encourage patients to ask questions. (3)Perform the steps in the right sequence. (4)Position the patients to provide a clear view of the skill being performed. While performing a demonstration, the nurse should encourage patients to ask questions. The nurse should perform the steps of the activity in the right sequence so patients learn the right technique. The patients should be positioned to provide a clear view of the skill being performed. Repositioning would help patients view the whole procedure correctly and practice accordingly. The nurse should not rush to complete the demonstration and should give ample time for demonstrating each step. The nurse should encourage patients to repeat the activity after the demonstration under the nurse's observation.

Which teaching principle would be appropriate when teaching a group of patients with heart disease how to plan a meal? Select all that apply. One, some, or all responses may be correct.

ANS: (2)Simulating (5)Maintaining learning attention and participation Simulation is a useful technique for teaching problem solving, application, and independent thinking. During individual or group discussions, the nurse poses a pertinent problem or situation for patients to solve. An effective educator maintains learners' attention and participation, and engages them by talking and moving among a group rather than remaining stationary behind a lectern or table. The telling approach is used to teach individual patients limited information, such as preparing a patient for an emergent diagnostic procedure. Building a care plan on existing patient knowledge is completely individualized and would not be taught in a group setting. Incorporating teaching with nursing care is an informal, unstructured style that relies on the positive therapeutic relationship between nurse and patient. This principle would not be used to teach patients in a group.

Which screening tool can be used to test literacy? Select all that apply. One, some, or all responses may be correct.

ANS: (2)Wide Range Achievement Test (WRAT 3) (4)Cloze test (5)Rapid Estimate of Adult Literacy in Medicine (REALM) The WRAT 3, cloze test, and REALM tool can be used to test literacy. The WRAT 3 evaluates reading, spelling, and arithmetic skills. The cloze test is a test for reading comprehension. The REALM tool determines reading levels by using pronunciation of health care terms. TJC's Speak Up Initiatives help patients understand their rights when receiving health care but do not test health literacy. The NAALS is a survey conducted to assess the extent of health literacy in America.

Which example is appropriate when teaching the reinforcement approach? Select all that apply. One, some, or all responses may be correct.

ANS: (3)Giving a child candy once the child has completed a given activity (5)Asking a child to perform an activity and congratulate the child on performing the activity well Reinforcement requires using a stimulus that increases the probability of a response. Giving a piece of candy is an example of material reinforcement and works best with children. Appreciating performance is an example of social reinforcement. Demonstrating an activity is the demonstration method of instruction. While preparing a patient for an emergency procedure, the nurse explains the procedure to the patient. Allowing a patient with diabetes to adjust his or her insulin dosage independently is an entrusting approach to teaching.

A patient diagnosed with coronary artery disease (CAD) has deficient knowledge related to the illness and its implications. Which teaching is a priority for the patient? Select all that apply. One, some, or all responses may be correct.

ANS: (3)Medication (5)Intervention for chest pain The nurse should set priorities for patient education based on the patient's needs. When the patient has deficient knowledge about the illness and its implications, the nurse teaches the patient how to take medication and interventions for chest pain, because these are immediate needs. Teaching about exercises, dietary changes, and home care can be performed after teaching about the illness and the medication.

The nurse is assessing the patient's learning needs and abilities. Which factor would affect the ability of a patient to learn optimally? Select all that apply. One, some, or all responses may be correct.

ANS: (3)Physical (4)Hearing deficit (5)Shortness of breath The patient should have the required physical strength to complete the tasks to be learned. A hearing deficit would affect the teaching process because the patient would not fully understand the teacher. Physical discomfort such as shortness of breath will prevent the patient focusing on the teaching process. Behavior and health beliefs are the factors that affect the motivation of the patient to learn.

Which intervention would the nurse employ while teaching an older adult about a new antiasthmatic medication? Select all that apply. One, some, or all responses may be correct.

ANS: (3)Present only the most significant information. (5)Establish personalized, realistic short-term learning goals. When teaching an older adult, the nurse should present only the most significant information to avoid overwhelming the learner. Repetition to reinforce content also helps the learner retain the information. Establishing personalized, realistic short-term learning goals is a strategy to facilitate learning when providing patient education to older adults. Learning in an older adult can be facilitated by creating a casual and relaxed learning environment; it is not necessary to speak loudly, and doing so may contribute to the patient's anxiety. While giving instructions or teaching a new skill to older adults, give concise step-by-step directions instead of presenting the information at once. When teaching older adults using visual aids, avoid blues and greens, because these colors can become more difficult to be distinguished with age.

The nurse would employ which action to maintain the attention and participation of learners attending a disease-prevention workshop? Select all that apply. One, some, or all responses may be correct.

ANS: (3)Use gestures that accentuate key points of discussion. (5)Actively talk about the topic and move among the group. Maintaining learners' attention and participation is a key principle of teaching and learning. An educator can increase learner attention and interest by using gestures that accentuate key points of discussion, remaining actively enthusiastic about the subject, and talking and moving among a group rather than remaining stationary behind a lectern or table. Incorporating teaching with nursing care involves teaching the learner while simultaneously providing care. Teaching during routine care is efficient and cost-effective. Participation as a teaching approach involves the educator directly participating in the learning process along with the learner. Building on existing knowledge involves assessing learners' previous knowledge about the topic.

A nurse describes arterial blood pressure as "like water flowing through a hose." Which teaching technique does this exemplify?

ANS: Analogy Nurses may use analogies to explain difficult concepts with familiar images to make the concepts more real and understandable. Role play involves having the patient pretend to be him- or herself or someone else to rehearse a desired behavior (e.g., a parent rehearsing techniques for getting his or her child to take medicine). Demonstration is used to teach psychomotor skills such as preparing a syringe, bathing an infant, crutch walking, or taking a pulse. Simulation involves giving a patient a scenario and having him or her apply the learning to the situation; for instance, a nurse may give a heart patient a restaurant menu and ask him or her to select the most heart-healthy meal.

The nurse is communicating with a patient diagnosed with acute lymphocytic leukemia. Which patient action indicates the patient is in the resolution stage of psychosocial adaptation?

ANS: Asks questions about his or her treatment or prognosis Patients in the resolution stage realize their illness has created changes and begin to ask questions. The patient who blames others for his or her condition is in the anger stage, not in the resolution stage. A patient in the denial stage does not believe the truth about the disease, may believe everyone is lying, and avoids giving consent for treatment.

Which teaching tool is beneficial for patients with reading comprehension problems and visual deficits?

ANS: Audiovisual materials Audiovisual materials include slides, audiotapes, television, and videotapes used with printed material or discussion. This teaching tool is effective for patients with reading comprehension problems and visual deficits. Graphs are visual presentations of numerical data. They help learners grasp information quickly about single concepts. This teaching tool may not be beneficial to patients with visual deficits. Likewise, using physical objects such as actual equipment, objects, or models to teach concepts or skills may not be beneficial to patients with visual deficits. The computer instruction method requires reading comprehension, psychomotor skills, and familiarity with computers.

A patient is scheduled for coronary artery bypass graft surgery. When is an appropriate time to teach breathing exercises and coughing techniques to this patient?

ANS: Before the surgery Deep breathing and coughing exercises are taught to the patient to prevent respiratory complications after surgery. These should be taught preoperatively so the patient learns the techniques and can perform them properly after surgery. The patient needs to start doing these exercises immediately after surgery. As a result of physical discomfort and fatigue after the surgery, the patient will not be able to learn the exercises properly. Teaching breathing exercises at discharge or during the next visit is inappropriate.

Which teaching tool is suitable for patients who have strong reading comprehension and psychomotor skills?

ANS: Computer instruction Computer instruction requires reading comprehension, psychomotor skills, and familiarity with computers. Physical objects such as actual equipment, objects, or models are used to teach concepts or skills. This teaching tool may not require the patient to have strong reading comprehension skills. Using printed material as a teaching tool requires the patient to have good reading comprehension skills but would not require psychomotor skills. Audiovisual materials include slides, audiotapes, television, and videotapes used with printed material or discussion. This teaching tool is suitable for patients with reading comprehension problems and visual deficits.

Which patient action reflects that the patient is ready to learn how to self-administer a subcutaneous injection?

ANS: Expresses the importance of performing the skill correctly Patients are ready to learn when they understand the importance of performing and are motivated to learn. Describing difficulties a family member has had with taking insulin, the ability to see and understand the markings on the syringe, and dexterity to prepare the medication are important considerations, but they do not demonstrate readiness to learn.

The nurse is educating a 25-year-old about the importance of diet and exercise to manage obesity. Which grade reading level teaching materials should be provided for this patient?

ANS: Fifth Teaching materials written at a fifth-grade reading level are appropriate for a 25-year-old patient because information written at a fifth- to sixth-grade reading level is recommended for adults. First- and third-grade levels are lower than necessary. A seventh-grade reading level is higher than the maximum recommendation for sixth grade.

While teaching pregnant women about nutrition and diet planning, the nurse randomly selects several women and gives them an opportunity to share their diet plans to correct mistakes and reinforce the correct information. The nurse is following which method of teaching?

ANS: Group discussion After a lecture, learners often need the opportunity to share ideas and seek clarification in the form of structured group discussion. Group discussions allow patients and families to learn from one another as they review common experiences. During role play, learners are asked to play themselves or someone else. Patients learn required skills and feel more confident in being able to perform them independently. Demonstrations are used to teach psychomotor skills such as preparing a syringe, bathing an infant, crutch walking, or taking a pulse. During one-on-one discussions, information is usually given in an informal manner, allowing the patient to ask questions or share concerns.

Which topic is of highest priority when teaching a newly diagnosed patient with asthma how to manage the disease?

ANS: How to use an inhaler during an asthma attack It is important to start with essential lifesaving information when teaching people because people usually remember what they are told first. Avoiding smoking, location of purchasing a medical bracelet, and importance of diet and exercise are important but can be taught after the most important, lifesaving information.

The nurse has provided teaching for four patients separately. Which patient is most likely to understand the teaching if the real equipment cannot be used for a demonstration?

ANS: Patient D (Teaching tool - Models) Nurses may use actual equipment, objects, or models to teach concepts or skills. Models are useful when real objects are too small, large, complicated, or unavailable. Computer instruction uses programmed instruction in which the computer stores response patterns for learners and selects further lessons on the basis of these patterns. Computer instruction is not a substitute for a demonstration using real equipment. Printed and online materials are written teaching tools available in print or online as pamphlets, booklets, or brochures. This method is ideal for understanding complex concepts and relationships but is not a substitute for a demonstration using real equipment. Graphs are visual presentations of numeric data. They are represented as bar, circle, or line graphs. Graphs help learners quickly grasp the information about a single concept, but they are not a substitute for a demonstration using real equipment.

Which basic step of the nursing process includes setting priorities based on the patient's immediate needs?

ANS: Planning In the planning phase of the nursing process, priorities are identified based on a patient's needs and expected outcomes. Evaluation involves identifying success or failure in meeting desired outcomes and goals. Assessment involves collecting data about the patient's physical, psychosocial, and spiritual needs. In the implementation step, the nurse performs nursing care therapies.

A nursing student is giving preparatory instructions to a patient undergoing an unfamiliar test. Which preparatory approach by the nursing student indicates the need for further learning?

ANS: Preparing patients for aspects of the experience that are rarely experienced The nurse should prepare the patient only for aspects of the experience that are commonly noticed, such as a tight tourniquet causing a person's hand to tingle and feel numb. The nurse should describe the physical sensations experienced during a procedure, such as the sticking sensation caused as the needle punctures the skin. The nurse should be sure the patient knows when the results will be available and who will give the results of the tests. The nurse should describe the cause of the sensation to prevent misinterpretation of the experience. For example, the nurse should explain that a needlestick burns because the alcohol used to clean the skin enters the puncture site.

Which intervention facilitates effective learning for older adults?

ANS: Speaking in a low tone voice Information should be presented in lower tones because lower tones are easier to hear than higher tones, and many older adults have hearing loss. The nurse may not want to provide all the available information about a chronic illness at one time, because this may overwhelm the patient; instead, the nurse should present only crucial information. The nurse should not provide the information about a chronic illness to the patient's family first, because this is a potential violation of the patient's privacy. Written materials should not be handwritten or printed in blue ink for an older patient, because this may be hard for the patient to read. Many older patients have impaired vision, so materials should be typed using a large font and black ink.

Which teaching approach would the nurse use when providing teaching to a patient about to undergo an emergency cardiac catheterization?

ANS: Telling approach The telling approach is the most appropriate when preparing a patient for an emergency procedure. The selling approach, entrusting approach, and participating approach are not appropriate for an emergency procedure.

Which behavioral objective does the nurse set to measure the patient's ability to perform a breast self-examination?

ANS: The patient will perform breast self-examination correctly on herself before the end of the teaching session. Return demonstration provides an excellent source of feedback and reinforcement to evaluate learning. Verbalizing steps is not as effective as return demonstration. Involving the patient is more effective than the nurse explaining or demonstrating a skill to the patient.