Lewis Ch 4 Patient Teaching ? Only til No. 21

The nurse observes that a client responds better to health education when the nurse motivates him and assures him about the benefits of teaching. In which of the following learning domains does this client's learning style fall? A. cognitive B. affective C. psychomotor D. interpersonal

B. affective

A nurse assisting a new mother in the act of breastfeeding is represented by which form of learning? A. cognitive B. psychomotor C. simplistic D. affective

B. psychomotor

the patient demonstrates how to change dressings using clean technique is what domain of learning? A. cognitive B. psychomotor C. Affective

B. psychomotor

the patient express renewed self-confidence after physical therapy is what domain of learning? A. cognitive B. psychomotor C. Affective

C. Affective

when caring for a client the nurse observes that the client is having difficulty understanding the health education. Which appropriate action should the nurse take when conducting health education for this client? A. vary the tone and pitch of her voice B. boost the moral of the client C. check for cultural differences D. implement health teaching in parts

C. check for cultural differences

when caring for a client the nurse discovers that the client is unable to read or write. Which of the following teaching approaches is most useful for the client? A. teach to read and write B. keep education sessions short C. use verbal and visual modes D. involve the client in an active way

C. use verbal and visual modes

What is the primary reason why nurses attend continuing education programs? 1. Update professional knowledge 2. Network within the nursing profession 3. Fulfill requirements for an advanced degree 4. Graduate from an accredited nursing program

1. Continuing education programs are formal learning experiences designed to update and enhance professional knowledge or skills. This is necessary because of the explosion in information and technology within health care. Some states require evidence of continuing education units (CEUs) for license renewal.

A nurse is providing health teaching for a patient with a comprehension deficit. Which is the best intervention by the nurse that will support this patient's learning? 1. Establishing a structured environment 2. Asking that unclear words be repeated 3. Speaking directly in front of the patient 4. Making a referral for a hearing evaluation

1. For people who have difficulty with comprehension, participating in a learning program often makes them feel overwhelmed and threatened. The teacher needs to provide a structured environment in which variables are controlled to reduce anxiety and support comprehension. The nurse should minimize ambiguity, provide a familiar environment, teach at the same time each day, limit environmental distractions, and provide simple learning materials.

A nurse uses computer-assisted instruction as a strategy when providing preoperative teaching. The nurse explains to preoperative patients that the greatest advantage of computer-assisted instruction is that: 1. Learners can progress at their own rate 2. It is the least expensive teaching strategy 3. There are opportunities for pre- and post-testing 4. Information is presented in a well-organized format

1. Learners progress through a program at their own pace viewing informational material, answering questions, and receiving immediate feedback. Some programs feature simulated situations that require critical thinking and a response. Correct responses are rationalized, praise is offered, and incorrect responses trigger an explanation of why the wrong answer is wrong and offer encouragement to try again. This is a superior teaching strategy for the learner who may find that group lessons are paced either too fast or too slow for effective learning.

A nurse is assessing a patient to determine educational needs. Which is most important for the nurse to consider? 1. Make no assumptions about the patient 2. Teaching may be informal or formal in nature 3. The teaching plan should be documented on appropriate records 4. A copy of the teaching/learning contract should be given to the patient

1. Many variables influence an individual's willingness and ability to learn (e.g., readiness, motivation, physical and emotional abilities, education, age, cultural and health beliefs, cognitive abilities). Because everyone is unique with individual needs, the nurse must avoid making assumptions and generalizations.

A nurse must implement a teaching plan for a patient recently diagnosed with heart failure. What should the nurse do first? 1. Identify the patient's level of recognition of the need for learning 2. Frame the goal within the patient's value system 3. Determine the patient's preferred learning style 4. Assess the patient's personal support system

1. The learner must recognize that the need exists and that the material to be learned is valuable. Motivation is the most important factor influencing learning.

Which best describes a patient with an external locus of control? Select all that apply. 1. _____ Behaving appropriately to obtain the right to watch a television program 2. _____ Is self-motivated when implementing health promotion behaviors 3. _____ Wants to please family members with efforts to get well 4. _____ Understands the expected outcome of therapy 5. _____ Is a self-actualized adult

1. The person with an external locus of control is motivated by rewards that center on privileges, incentives, or praise received from pleasing significant others or members of the health-care team. Watching television is a privilege in this situation. 3. Pleasing others precipitates feedback that is often viewed as positive by the recipient. Positive verbal or nonverbal communication from another is an external reward.

Every person who attended a smoking cessation educational program completed a questionnaire. What is this type of evaluation called? 1. Survey 2. Post-test 3. Case study 4. Focus group

1. The terms questionnaire and survey are used interchangeably to describe a type of evaluation tool designed to gather data about a topic

A patient asks the nurse, "What does 96 indicate when my blood pressure is 140 over 96?" What is the best response by the nurse? 1. "The 96 is the pressure within an artery when the heart is resting between beats." 2. "The 96 reflects the lowest pressure within a vein when blood moves through it." 3. "Everyone is different so it's really relative to each individual what it means." 4. "Let's talk about the concerns you may have about your blood pressure."

1. This response is simple, is direct, and uses language that is easily understood.

A nurse is planning a teaching plan for an older adult. Which common factor among older adult patients must be considered by the nurse? 1. Learning may require more energy 2. Intelligence decreases as people age 3. Older adults rely more on visual rather than auditory learning 4. Older adult patients are more resistant to change that accompanies new learning

1. Various physiological changes of aging impact on the rate of learning (e.g., declines in sensory perception and speed of mental processing and more time needed for recall), requiring the use of multisensory teaching strategies and a slower approach. In addition, older adults may have less physical and emotional stamina because of more chronic illnesses, so they may require shorter and more frequent learning sessions.

Place the following aspects in the correct order that the nurse should perform them. 1. determine their emotional readiness to learn 2. select educational strategies 3. implement various educational techniques 4. draft learning outcomes 5. revise the learning plan if needed

1. determine their emotional readiness to learn 4. draft learning outcomes 2. select educational strategies 3. implement various educational techniques 5. revise the learning plan if needed

A nurse is teaching a postoperative patient deep breathing and coughing exercises. Which method of instruction is most appropriate in this situation? 1. Explanation 2. Demonstration 3. Video presentation 4. Brochure with pictures

2. A demonstration is the best strategy for teaching a psychomotor skill. A demonstration is an actual performance of the skill by the teacher who is acting as a role model. A demonstration usually is followed by a return demonstration. The learner can imitate the teacher during a return demonstration, ask questions, and receive feedback from the instructor.

A patient is readmitted to the hospital because of complications resulting from nonadherence to the prescribed health-care regimen. What should the nurse do first? 1. Encourage healthy behaviors 2. Develop a trusting relationship 3. Use educational aids to reinforce teaching 4. Establish why the client is not following the regimen

2. A trusting relationship between the patient and the nurse is essential. Patients have to be confident that the nurse will maintain confidentiality, has credibility, and is genuinely interested in their success

A nurse is attending a class about a new intravenous pump presented by the hospital staff education department. What is this type of educational program? 1. Continuing education program 2. Inservice education program 3. Certification program 4. Orientation program

2. Inservice programs generally are provided by health-care agencies to reinforce current knowledge and skills or provide new information about such issues as policies, theory, skills, practice or equipment

A nurse is planning to engage a patient in a program to learn about a newly diagnosed illness. Which psychosocial response to the illness will have the greatest impact on the patient's future success with learning? 1. Fear 2. Denial 3. Fatigue 4. Anxiety

2. Of all the options presented, the patient in denial is the person least ready and motivated to learn. The patient in denial is unable to recognize the need for the learning.

A nurse is assessing a patient's readiness to learn about smoking cessation. Which patient factor does the nurse consider is most important when determining if a teaching program is needed by the patient? 1. Previous experience 2. Perceived need 3. Expectations 4. Flexibility

2. Readiness to learn and motivation, which are closely tied together, are the two most important factors contributing to the success of any learning program. The learner must recognize that the learning need exists and that the material to be learned is valuable.

A nurse is evaluating a patient's learning regarding nutrition. Which behavior reflects the highest level of learning in the cognitive domain? 1. Modifies favorite recipes by eliminating foods that have to be avoided 2. Evaluates the benefits associated with avoidance of certain foods 3. States why a mother's diet may affect breast-feeding 4. Identifies a list of foods to be avoided

2. This is an appropriate example of learning on the evaluation level and is the highest level of learning of the six levels of learning in the cognitive domain.

A nurse is assessing the results of dietary teaching for a patient with diabetes mellitus. What patient behavior indicates that learning occurred in the affective domain? 1. Discusses which food on the ordered diet must be avoided 2. Eats the food on the special diet ordered by the physician 3. Compiles a list of foods that are permitted on the diet 4. Asks about which foods can be eaten

2. This is an example of learning on the valuing level in the affective domain. Valuing is demonstrated when learning is incorporated into the learner's behavior because it is perceived as important. Affective learning involves the expression of feelings and the changing of beliefs, attitudes, or values.

A nurse is teaching a preschool-age child. What teaching method is most appropriate for the nurse to use when teaching a child in this age group? 1. Demonstrations 2. Coloring books 3. Small groups 4. Videos

2. This is the best approach because it requires preschoolers to be active participants in their own learning. In addition, the child has a product to take home and be proud of, it reduces anxiety associated with learning because coloring is an activity most preschoolers are familiar with, and it is within a preschooler's cognitive level.

A nurse is teaching a patient colostomy care in relation to the affective domain. Which teaching method is most effective for this situation? 1. Discussing a pamphlet about colostomy care from the American Cancer Society 2. Exploring how the patient feels about having a colostomy 3. Providing a demonstration on how to do colostomy care 4. Showing a videotape demonstrating colostomy care

2. This option reflects learning in the affective domain. Affective learning is concerned with feelings, emotions, values, beliefs, and attitudes about the colostomy

A teaching-learning concept basic to all teaching plans is to present content from the: 1. Cognitive to the affective domain 2. Formal to the informal 3. Simple to the complex 4. Broad to the specific

3. Complex material is best learned when easily understood aspects of the topic are presented first as a foundation for the more complex aspects. When moving from the simple to the complex, a person works at integrating and incorporating the less complex, new learning into one's body of knowledge and understanding before moving on to more complex information.

A nurse is planning teaching about weight reduction strategies to an obese patient. Before implementing the teaching plan the nurse first should assess the patient's: 1. Intelligence 2. Experience 3. Motivation 4. Strengths

3. If the patient does not recognize the need to learn or value the information to be learned, the patient will not be ready to learn.

A school nurse is teaching a class of adolescents about avoiding smoking and includes role-playing as a creative learning activity. What is the primary reason for using role-playing? 1. Provides more fun than other methods 2. Eliminates the need for media equipment 3. Requires active participation by the learner 4. Gives the learner the opportunity to be another person

3. Learning activities that actively engage the learner have been shown to be more effective as well as more fun than methods that do not actively engage the learner. When learners are actively involved, they assume more responsibility for their own learning and develop more self-interest in learning the content.

Which word best describes the nurse's role when functioning as a teacher? 1. Provide 2. Comfort 3. Empower 4. Collaborate

3. The purpose of teaching patients is to ensure that they have the knowledge and authority to respond most effectively to their own situation.

A nurse educator designed various educational programs that employ role-playing as a teaching strategy. Which group of people should the nurse anticipate will benefit the most from role-playing? 1. Older adults preparing to retire from the workforce 2. Men unwilling to admit that they have a drinking problem 3. Adolescents learning to abstain from recreational drug use 4. Middle-aged adults preparing for total-knee replacement surgery

3. This group should benefit most from role-playing. Role-playing provides a safe environment in which to practice interpersonal skills. It enables the adolescen to rehearse what should be said, learn to respond to the emotional environment, and experience the pressures of the person playing the peer using drugs.

Which behavior identified by the nurse indicates the highest level of learning in the psychomotor domain? 1. Demonstrating a well-balanced stance with crutches 2. Identifying the correct equipment that is needed for a colostomy irrigation 3. Performing a dry sterile dressing change without contaminating the equipment 4. Recognizing the difference between systolic and diastolic blood pressure sounds

3. This option reflects the highest level of learning of the options offered. When a person achieves the ability to perform a behavior that requires a complex movement pattern with confidence, learning has been achieved on the complex-overt response level of learning in the psychomotor domain

A nurse is teaching a patient with a hearing impairment. What should the nurse do? 1. Limit educational sessions to 10 minutes 2. Provide information in written format 3. Use at least 2 teaching methods 4. Teach in group settings

3. Varieties of teaching methods facilitate learning because multiple senses are stimulated. When we see, hear, and touch, learning is more effective than when we see or hear alone. In addition, research demonstrates that we remember only 10% of what we read, 20% of what we hear, 30% of what we see, 50% of what we see and hear, and 80% of what we say and do.

A nurse is teaching a patient recently diagnosed with diabetes mellitus the step-by step procedure of administering an insulin injection. However, after two sessions the patient is still reluctant to self-administer the insulin. What should the nurse do? 1. Have the patient administer the injection to an orange 2. Keep reinforcing the principles that have been presented 3. Give the patient an opportunity to explore concerns about the injection 4. Determine if a member of the family is willing to administer the insulin

3. When a teaching plan is ineffective the nurse must gather more data and revise the teaching plan to achieve the desired goal.

A nurse is preparing a patient with a colostomy for discharge. What patient outcome indicates that learning has occurred in the psychomotor domain? 1. Accepts the need to have a colostomy 2. Understands why certain foods should be avoided 3. Verbalizes the rationale for daily colostomy irrigations 4. Changes a colostomy bag without contaminating the hands

4. Changing a colostomy bag without contaminating the hands is an example of learning in the psychomotor domain. Learning in the psychomotor domain is related to mastering a skill and requires motor activity.

A nurse is to provide nutritional counseling for an older adult. What should the nurse do first? 1. Plan educational sessions in the late afternoon 2. Speak louder when talking 3. Provide large-print books 4. Assess for readiness

4. If the patient does not recognize the need to learn or value the information to be learned, the patient will not be ready to learn.

A culturally competent nurse is planning to teach a patient about a new regimen of self-care. What must the nurse assess first about the patient before implementing the teaching plan? 1. Religious affiliation 2. Support system 3. National origin 4. Health beliefs

4. Individuals have their own beliefs associated with cultural health practices, faith beliefs, diet, illness, death and dying, and lifestyle, which all have a major impact on health beliefs.

A nurse is designing a teaching-learning program for a patient who is to be discharged from the hospital. What should the nurse do first? 1. Identify the patient's locus of control 2. Use a variety of teaching methods appropriate for the patient 3. Formulate an achievable, measurable, and realistic patient goal 4. Assess the patient's current understanding of the content to be taught

4. Learners bring their own lifetimes of learning to the learning situation. The nurse needs to customize each teaching plan, capitalize on the patient's previous experience and knowledge, and identify what the patient still needs to know before teaching can begin.

To be most effective, at what grade reading level should the nurse prepare educational medical material? 1. Fourth-grade 2. Eighth-grade 3. Tenth-grade 4. Sixth-grade

4. Randomized studies demonstrate that the average reading level of individuals who need health teaching is 6.8 grades of schooling.

A nurse is teaching an older adult how to perform a dressing change. Which nursing action is most important to address a developmental stress of aging? 1. Speak louder when talking to the patient 2. Use terminology understandable to the patient 3. Have the patient provide a return demonstration 4. Allow more time for the patient to process information

4. Reaction time will slow with aging; therefore, older adults need more time to process and respond to information or perform a skill. In addition, some older adults may have less energy, experience more fatigue, and may need shorter, frequent learning sessions.

A nurse is planning a weight reduction program with an obese patient. What should the nurse anticipate will be the most important component that will determine the success or failure of this plan? 1. Rewarding compliant behavior with favorite foods 2. Encouraging at least 1 hour of exercise daily 3. Using an 800-calorie daily dietary regimen 4. Setting realistic goals

4. Setting realistic goals is important to the success of a weight-loss plan. Because achieving success is dependent largely on motivation, the teacher and patient should design goals that demonstrate immediate progress or growth. One strategy is to design numerous realistic short-term intermediary goals that are achieved more easily than one long-term goal.

A nursing instructor is evaluating a student nurse's knowledge. Which student behavior indicates that learning has occurred in the highest level of learning in the cognitive domain? 1. Identifies the expected properties of urine 2. Explains the importance of producing urine 3. Recognizes when something is contaminated 4. Interprets laboratory results of diagnostic urine testing

4. This is the highest level of learning in the cognitive domain of the choices offered. Interpretation of laboratory results of urine testing reflects learning on the analysis level, which is the fourth of six levels of learning in the cognitive domain.

A patient tells the nurse that she enjoys talking with others and sharing experiences, but easily falls asleep when reading. Which teaching strategy would be most effective with this patient? A. Group teaching B. Discussion supplemented with computer programs C. Lecture-discussion D. Role play

A

Which technique is most appropriate when using motivational interviewing with a patient who tells you that he is ready to start a weight loss program? A. Focus on the patient's strengths to support his optimism that he can successfully lose weight. B. Ask a prescribed set of questions to increase the patient's awareness of his dietary behaviors. C. Confirm that the patient is serious about losing weight. D. Insist that the patient consider an organized group weight loss program.

A

A client age 8 years has just been diagnosed with insulin dependent diabetes. What type of learning will the nurse focus os? A. evaluative B. affective C. andragogy D. pedagogy

D. pedagogy

A nurse is caring for a client 72 with arthritis. Which action is the highest priority for the nurse when conduction the health education for the client? A. find out what the client wants to know B. provide an environment conducive to learning. C. divide info into manageable amounts D. identify how long the teaching season will last

A. find out what the client wants to know reasoning: shows personal interest, which facilitates better learning to an adult client

When the nurse instructs a client about self-examination, the primary purpose of the client education is what? A. illness prevention B. promotion of coping C. restoration of function D. wellness promotion

A. illness prevention

The hospital nurse implements a teaching plan to assist an older patient who lives alone to independently accomplish daily activities. How would the nurse best evaluate the patient's long-term response to the teaching? a. Make a referral to the home health nursing department for home visits. b. Have the patient demonstrate the learned skills at the end of the teaching session. c. Arrange a physical therapy visit before the patient is discharged from the hospital. d. Check the patient's ability to bathe and get dressed without any assistance the next day.

ANS: A A home health referral would allow for the assessment of the patient's long-term response after discharge. The other actions allow evaluation of the patient's short-term response to teaching.

A middle-aged patient who has diabetes tells the nurse, "I want to know how to give my own insulin so I don't have to bother my wife all the time." What is the priority action of the nurse? a. Demonstrate how to draw up and administer insulin. b. Discuss the use of exercise to decrease insulin needs. c. Teach about differences between the various types of insulin. d. Provide handouts about therapeutic and adverse effects of insulin.

ANS: A Adult education is most effective when focused on information that the patient thinks is needed right now. All of the indicated information will need to be included when planning teaching for this patient, but the teaching will be most effective if the nurse starts with the patient's stated priority topic.

A patient with newly diagnosed colon cancer has a nursing diagnosis of deficient knowledge about colon cancer. The nurse should initially focus on which learning goal for this patient? a. The patient will select the most appropriate colon cancer therapy. b. The patient will state ways of preventing the recurrence of the cancer. c. The patient will demonstrate coping skills needed to manage the disease. d. The patient will choose methods to minimize adverse effects of treatment.

ANS: A Adults learn best when given information that can be used immediately. The first action the patient will need to take after a cancer diagnosis is to choose a treatment option. The other goals may be appropriate as treatment progresses.

A family caregiver tells the home health nurse, "I feel like I can never get away to do anything for myself." Which action is best for the nurse to take? a. Assist the caregiver in finding respite services. b. Assure the caregiver that the work is appreciated. c. Encourage the caregiver to discuss feelings openly with the nurse as needed. d. Teach the caregiver that family members can also provide excellent patient care.

ANS: A Respite services allow family caregivers to have time away from their caregiving responsibilities. The other actions may also be helpful, but the caregiver's statement clearly indicates the need for some time away.

The nurse educator teaches students how to be more assertive. Which teaching strategy, if implemented by the nurse educator, would be most effective? a. Role playing b. Peer teaching c. Printed materials d. Lecture-discussion

ANS: A Role playing allows the students to practice assertive behavior and receive feedback about how the behavior is perceived. Lecture-discussion, peer-teaching, and printed materials are more useful for other learning needs.

A patient states, "I told my husband I wouldn't buy as much prepared food snacks, so I will go the grocery store to buy fresh fruit, vegetables, and whole grains." When using the Transtheoretical Model of Health Behavior Change, the nurse identifies that this patient is in which stage of change? a. Preparation b. Termination c. Maintenance d. Contemplation

ANS: A The patient's statement indicating that the plan for change is being shared with someone else indicates that the preparation stage has been achieved. Contemplation of a change would be indicated by a statement like "I know I should exercise." Maintenance of a change occurs when the patient practices the behavior regularly. Termination would be indicated when the change is a permanent part of the lifestyle.

The nurse prepares written handouts to be used as part of the standardized teaching plan for patients who have been recently diagnosed with diabetes. What statement would be appropriate to include in the handouts? a. Eating the right foods can help in keeping blood glucose at a near-normal level. b. Polyphagia, polydipsia, and polyuria are common symptoms of diabetes mellitus. c. Some diabetics control blood glucose with oral medications, injections, or nutritional interventions. d. Diabetes mellitus is characterized by chronic hyperglycemia and the associated symptoms than can lead to long-term complications.

ANS: A The reading level for patient teaching materials should be at the 5th grade level. The other responses have words with three or more syllables, use many medical terms, and/or are too long.

The nurse and the patient who is diagnosed with hypertension develop this goal: "The patient will select a 2-gram sodium diet from the hospital menu for the next 3 days." Which evaluation method will be best for the nurse to use when determining whether teaching was effective? a. Have the patient list substitutes for favorite foods that are high in sodium. b. Check the sodium content of the patient's menu choices over the next 3 days. c. Ask the patient to identify which foods on the hospital menus are high in sodium. d. Compare the patient's sodium intake before and after the teaching was implemented.

ANS: B All of the answers address the patient's sodium intake, but the desired patient behaviors in the learning objective are most clearly addressed by evaluating the sodium content of the patient's menu choices.

After the nurse provides dietary instructions for a patient with diabetes, the patient can explain the information but fails to make the recommended dietary changes. How would the nurse evaluate the patient's situation? a. Learning did not occur because the patient's behavior did not change. b. Choosing not to follow the diet is the behavior that resulted from learning. c. The nursing responsibility for helping the patient make dietary changes has been fulfilled. d. The teaching methods were ineffective in helping the patient learn the dietary instructions.

ANS: B Although the patient behavior has not changed, the patient's ability to explain the information indicates that learning has occurred and the patient is choosing at this time not to change the diet. The patient may be in the contemplation or preparation stage in the Transtheoretical Model. The nurse should reinforce the need for change and continue to provide information and assistance with planning for change.

A patient with diabetic neuropathy requires teaching about foot care. Which learning goal should the nurse include in the teaching plan? a. The nurse will demonstrate the proper technique for trimming toenails. b. The patient will list three ways to protect the feet from injury by discharge. c. The nurse will instruct the patient on appropriate foot care before discharge. d. The patient will understand the rationale for proper foot care after instruction.

ANS: B Learning goals should state clear, measurable outcomes of the learning process. Demonstrating technique for trimming toenails and providing instructions on foot care are actions that the nurse will take rather than behaviors that indicate that patient learning has occurred. A learning goal that states that the patient will understand the rationale for proper foot care is too vague and nonspecific to measure whether learning has occurred.

The nurse is planning a teaching session with a patient newly diagnosed with migraine headaches. To assess a patient's readiness to learn, which question should the nurse ask? a. "What kind of work and leisure activities do you do?" b. "What information do you think you need right now?" c. "Can you describe the types of activities that help you learn new information?" d. "Do you have any religious beliefs that are inconsistent with the planned treatment?"

ANS: B Motivation and readiness to learn depend on what the patient values and perceives as important. The other questions are also important in developing the teaching plan, but do not address what information most interests the patient at present.

A patient is diagnosed with heart failure after being admitted to the hospital for shortness of breath and fatigue. Which teaching strategy, if implemented by the nurse, is most likely to be effective? a. Assure the patient that the nurse is an expert on management of heart failure. b. Teach the patient at each meal about the amounts of sodium in various foods. c. Discuss the importance of medication control in maintenance of long-term health. d. Refer the patient to a home health nurse for instructions on diet and fluid restrictions.

ANS: B Principles of adult education indicate that readiness and motivation to learn are high when facing new tasks (such as learning about the sodium amounts in various food items) and when demonstration and practice of skills are available. Although a home health referral may be needed for this patient, teaching should not be postponed until discharge. Adult learners are independent. The nurse should act as a facilitator for learning, rather than as the expert. Adults learn best when the topic is of immediate usefulness. Long-term goals may not be very motivating.

A patient who smokes a pack of cigarettes per day tells the nurse, "I enjoy smoking and have no plans to quit." Which nursing diagnosis is most appropriate? a. Health seeking behaviors related to cigarette use b. Ineffective health maintenance related to tobacco use c. Readiness for enhanced self-health management related to smoking d. Deficient knowledge related to long-term effects of cigarette smoking

ANS: B The patient's statement indicates that he or she is not considering smoking cessation. Ineffective health maintenance is defined as the inability to identify, manage, and/or seek out help to maintain health.

An older Asian patient, who is seen at the health clinic, is diagnosed with protein malnutrition. What priority action should the nurse include in the teaching plan? a. Suggest the use of liquid supplements as a way to increase protein intake. b. Encourage the patient to increase the dietary intake of meat, cheese, and milk. c. Ask the patient to record the intake of all foods and beverages for a 3-day period. d. Focus on the use of combinations of beans and rice to improve daily protein intake.

ANS: C Assessment is the first step in assisting a patient with health changes. The other answers may be appropriate for the patient, but the nurse will not be able to determine this until the assessment of the patient is complete.

The nurse considers a nursing diagnosis of ineffective health maintenance related to low motivation for a patient with diabetes. Which finding would the nurse most likely use to support this nursing diagnosis? a. The patient does not perform capillary blood glucose tests as directed. b. The patient occasionally forgets to take the daily prescribed medication. c. The patient states that dietary changes have not made any difference at all. d. The patient cannot identify signs or symptoms of high and low blood glucose.

ANS: C The patient's motivation to follow a diabetic diet will be decreased if the patient feels that dietary changes do not affect symptoms. The other responses do not indicate that the ineffective health maintenance is caused by lack of motivation.

A patient who was admitted to the hospital with hyperglycemia and newly diagnosed diabetes mellitus is scheduled for discharge the second day after admission. When implementing patient teaching, what is the priority action for the nurse? a. Instruct about the increased risk for cardiovascular disease. b. Provide detailed information about dietary control of glucose. c. Teach glucose self-monitoring and medication administration. d. Give information about the effects of exercise on glucose control.

ANS: C When time is limited, the nurse should focus on the priorities of teaching. In this situation, the patient should know how to test blood glucose and administer medications to control glucose levels. The patient will need further teaching about the role of diet, exercise, various medications, and the many potential complications of diabetes, but these topics can be addressed through planning for appropriate referrals.

The nurse plans to provide instructions about diabetes to a patient who has a low literacy level. Which teaching strategies should the nurse use (select all that apply)? a. Discourage use of the Internet as a source of health information. b. Avoid asking the patient about reading abilities and level of education. c. Provide illustrations and photographs showing various types of insulin. d. Schedule one-to-one teaching sessions to practice insulin administration. e. Obtain CDs and DVDs that illustrate how to perform blood glucose testing.

ANS: C, D, E For patients with low literacy, visual and hands-on learning techniques are most appropriate. The nurse will need to obtain as much information as possible about the patient's reading level in order to provide appropriate learning materials. The nurse should guide the patient to Internet sites established by reputable heath care organizations such as the American Diabetes Association.

The nurse plans to teach a patient and the caregiver how to manage high blood pressure (BP). Which action should the nurse take first? a. Give written information about hypertension to the patient and caregiver. b. Have the dietitian meet with the patient and caregiver to discuss a low sodium diet. c. Teach the caregiver how to take the patient's BP using a manual blood pressure cuff. d. Ask the patient and caregiver to select information from a list of high BP teaching topics.

ANS: D Because adults learn best when given information that they view as being needed immediately, asking the caregiver and patient to prioritize learning needs is likely to be the most successful approach to home management of health problems. The other actions may also be appropriate, depending on what learning needs the caregiver and patient have, but the initial action should be to assess what the learners feel is important.

A patient who is morbidly obese states, "I've recently made some changes in my life. I've decreased my fat intake and I've stopped smoking." Which statement, if made by the nurse, is the best initial response? a. "Although those are important, it is essential that you make other changes, too." b. "Are you having any difficulty in maintaining the changes you have already made?" c. "Which additional changes in your lifestyle would you like to implement at this time?" d. "You have already accomplished changes that are important for the health of your heart."

ANS: D Positive reinforcement of the learner's achievements is critical in making lifestyle changes. This patient is in the action stage of the Transtheoretical Model, when reinforcement of the changes being made is an important nursing intervention. The other responses are also appropriate, but are not the best initial response.

A postoperative patient and caregiver need discharge teaching. Which actions included in the teaching plan can the nurse delegate to unlicensed assistive personnel (UAP)? a. Evaluate whether the patient and caregiver understand the teaching. b. Show the caregiver how to accurately check the patient's temperature. c. Schedule the discharge teaching session with the patient and caregiver. d. Give the patient a pamphlet reinforcing teaching already done by the nurse.

ANS: D Providing a pamphlet to a patient to reinforce previously taught material does not require nursing judgment and can safely be delegated to UAP. Demonstration of how to take a temperature accurately, determining the best time for teaching, and evaluation of the success of patient teaching all require judgment and critical thinking and should be done by the registered nurse.

While admitting a patient to the medical unit, the nurse determines that the patient is hard of hearing. How should the nurse use this information to plan teaching and learning strategies? a. Motivation and readiness to learn will be affected. b. The family must be included in the teaching process. c. The patient will have problems understanding information. d. Written materials should be provided with verbal instructions.

ANS: D The information that the patient is hard of hearing indicates that the nurse should use written and verbal materials in teaching along with other strategies. The patient does not indicate a lack of motivation or an inability to understand new information. The patient's decreased hearing does not necessarily imply that the family must be included in the teaching process.

The unit secretary tells the nurse that the practitioner has just ordered a low-calorie diet for a patient who is overweight. Place these nursing interventions in the order in which they should be implemented. 1. Verify the dietary order 2. Determine food preferences 3. Teach specifics about a low-calorie diet 4. Review a meal plan designed by the patient 5. Assess the patient's motivation to follow the diet

Answer: 1, 5, 2, 3, 4 1. This should be done first because a diet requires a practitioner's order; following a specific diet is a dependent function of the nurse. 5. Assessing motivation is one of the most important factors influencing learning. The learner must recognize that the need exists and that the need will be addressed through the learning. 2. Determining food preferences is part of nursing assessment. Food preferences can then be included in the teaching plan about the low-calorie diet. 3. Details of the diet can be taught after the order is verified, motivation is determined, and preferences identified. 4. Evaluation is the final step of teaching. A meal plan designed by the patient requires not just an understanding of the information but an ability to apply the information.

When planning teaching with consideration of the diverse learning needs of adults, the nurse's best approach would include: A. Recognizing that adults enjoy learning regardless of the relevance to their personal lives. B. Providing opportunities for the patient to learn from other adults with similar experiences. C. Presenting material in an efficient lecture format. D. Postponing practice of new skills until the patient can independently practice the skill at home.

B

the patient describes how salt intakes affects B/P. What domain of learning is this? A. cognitive B. psychomotor C. Affective

cognitive