NURS 108 EXAM 2

Assertive Communication

A process in which positive and negative ideas and feelings are expressed in an open and direct way.

What is patient education?

A process of assisting people to learn health-related behaviors so that they can incorporate these behaviors into everyday life.

Communication

A process of interaction between people in which symbols are used to create, exchange, and interpret messages about ideas, emotions, and mind states.

Adherence

A self-initiated action taking to promote wellness, recovery, and rehabilitation.

The nurse assesses that a patient has not been taking antihypertension medication as prescribed. How should the nurse proceed? (Select all that apply.) A. Evaluate the teaching plan to determine if there is a need to reeducate the patient. B. Assess the patient's perception and attitude towards the risks associated with missing doses of medication. C. Review and reinforce the need to take the medication as prescribed. D. Ask the provider to prescribe a different medication because the patient does not want to take this medication. E. Emphaize the risk of stroke and heart attack if the patient does not adhere to the treatment plan.

Answers: A, B, C Rationale: The patient may need additional information. Assessing what the patient's perceptions are will provide the nurse with insight on how to proceed next. Reviewing and reinforcing will reaffirm the importance of taking the medication which leads to adherence. The nurse should first explore why the patient is not taking the medication before requesting a different medication order from the provider. Scare tactics may cause the patient to become defensive and may lead to nonadherence.

A patient is admitted to the long-term care setting. The nurse notes that the patient does not read or write well. Which nursing actions are priority while developing a teaching plan to increase adherence? (Select all that apply.) A. Determine the patient's motivation and readiness to learn. B. Assess what the patient knows about their health issues. C. Include the family in the orientation to the unit and include them in the teaching process. D. Assess what grade level the patient can read and write and tailor teaching strategies accordingly. E. Give the patient brochures with more pictures and explanations with short sentences.

Answers: A, B, C, D Rationale: It is most important to determine the level at which the patient will understand then the nurse can avoid teaching over the patient's level of understanding. Motivation is an important component to learning new information. Assessing what the patient does know will help determine what areas still need to be addressed. Including the family will aid in the teaching process. The patient may not be able to read even short sentences. The priority is to assess the patient's reading level first, then choose appropriate teaching tools.

Psychomotor Learning

SKILL teaching, requires that the patient has opportunities to touch and manipulate equipment and practice skills.

Mentoring

Special type of collaboration, or creative partnership, typically between a novice nurse and an expert nurse, that has been recognized as beneficial to the development of professional nurses. This type of collaboration is often purposeful and facilitate in career development, personal growth, caring, empowerment, and nurturance that are important to nursing practice and leadership. The purpose of mentoring is to enable a smooth transition from novice nurse to a knowledeable practitioner.

Intrapersonal Communication

Takes place within the individual, and may be positive/helpful to the person, or negative/self-destructive.

Literacy Level

The ability to read and understand written word is critical if including any written material. 43% of adults have literacy skills at the basic or below basicl level. The nurse should known how they read health-related information. What is their health literacy? The nurse should focus on cues if they are uncomfortable admitting they can have difficulty with literacy.

Advocacy

The act of speaking for others to assist them to meet needs, and is an expectation for all nurses.

Communication Competence

The communication is both effective and appropriate.

Concordance

The most recent term added in an attempt to reflect the behavior of adherence more accurately and suggests that patients and health care professionals come to a mutual agreement on a regimen through a process of negotiation and shared decision making.

Documenting Education

The nurse should ensure consistency. The documentation should be comprehensive and include the description of information taught, assessment of motivation, ability to learn, developmental level, and resources. After teaching has been performed, the nurse should document the detailed plan, patient's response, adjustments, and other factors that affected education.

Pedagogy Vs. Androgogy

The nurse should ensure the type of education method used is appropriate to the stage of development of the client. (Child Vs. Adult) The nurse should tailor learning activities to account for these differences.

Implementation of Educational Plan

The nurse's ability to carry out the plan. The nurse should make it flexible. Determine the length of education, sessions, content, and methods of teaching. Goals should be measurable.

Handoff/Reporting

The process of nurse-to-nurse communication in which patient data is shared between shifts and at other points of transition, with the primary intent of ensuring accuracy and continuity of care.

Interpersonal Communication

The verbal and nonverbal interaction that occurs among human beings, and can be one-tone or occur within groups. (Think Interstates)

Linguistic

The verbal exchange of messages through spoken words and written symbols.

Identify Roles/ Responsibilities for successful collaboration.

* Engage diverse health care professional who complements one's own professional expertise, as well as associated resources, to develop strategies to meet specific patient care needs. * use the full scope of knowledge, skills, and abilities of available health professionals and health care workers to provide care that is safe, timely, efficient, effective, and equitable. * Communication with team members to clarify each member's responsibility in executing components of a treatment plan or public health intervention.

Identify Value / Ethics for successful collaboration.

* Embedded in patient centeredness and strive for safter, more efficient, and more effective systems of care. * Embrace the cultural diversity and individual differences that characterize patients, populations, and the health care team. * Respect the unique cultures, values, roles and responsbilities, and expertise of other health professions. *Work in cooperation with those who recieve care, those who provide care, and others who contribute to or support the dilvery of disease prevention and health services. * Demonostrate high standards of ethical conduct and quality of care in one's contribution of team based care.

Identify teams and teamwork for successful collaboration.

* Describe the process of team development and the roles and practices of effective teams. * Engage other health professionals appropriate to the specific care situation in shared patient-centered problem-solving. * Apply leadership practices that support collaborative practice and team effectiveness.

Identify communication for successful collaboration.

* Organize and communicate information with patients, families, and health care team members in a form that is understandable, avoiding specific terminology when possible. * Listen actively, and encourage ideas and opinions of other team members. *Recognize how one's own uniqueness, including experience levels, expertise, culture, power, and hierarchy within the health care team, contributes to effective communication, conflict resolution, and positive interprofessional working relationships.

What are some of the major attributes of patient education?

* Patient needs motiviation and needs to be ready. * Planning is involved. *Outcomes are goal oriented. *Patient is motivated to learn.

Describe Altruism, Coalition, Consortium and how it relates to collaboration.

***Altruism - selfless concern for the well-being of others. -Moral obligation to help others even without getting anything in return. -Self-scarifies ***Coalition = Alliance for combined action. -Nursing groups get together -EXAMPLE: Rapid Response Team -Each goal is self-interest of the persons ***Consortium = An association; several business companies -All involve "want" and "need" to achieve a common goal.

What is the role of the nurse in client education?

*Assist Patient in forming goals. *Assess patient needs, motivation, and ability. *Plan educational interventions to achieve goals. *Evaluate patient outcomes toward goal attainment. *In short, nurses empower the patients.

What are the three domains of learning?

*Cognitive *Affective *Psychomotor

What are some barriers to education?

*Lack of a SOCIAL SUPPORT. *Cultural Differences *Lack of financial resources/time. *Frequent interruptions. ***Nursing barriers involve: lack of time, multiple competing demands, nurse's attitude.

What is the scope of patient education?

*Self-directed *Formal patient education classes. *Patient-nurse learning encounters.

What are the three attributes of communication that form the basis of study in the nursing process?

1. A process of complementary exchange. 2. Context. 3. Learned Skill.

Interorganizational Collaboration

A pooling of resources and information between organizations that can benefit patients and communities at regional, national, or international levels. This often takes the form of COALITIONS or CONSORTIUMS. Think communication between the ANA and CDC in EBP for infection control.

What are the 6 attributes of adherence?

1. Decisional Conflict 2. Predictability 3. Personal Experience 4. Power Conflict 5. Agreement 6. Alignment

What are the three primary categories of communication?

1. Linguistic 2. Paralinguistic 3. Metacommunication

Identifiy the four categories of collaboration.

1. Nurse-Patient Collaboration 2. Nurse-Nurse Collaboration 3. Interprofessioanl Collaboration 4. Interorganization Collaboration

Identify the four attributes of successful collaboration.

1. Values/Ethics 2. Roles/Responsibilities 3. Communication 4. Teams and Teamwork

What are the three examples of sentinel events?

1. Wrong-Site Surgery. 2. Adverse Drug Events. 3. Patient Falls.

Electronic Health Record (EHR)

A communication tool used between members of the health care team for documenting progress, interventions, and patients responses to care.

What would be a measure of acceptence of a prescribed medical treatment?

Adherence

What is androgogy?

Adult learning.

Affective Learning

Affective learning deals with expression of feelings and acceptance of attitudes, opinions, or values.

Effective Patient Education

Allows patients and families opportunity to control their own health, reduce risk of illness, improve longevity, and enchance overall wellness.

Therapeutic Communication

An interactive process between the nurse and the client that helps the client overcome temporary stress, to get along with other poeple, to adjust the unalterable, and to overcome psychological block which stand in the way of self-realizations.

Learner Assessment

Comprehensive assessment of patient learning needs: resources (education level, literacy level, social support, financial resources). Use to develop a teaching plan that is appropriate for the patient and meets their desired goals. The nurse should consider age, stage of development, and motivation to change behavior.

What would be a measure of mutual agreement between a patient and a health care provider?

Concordance

Interrelated concepts regarding patient attributes and perferences that a nurse would consider when addressing patient education include which concept? A. Adherence B. Health Promotion C. Quality D. Technology

Answer: A Adherence, culture, developmental level, family dynamics, and motivation are considered interrelated concepts regarding patient attributes and preferences. Interrelated concepts regarding the professional role of a nurse include health promotion, leadership, technology and informatics, quality, collaboration, and communication.

Which factors should the nurse assess to determine a patient's ability to learn? A. Developmental capabilities and physical capabilities. B. Sociocultural background and motivation. C. Psychosocial adaptation to illness and active participation. D. Stage of grieving and overall physical health

Answer: A Developmental and physical capabilities reflect one's ability to learn. Sociocultural background and motivation are factors in readiness to learn. Psychosocial adaptation to illness and active participation are factors in readiness to learn. Readiness to learn is related to the stage of grieving. Overall physical health does reflect ability to learn; however, because it is paired here with stage of grieving (which is a readiness to learn factor), this is a wrong answer.

Formal patient education courses or classes would be the most appropriate strategy in which situation? A. Address needs common to a group. B. Explain self-directed learning. C. Describe nursing interventions. D. Respond to questions of a patient's family.

Answer: A Group needs are often the focus of formal patient education courses or classes. Self-directed learning refers to an educational activity completed independently from the nurse or other health care providers. Describing nursing interventions with formal patient education courses or classes is not the most appropriate strategy, because most patient education is done by nurses during the explanation of an intervention, and that is a spontaneous, one-to-one activity. Formal courses or classes are not the most appropriate strategy to address a patient's or a family's questions; from a time perspective, it is not appropriate to have the patient or family wait for a class.

A client from a homeless shelter who has had minor surgery and has been given an instruction sheet in preparation for discharge is noted to be noncompliant with instructions when dressing for discharge. When asked by the nurse if the instructions were clear, the client said, "I'll read them later, when I have my glasses; besides, I know all that stuff." Based on these behaviors, the nurse may suspect that: A. The client may be unable to read the instructions B. The client is noncompliant C. The client doesn't understand the instructions D. The client is confused

Answer: A Rationale: Clients who can't read may be noncompliant, insist that they know information, or have excuses for not reading the instructions. Behaviors such as these should alert the nurse to the need to further assess literacy.

A patient does not make eye contact with the nurse and is folding his arms at his chest. Which aspect of communication has the nurse assessed? A. Nonverbal communication B. A message filter C. A cultural barrier D. Social Skills

Answer: A Rationale: Eye contact and body movements are considered nonverbal communication. There are insufficient data to determine the level of the patient's social skills or whether a cultural barrier exists.

Which of the following statements by a nursing student demonstrates an understanding of collaboration? A. "Collaboration is a new way of interacting with physicians." B. "Collaboration means that the care team can make all of the decisions for the patient." C. Collaboration with patients has been used by nurses throughout the history of nursing." D. Collaboration is an outdated concept that has been replaced by managed care."

Answer: A Rationale: History shows that from the time of Florence Nightingale, nurses have worked with patients to assess their needs and wants. Collaboration with fellow care providers such as physicians is not a new concept; it is becoming more prevalent. to correctly use collaboration, the team does not make decisions without including the patient.

When interacting with a client, the nurse answers, "I am sure everything will be fine. You have nothing to worry about." This is an example of what type of INAPPROPRIATE communication technique? A. Cliche B. Giving Advice C. Being Judgmental D. Changing the Subject

Answer: A Rationale: Telling a patient that everything is going to be all right is a cliche. This statement gives false assurance and gives the patient the impressive that the nurse is not interested in the patient's condition.

The nurse is developing a teaching plan on self-injection of insulin for a group of diabetic clients. The plan includes information about injections and types of insulin, and demonstrations of injection technique. What affective component is important for the nurse to plan to include in educating these clients? A. Helping clients accept the need for daily injections B. Having clients demonstrate injection procedures on themselves C. Asking clients to describe the injection procedure D. Giving a test on the types of insulin and duration of action

Answer: A Rationale: The affective domain of learning is the feeling domain, and involves emotions, attitudes, interests, and appreciations. The cognitive domain is the thinking domain, and involves intellectual abilities. The psychomotor domain is the skill domain, and involves motor skills. All three domains should be included in planning client education.

Whan planning the evaluation of a teaching activity that has the goal of educating a patoent and family about the long-term effects of diabetes, it would be more appropriate for the nurse to include whcih opportunity for the patient? A. Ask questions. B. Inject insulin. C. Meeet exercise goals. D. Prepare a menu.

Answer: A Rationale: The evaluation should match the goal. In this scenario, the goal is related to long-term effects, so providing an opportunity for the patient and family to ask questions gives the nurse information about their understanding of the content and allows the nurse to evaluate the cognitive and affective impacts of the teaching. Opportunities to inject insulin, meet exercise goals, and prepare a menu would be strategies to assess psychomotor domain learning, and this is not the goal of the teaching activity.

The nurse is assessing learning needs for a patient who has coronary heart disease. The nurse finds that the patient has recently made dietary changes to decrease fat intake and has stopped smoking. The best initial response by the nurse at this time is: A. "You did an excellent job of changing your eating habits and quitting smoking. This is so important for your heart health. Nice work!'' B. "Although the changes you made are important, it is essential that you make other changes, too." C. "Which additional changes in your lifestyle would you like to implement at this time?" D. "Are you having any difficulty in maintaining the changes you have already made?"

Answer: A Rationale: The perceived behavioral expectations (normative beliefs) of family, friends, coworkers, and health care providers influence an individual's motivation to comply with the perceived social pressures from these groups (subjective norm) to behave in a certain way. Responses B, C, and F are appropriate, but A is the best initial response.

A patient has been taught how to cough and deep breathe. Which evaluation method is most appropriate? A. Return demonstration B. Computer instruction C. Verbalization of steps D. Cloze test

Answer: A Rationale: To demonstrate mastery of the skill, have the patient perform a return demonstration under the same conditions that will be experienced at home or in the place where the skill is to be performed. Computer instruction is use of a programmed instruction format in which computers store response patterns for learners and select further lessons on the basis of these patterns (programs can be individualized). Computer instruction is a teaching tool, rather than an evaluation tool. Verbalization of steps can be an evaluation tool, but it is not as effective as a return demonstration when evaluating a psychomotor skill. The Cloze test, a test of reading comprehension, asks patients to fill in the blanks in a written paragraph.

The nurse is communicating with a primary care provider about medical interventions prescribed for a client. Which statement is MOST represents a collaborative relationship? A. "The new medication you prescribed for Mr. Black is not working." B. "I am worried about Mr. Black's blood pressure. It is not decreasing even with the antihypertensive medications that were prescribed." C. "Can we talk about Mr. Black?" D. "Excuse me doctor. I think we need to talk about Mr. Black's blood pressure."

Answer: B Rationale: (A) Contains inflammatory language and should be eliminated. (B) Uses "I" and is considered assertive communication, which is clear and direct. This message includes only the necessary information. (C) Does not provide the health care provider with specific information regarding the client. (D) Does not provide the health care provider with specific information regarding the client.

A student nurse learns that a normal adult heartbeat is 60 to 100 beats/minute. In which domain did learning take place? A. Kinesthetic B. Cognitive C. Affective D. Psychomotor

Answer: B Rationale: Cognitive learning includes all intellectual behaviors and requires thinking. In the hierarchy of cognitive behaviors, the simplest behavior is acquiring knowledge. The student nurse acquired knowledge, which is cognitive. Kinesthetic is a type of learner who learns best with a hands-on approach. Affective learning deals with expression of feelings and acceptance of attitudes, opinions, or values. Psychomotor learning involves acquiring skills that require integration of mental and muscular activities, such as the ability to walk or to use an eating utensil.

A nurse is explaining why collaboration is valued to a new nurse during her orientation to the unit. Which of the following outcomes is a key patient care outcome that occurs when collaboration is correctly used? A. Governmental accrediting agencies give more favorable review to the agency. B. There are fewer errors that occur in patient care. C. Agencies can offer higher salaries due to the cross-training of staff. D. Ongoing education is not needed, because other specialities contribute to care decisions.

Answer: B Rationale: Collaboration results in fewer errors in patient care due to the interactions between health providers of all disciplines and patient involvement in planning. A positive accreditation review benefits the agency directly and the patient only indirectly. Collaboration is not the same as cross-training, and ongoing education is an expectation of all professions.

Which of the following communication terms can be applied to this statement: How messages are received and interpreted would include personal states such as mood disturbance, environmental stimuli related to the setting of the communication, and contextual variables? A. Therapeutic Communication B. Metacommunication C. Vigor Communication D. Internal Noise

Answer: B Rationale: Metacommunication is a term which means how messages are received and interpreted would include personal states such as mood disturbance, environment stimuli related to the setting of the communication, and contextual variable. Therapeutic communication is consciously influencing communication to thelp patient underatand the plan of care. Vigor communication is used by advertisers for prdoucts such as soaps and foods are colorful, humorous and often quite memorable. Internal noise inhibits the ability to accurately received and interpreted messages.

A patient has been taught how to change a colostomy bag but is having trouble measuring and manipulating the equipment and has many questions. What is the nurse's next action? A. Refer to a mental health specialist. B. Refer to an ostomy specialist. C. Refer to a dietitian. D. Refer to a wound care specialist.

Answer: B Rationale: Resources that specialize in a particular health need (e.g., wound care or ostomy specialists) are integral to successful patient education. A mental health specialist is helpful for emotional issues rather than for physical problems. A dietitian is a resource for nutritional needs. A wound care specialist provides complex wound care.

A mother rescues two of her four children from a house fire. In the emergency department, she cries. "I should have gone back in to get them. I should of died, not them." What is the nurse's BEST response? A. "The smoke was to thick. You couldn't have gone back in." B. "You're feeling gulty because you weren't able to save your children." C. "Focus on the fact that you could have lost all four of your children." D. "It's best if you try not to think about what happened. Try to move on."

Answer: B Rationale: The best response by the nurse is option (B) because this response utilizies the therapeutic communication technique of reflection which identifies a client's emotional response and reflects these feelings back to the client so that they may be recongnized and accepted.

A nurse is preparing to teach a patient about heart failure. Which environment is best for patient learning? A. A darkened, quiet room B. A well-lit, ventilated room C. A private room at 85 F temperature D. A group room for 10 to 12 patients with heart failure

Answer: B Rationale: The ideal environment for learning is a room that is well lit and has good ventilation, appropriate furniture, and a comfortable temperature. Although quiet is appropriate, a darkened room interferes with the patient's ability to watch your actions, especially when you are demonstrating a skill or using visual aids such as posters or pamphlets. A room that is cold, hot, or stuffy makes the patient too uncomfortable to focus on the information being presented. Learning in a group of six or fewer is more effective than in larger groups and avoids outburst behaviors.

A patient states that everything has been going great; however, the nurse observes the patient biting his nails and fidgeting. What type of communication does the nurse recognize from the patient's actions and statements? A. Linguistic B. Paralinguistic C. Explicit D. Inadequate

Answer: B Rationale: Mixed messages involve the transmission of conflicting or incongruent messages by the speaker. The patient's verbal message that all is well in the relationship is modified by the nonverbal behaviors denoting anxiety. Data is not present to support the vhoice of the verbal message being clear, explicit, or inadequate.

Which situation will cause the nurse to postpone a teaching session? (Select all that apply.) A. The patient is mildly anxious. B. The patient is fatigued. C. The patient is asking questions. D. The patient is hurting. E. The patient is febrile (high fever). F. The patient is in the acceptance phase.

Answer: B, D, E Rationale: Any condition (e.g., pain, fatigue) that depletes a person's energy also impairs his or her ability to learn, so the session should be postponed until the pain is relieved and the patient is rested. Postpone teaching when an illness becomes aggravated by complications such as a high fever or respiratory difficulty. A mild level of anxiety motivates learning. When patients are ready to learn, they frequently ask questions. When the patient enters the stage of acceptance, the stage compatible with learning, introduce a teaching plan.

A mother is to undergo a breast biopsy. She tells the nurse, "If I lose my breast, I know my husband will no longer find me attractive." Which of the following responses by the nurse would be MOST appropriate? A. "You don't know if you are going to lose your breast. They are just doing the biopsy now." B. "You should focus on your children. They are young and they need." C. "You seem to be concerned that your relationship with your husband might change." D. "Why don't you wait and see what your busband's reaction is before you get upset."

Answer: C Rationale: (A) Gives false reassurance and discount the client's feelings and should be eliminated. (B) This response is authoritarian: the nurse tells the client what to do and should be eliminated. (C) This response reflects the fears of the client, is open-ended and allows the client to express what she is feeling. (D) This response dismisses the feelings that the client is experiencing and gives advice and should be eliminated.

A nurse has taught a patient about healthy eating habits. Which learning objective/outcome is most appropriate for the affective domain? A. The patient will state three facts about healthy eating. B. The patient will identify two foods for a healthy snack. C. The patient will verbalize the value of eating healthy. D. The patient will cook a meal with low-fat oil.

Answer: C Rationale: Affective learning deals with expression of feelings and acceptance of attitudes, opinions, or values. Having the patient value healthy eating habits falls within the affective domain. Stating three facts or identifying two foods for a healthy snack falls within the cognitive domain. Cooking falls within the psychomotor domain

A nurse is teaching a group of healthy adults about the benefits of flu immunizations. Which purpose of patient education is the nurse fulfilling? A. Restoration of health B. Coping with impaired functions C. Promotion of health and illness prevention D. Health analogies

Answer: C Rationale: As a nurse, you are a visible, competent resource for patients who want to improve their physical and psychological well-being. In the school, home, clinic, or workplace, you promote health and prevent illness by providing information and skills that enable patients to assume healthier behaviors. Injured and ill patients need information and skills to help them regain or maintain their level of health; this is referred to as restoration of health. Not all patients fully recover from illness or injury. Many have to learn to cope with permanent health alterations; this is known as coping with impaired functions. Analogies supplement verbal instruction with familiar images that make complex information more real and understandable. For example, when explaining arterial blood pressure, use an analogy of the flow of water through a hose.

Which of the following behaviors by a nurse indicates the effective use of collaboration with other professionals? A. Strongly defends own professional role. B. Avoids conflict. C. Negotiates with others. D. Aggressively presents a personal view of a situation.

Answer: C Rationale: Conflicts may arise during collaboration, requiring the skill of negotiation. Strongly defending the profesional role does not allow for input from other disciplines. Avoiding conflict does not allow proper representation of the nursing role. Coolaboration should be based on professional roles, not personal views.

The nurse has offered a diabetic education program. What is the best indication of client compliance with a diabetic treatment plan? A. The client expresses a desire to learn about diabetes treatment. B. The client can list foods that are not allowed on a diabetic diet. C. The client willingly learns about diabetes treatment and follows the treatment plan. D. The client is able to discuss diabetes treatment and passes a test on program content with a score of 90%.

Answer: C Rationale: Evaluation of compliance involves evaluating the extent to which the client recognizes and accepts the need to learn, and then follows through with appropriate behavior. Clients may learn the educational material and still not be compliant.

An instructor is correcting a nursing student's clinical worsheet. Which instructuor statement is the best example of effective feedback? A. "Why did you use the client's name on your clinical worksheet?" B. "You were veryt careless to refer to your client by name on your clinical worksheet." C. "Surely you didn't do this deliberately, but you breached condfidentiality by using the client's name." D. "It is disappointing that after being told, you're still using client names on your worksheet."

Answer: C Rationale: Feedback is a method of communication to help others consider a modification of behavior. Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather then offer advice or criticize the individual.

A 28-year old Hispanic female has been recently diagnosed with cervical cancer at a local emergency department. She speaks very little English but requires extensive education at discharge regarding this new diagnosis. Which of the following is the BEST course of action the nurse should take in educating the client? A. Give written information. B. Proceed in giving verbal information. C. Utilize a facility interrupter as a mediator. D. Speak slow and loudly so she might understand better.

Answer: C Rationale: When ever possible the nurse should always use an interrupter as a mediator when giving any information to a client who does not speak the same primary language as the caregiver. This aides in effective communation and education and allows the client to ask questions back to the nurse after education has been complete.

A toddler is going to have surgery on the right ear. Which teaching method is most appropriate for this developmental stage? A. Encourage independent learning. B. Use discussion throughout the teaching session. C. Apply a bandage to a doll's ear. D. Develop a problem-solving scenario.

Answer: C Use play to teach a procedure or activity (e.g., handling examination equipment, applying a bandage to a doll) to toddlers. Encouraging independent learning is for the middle-aged adult. Use of discussion is for older children, adolescents, and adults, not for toddlers. Use problem solving to help adolescents make choices. Problem solving is too advanced for a toddler.

The nurse is admitting a new patient to the psychiatric unit. Which factors will most likely contribute to a positive outcome for the interaction? (Select all that apply.) A. The patient is in a bad mood. B. The patient states that he or she is in pain. C. The unit is quiet. D. The patient has been admitted to the facility in the past. E. The patient is awake, alert, and oriented to person, place and time. F. There are various interactive sessions going on in the unit today.

Answer: C, D, E Rationale: Positive outcomes for interactions include factors such as the relationship between participants, internal mood states, mental and physical condition, experience and education, and external noise emanating from the environment. Noisy environments increase stress, as does pain. If the patient is in a bad mood, it may be best to address this issue prior to completing the admission because the patient will be more receptive.

A patient receiving electroconvulsive therapy tells the nurse, "I am always forgetting appointments and losing things." Which response is the MOST therapeutic? A. "You still really need this treatment." B. "Your memory will get better." C. "This is an expected side effect." D. "The memory loss must be upsetting. Let's talk about it."

Answer: D Rationale: This statement by the nurse expresses empathy and ends with an open-ended invitation to allow further discussion. Once the patient verbalizes their feelings and concerns about the symptoms they are having and the nurse reflects these back and validates them, the nurse can clarify misconceptions the patient may have. Memory loss and confusion are common but transient symptoms associated with ECT treatment. These symptoms usually subside within a few weeks after the course of treatment is complete. The other statements may be true, but they do not express empathy or encourage further discussion.

A client is admitted to the emergency room with a diagnosis of acute myocardial infarction. The client tells the nurse, "I'm scared. I think I'm going to die." Which of the following responses by the nurse would be MOST appropriate? A. "Everything is going to be fine. We'll take good care of you." B. "I know what you mean. I thought I was having a heart attack once." C. "I'll call your doctor so you can discuss it with him." D. "It's normal to feel frightened. We're doing everything we can for you."

Answer: D Rationale: (A) is a "don't worry" response and does not acknowledge the client's fears. (B) Focuses on the nurse rather then client. (C) It is within the nurse's scope of practice to respond to the client's feelings, don't pass this off to the physician. (D) This answer choice shows the nurse as empathetic, acknowledging that the client feels frightened, and provides information.

A nurse is assessing the ability to learn of a patient who has recently experienced a stroke. Which question/statement will best assess the patient's ability to learn? A. "What do you want to know about strokes?" B. "On a scale from 1 to 10, tell me where you rank your desire to learn." C. "Do you feel strong enough to perform the tasks I will teach you?" D. "Please read this handout and tell me what it means."

Answer: D Rationale: A patient's reading level affects ability to learn. Reading level is often difficult to assess because patients who are functionally illiterate are often able to conceal it by using excuses such as not having the time or not being able to see. One way to assess a patient's reading level and level of understanding is to ask the patient to read instructions from an educational handout and then explain their meaning. Asking patients what they want to know identifies previous learning and learning needs and preferences; it does not assess ability to learn. Motivation is related to readiness to learn, not ability to learn. Just asking a patient if they feel strong is not as effective as actually assessing the patient's strength.

When a patient tells the nurse about plans to do research about his diagnosis and potential treatment on the Internet, what is the nurse's most appropriate initial response? A. Discount the reliability of the internet. B. Evaluate the patient's computer competency. C. Provide a list of recommended sources. D. Teach about evaluation of internet resources.

Answer: D Rationale: Evaluation of resources is an essential component of gathering information from the Internet, and the nurse would want to be sure the patient finds valid and reliable information. A majority of adults in the United States use the Internet to find information on many aspects of life, and this use of technology expands the role of the nurse in patient education to include teaching on how to evaluate Internet sources. Discounting the reliability of the Internet would not support the positive behavior and motivation of the patient to learn. The nurse would want to evaluate what the patient learns from the Internet rather than the patient's computer competency. Providing a list of recommended sources would be appropriate and support the patient's motivation, but it would not be the first thing the nurse would do.

A nurse teaches a patient with heart failure healthy food choices. The patient states that eating yogurt is better than eating cake. In this situation, which element represents feedback? A. The nurse B. The patient C. The nurse teaching about healthy food choices D. The patient stating that eating yogurt is better than eating cake

Answer: D Rationale: Feedback should show the success of the learner in achieving objectives (i.e., the learner verbalizes information or provides a return demonstration of skills learned). The nurse is the sender. The patient is the receiver. The teaching is the message.

The nurse working in a free clinic has recognized that health promotion for teenagers who are pregnant is needed. The nurse works to develop a team of healthcare experts in several disciplines from across the region to work toward improving the nutrition of pregnant teenagers. This is an example of what type of collaboration? A. Nurse-Patient Collaboration B. Nurse-Nurse Collaboration C. Intraprofessional Collaboration D. Interorganizational Collaboration

Answer: D Rationale: Interorganizational collaboration occurs between regional, national, or international organizations to achieve a common goal. Nurse-patient collaboration occurs when a nurse is working directly with a patient. Nurse-nurse collaboration occurs between nurses and among professionals in nursing management projects. Intraprofessional collaboration occurs amoung members of a professional discipline.

A patient with a diagnosis of major depression who as attempted suicide says to the nurse, "I should have died! I've always been a failure. Nothing ever goes right for me." Which response demonstrates therapeutic communication? A. "You have everything to live for." B. "Why do you see yourself as a failure?" C. "Feeling like this is all part of being depressed." D. "You've been feeling like a failture for a while?"

Answer: D Rationale: Responding to the feelings expressed by a patient is an effective therapeutic communication technique. The correct option is an example of the use of restating. The remaining options block communication because they minimize the patient's expereince and do not facilitate exploration of the patient's expressed feelings. In addition, use of the word "why" is nontherapeutic.

A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes hands continually. This behavior prevents unit activity attendance. Which nursing statement BEST addresses this situation? A. "Everyone diagnosed with OCD needs to control their ritualistic behaviors." B. "It is important for you to discontinue these ritualistic behaviors." C. "Why are you asking for help if you won't participate in unit therapy?" D. "Let's figure out a way for you to attend unit activities and still wash your hands."

Answer: D Rationale: The best option is (D) because this statement reflects the therapeutic communication technique of showing care and competence. The nurse attempts to work with the client to develop a plan of action without damaging the therapetuic relationship or increasing the client's anxiety.

To address administrative concerns about the effectiveness of staff nurses related to patient education, the nurse manager would FIRST? A. Assign one nurse to teach patients B. Organize patient teaching resources C. Post a teaching outline in the lounge D. Survey nurses about patient teaching

Answer: D Rationale: The first step in addressing any concern is ASSESSMENT, or determining what the issues are, so conducting a verbal or written survey would be the most appropriate first step. Education of patients is integral to professional nursing practice; it would not be appropriate, or even possible, to assign one nurse to teach patients, because much patient education is informal, spontaneous, and takes place during treatment or when a nurse is responding to patient questions. There is no information to support a problem with the organization of patient teaching resources. Posting a teaching outline in the lounge could be an appropriate strategy if a need related to a specific area was identified, however, a needs assessment must first be completed.

A patient is being treated for tuberculosis (TB) with a standard four-drug regimen but continues to have positive sputum smears for acid-fast bacilli. Which actions should the nurse implement? (Select all that apply.) A. Assist the patient with short-term goals and plan teaching according to these goals. B. Provide the patient with all the educational materials about drug-resistant TB. C. Refer the patient to a pulmonary specialist, who can assist the patient with the treatment regimen. D. Ask the patient about any barriers to obtaining medications. e. Ask the patient whether medications have been taken as directed.

Answers: A, B, D Rationale: The first action should be to determine whether the patient has been compliant or encountered any barriers with completing the drug therapy regimen; because negative sputum smears would be expected if the TB bacillus is susceptible to the medications and if the medications have been taken correctly. Obtaining medications may be a factor in whether the client is taking medications as prescribed. Depending on whether the patient has been compliant or not, goals should be established and different medications or directly observed therapy may be indicated. The nurse is responsible and capable of providing education to patients regarding medication regimens and illness pathology. Referring the patient will not help with determining compliance.

The nurse is having a therapeutic conversation with a patient who is newly diagnosed with hypertension. Which communication technique will most likely prove effective for the newly diagnosed patient? (Select all that apply.) A. The nurse presents a laminated poster to the patient that depicts pictures of foods that would be on a low sodium diet. B. The nurse and patient engage in a humorous conversation about the top then "what not to eat when you are being treated for hypertension." C. The nurse gives the patient a sheet full of information and asks the patient to read the information and let the nurse know if they have any questions. D. The nurse states the risks factors and statistics of patients who do not take their medications as prescribed. E. The nurse helps the patient identify weight loss goals that are reasonable. F. The nurse waits until the patient has been awake for a few hours before beginning the teaching plan.

Answers: A, B, E, F Rationale: Effective communication has clarity and is goal-directed. Engaging techniques such as humor, visual props, and waiting for the client to be more alert will increase the therapeutic interaction. Providing the patient with written materials is important; however, there is no way to gauge the effectiveness of the teaching and does not guarantee that the patient has read the information. It will be useful to implement the teaching plan and supplement the teaching with a handout at the end of the session to reinforce the teaching. Stating the consequences of not taking the medication is a scare tactic and may result in defensiveness or closed communication.

A nurse mentor is explaining the benefits of collaborative practice to a nurse new to a facility. Which of the following research-based benefits is the nurse likely to identify as positive outcomes of collaboration? (Select all that apply): A. Decreased length of stay for patients. B. Decreased staff resignations. C. Decreased use of pain medications. D. Increased reimbursement from insurance carriers. E. Increased patient follow-up appointments after discharge. F. Increased job satisfaction of the staff.

Answers: A, B, F Rationale: Documented positive outcomes from collaboration include a shortended lenth of stay, increased job retention and decreased staff turnover, increased job satisfaction for RNs, and improved problem-solving skills. Identified research has not demonstrated less use of pain medication, increased reimbursement, or better follow-up by patients after discharge.

The nurse is discharging a hospitalized patient to the home care setting. Place the following actions in order of priority. A. Arrange a physical therapy visit before the patient is discharged from the hospital. B. Assess the patient's ability to perform activities of daily living before discharge. C. Have the patient demonstrate the learned skills at the end of the teaching session. D. Determine if the patient has had home visits before and if the experience was positive.

Answers: D-B-C-A Rationale: To begin the assessment of adherence, it is first important to clarify with the patient their beliefs and perceptions about his health risk status, assessment of performing ADLs will assist in determining the number of visits needed or if the patient needs additional therapies. Demonstration of skills prior to discharge will ensure patient understands the teaching. Physical therapist can aid in evaluating the need for assistive devices in the home and also help the patient adhere to prescribed treatment plan.

Evaluation

Be consistant with the domains of learning! Promote ADHERENCE

Context

Can include factors such as the relationship between participants, internal mood states, mental and physical condition, experience and education, and external noise emitted from the environment.

What would be a measure of conformance?

Compliance

Persistence

Defined as the time from intitiation to the discontinuation of a recommended or prescribed treatment and is a measurement of continuation.

Educational Planning

Determination of what methods will be used to meet the educational need. Will the outcome be cognitive, psychomotor, or affective change? A combination or all of them?

Nurse-Nurse Collaboration

Develop nursing teams on hospital units, in clinics, and in community settings that provide collaboration and support in patient caregiving. Can also be mentoring and/or shared governance (both making decisions)

Collaboration

Development of partnerships to achieve best possible outcomes that reflect the particular needs of the patient, family, or community, requiring an understanding of what others have to offer.

Learned Skill

Develops over time and through interactions with others.

Generational Differences

Differences in learning styles between generations can not only be by the patients age but also the era they were raised in and social/political experiences.

Psychosocial Development

Education interventions have to attend to patients achieveing developmental tasks. The nurse should also incorporate a patient's culture to make the process meaningful.

Metacommunication

Factors that affect how messages are reciebved and interpreted.

Shared Governance

Fosters a decentralizes style of management that creates an evnironment of empowerment so everyone works on the same level in hierarchy. Often seen in Magnet designation. The goal is to transition from a traditional hierachical magnement style to one in which nursing staff are more involved in decision making processes and mangers are facilitative rather then controlling. This helps to improve quality of care and clinical effectiveness, facilitate and the development of knowledge and skills, and increase profesionalism and accountability.

What would be a measure of continuation?

Persistence

What does the acronym ISBARR stand for?

I: Identify Self. S: Situation of Patient B: Background Information A: Assessment. R: Recommendations for Action. R: Read Back Orders.

Interprofessional Collaboration

Individual areas of expertise are represented along with diverse perspectives influenced by professional orientation, experience, age, gender, education, and socioeconomic status. The goal is the formation of a partnership between a team of health providers and a patient in a participatory, collaborative, and coordinated approach to share in the decision making of health and social issues. Involves navigating different professional cultures and specialized languages and understanding different viewpoints and goals.

Cognitive Learning

Intended to increase a patient's KNOWLEDGE of a subject and uses methods like written material, lecture, and discussions.

Paralinguistic

Less recognizable means of transmitting messages which includes the use of gestures, eye contact, and facial expressions.

Hierarchy of Needs

Maslow's Theory: For higher level needs to be addressed, lower level needs must be met first! (Prioritization.) If environmental conditions are appropriate to meet basic needs, individuals can learn and self-actualize.

Nurse-Patient Collaboration

Nurses collaborate with patients regarding health promotion and disease prevention behaviors, treatment strategies and options, lifestyle changes, and end-of-life decision making.

Compliance

Obedience with a prescribed treatment promotes an undertone of blame toward the patient when the patient's behavior does not meet health professionals' expectations.

Process of Complementary Exchange

Occurs between people, where each participant is either a sender or a reciever.

Educational Process

This process is similiar to the nursing process. The nurse should use ADPIE.

Goals of Patient Education

To ensure the client learns and adapts by forming connections and associations that facilitate changes in behavior, resulting in enchanced health and well-being or improved treamtsn of illness. Overall the goal of patient education is to PRODUCE CHANGE.

Sentinel Events

Unusually serious, unexpected events that occur during episodes of care, not only resulting in harm to the patient but also lead to increased health care costs.

What is pedagogy?

the art and science of teaching children.