PrepU Ch 9 Teaching and Counseling

The nurse is visiting a client who was released from inpatient rehabilitation 6 weeks ago after a 5-month recovery from a motor vehicle accident that left the client immobile. As the nurse enters the home, the client braces hands on the arms of a chair to rise and uses crutches to walk across the room. What is the best response by the nurse?

"You have made an amazing recovery." Explanation: Reinforcement of learning shows that the nurse supports and wants to encourage the client. Giving credit where it is due communicates these values. Documenting is necessary, but stating this does not show interest in the client's progress. Crediting the therapists does not encourage the client. Asking about permission to ambulate negates the goal for improving wellness.

A nurse is counseling several clients for depression. Four of them do not seem to be improving, which leads the nurse to suggest a referral to a psychiatric nurse practitioner. Which of these clients would be most likely to attend the scheduled appointment?

A 28-year-old female who works nights, is willing to try, and asks about insurance coverage of the appointment Explanation: Cultural issues, a low income, poor family support, and lack of transportation are potential barriers to obtaining needed care. If a client must choose between work and keeping an appointment, scheduling is an important factor. The characteristics of a client who will keep appointments with specialists include those clients who have been well educated about the importance of the referral, understand the benefit to seeing a specialist, and will not have to struggle to keep the appointment. A client who agrees, who has input in scheduling, and shows curiosity or hope about the benefit of the referral is more likely to keep the appointment.

Which guideline is most important for the nurse to keep in mind when planning to teach an exercise class to a group of older adults?

Allow ample time for psychomotor skills. Explanation: Older adults need more time to learn psychomotor skills. Sessions of 2 to 3 hours are too long; short-term rather than long-term memory loss affects older adults; and information can be structured or nonstructured, depending on the content.

A client reads the nutritional chart and follows it accurately. The nurse also notes that the client understands the need for a balanced diet and its relationship with a quick recovery. In which domain is the client demonstrating successful learning?

Cognitive Explanation: As the client is able to understand the need for a balanced diet after the session and follows the nutritional chart accurately, the client is demonstrating successful learning in the cognitive domain. Learning in the cognitive domain involves processing information by listening to or reading facts and descriptions. Learning in the affective domain involves appealing to a person's feelings, beliefs, or values. Learning in the psychomotor domain involves learning by doing. Interpersonal is not a domain of learning but a type of communication in which ideas are exchanged between two or more people.

As the nurse enters the room to teach the client about self-care at home, the client states, "I am glad you are here. I need some pain medicine. I can't stand it anymore." What is the best action of the nurse?

Have the client rate pain level, and reschedule the teaching session. Explanation: The client is not ready or able to learn and is reporting a need that first must be met. Assessing the client's knowledge of self-care or redirecting the client to discuss self-care only delays the care that must be done before the client is able to learn. Although providing written materials is an excellent supplement to a teaching session, it does not replace teaching the client. It is best to address the physical needs before attempting to educate the client.

Which nursing action is applicable to the psychomotor domain of learning when conducting a teaching session for breastfeeding mothers?

Observing a mother expressing the breast milk Explanation: Observing is one of the levels of psychomotor skills, which involves watching an experienced person perform a physical skill. Telling, showing, and advising are examples of addressing the cognitive domain, which helps the mothers process information by listening or reading facts.

When establishing a teaching-learning relationship with a client, it is most important for the nurse to remember that effective learning can best be achieved through which concept?

The client and the nurse are equal participants. Explanation: Effective learning occurs when clients and health care professionals are equal participants in the teaching-learning process, not when the nurse is viewed as the expert. Although it is important for the nurse to be able to handle criticism and to understand and apply psychomotor concepts when teaching, these are not as important as viewing the client and nurse as equal participants.

The nurse is teaching a client with diabetes how to inject daily insulin. Which method is most effective in evaluating the teaching?

Ask the client to demonstrate how to self-inject the morning insulin. Explanation: By using the teach-back method, the nurse teaches and demonstrates a skill, then the client returns the skill as if teaching the nurse how it is done. This is an effective way to determine the client's ability to independently perform a skill. Asking the client to repeat the steps is good, but self-administering the injection is a better indicator. A brochure could be used as a teaching aid, but it is not the most effective means of determining if the client can perform the skill. Providing a teaching session that includes questions and answers should be done; however, the client should demonstrate the skill.

The nurse is completing documentation after an education session with a client. Which statement best demonstrates detailed documentation of an effective teaching plan?

Demonstrated cord care to mother, who stated understanding and performed return demonstration using correct technique. Explanation: Documentation of teaching must include who was taught, the topic taught, and some indication of the success of the learning plan beyond a simple verbal statement by the client. Only the answer with a mother being taught cord care and then performing return demonstration is complete.

A client diagnosed with type 2 diabetes has been prescribed insulin therapy in conjunction with an oral agent because the client has been experiencing difficulty controlling blood sugar levels with an oral agent alone. The nurse is preparing a teaching plan for this client. Which intervention would the nurse include in the teaching plan to address the psychomotor domain?

Demonstrating the technique for insulin self-injection Explanation: The psychomotor domain involves skill performance. In this case, demonstrating the insulin self-injection technique would apply. Describing signs and symptoms, explaining what to do if hypoglycemia occurs, and reviewing appropriate food choices are appropriate for the cognitive domain.

What is the most appropriate teaching strategy for the nurse to use for a 1-hour presentation on the prevention of osteoporosis to a group of 30 college-age women?

Lecture/discussion Explanation: Lecture/discussion is appropriate for this topic, audience, and group size. A lecture is a formal presentation of information by a teacher to a group of learners. This format is most effective when communicating facts. Role play would not be an appropriate teaching strategy for this topic, as key points cannot be acted out, or for this size of a group, as there are too many students for each one to be able to participate in role play. Demonstration would not be appropriate, either, as the topic does not focus on particular skills that can be demonstrated. Test taking is not appropriate for teaching but for evaluation of learning.

The nurse is educating a client regarding a new skill. When evaluating the client's knowledge about the topic covered, which best represents that the client has learned a new skill?

The client organizes materials needed and gives return demonstration. Explanation: Confirmation that a client has learned a skill requires more than the client verbalizing understanding, passing a written test, nodding, or assisting with cleanup. Being able to gather all equipment needed for a skill and then perform it demonstrates proficiency.

Which documentation example best reflects the complexity of client teaching by the nurse?

"Client and spouse taught how to use phone app to count carbohydrates; client return demonstrated carb counting for a hypothetical meal." Explanation: The nurse should document who the teaching was provided to, what was taught, the teaching method, and the evidence of learning. The other answer choices are not as comprehensive and, therefore, are not the best examples of teaching.

A nurse is assessing a client who has come to the clinic for a follow-up appointment. The client was diagnosed with asthma several months ago and has missed several appointments since that time. The client also has not been following the medication plan and has not kept the appointment for allergy testing. The nurse suspects that the client may be experiencing problems with health literacy. The nurse teaches the client about the condition and prescribed treatment. Which question from the nurse would help to assess the client's health literacy about the condition?

"How are you supposed to take your medication?" Explanation: The teach-back method assesses health literacy, seeking to confirm that the learner understands the health information received from the health professional. The question about how to take the medication reflects this method. Clients and caregivers have the opportunity to repeat back to the health care provider the key points they understand from a teaching session. Asking whether the client understands, has questions, or is having trouble getting the medications are "yes" or "no" type questions, which do not allow the nurse to determine the client's ability to obtain, read, understand, and act on health information.

A nurse is reviewing the teaching plan about heart failure with a client. The nurse determines that learning in the affective domain has been achieved based on which client statement?

"I realize now just how important it is to watch how much salt I use." Explanation: Affective learning includes changes in attitudes, values, and feelings, as evidenced by the client's statement about realizing the importance of watching salt intake. Statements about signs and symptoms, taking a water pill, and calling the provider reflect learning in the cognitive domain.

The nurse is providing education for a client who will be providing self-care at home. The client states, "I just do not think I can do all of this. It is too much to learn." What is the best response by the nurse?

"I understand that you feel overwhelmed with all of the information. Tell me what I can do to help." Explanation: Letting the client know that the nurse is aware the information is overwhelming and placing some of the control with the client is a therapeutic approach to the statement. The other responses are nontherapeutic. Informing the client that "You will be just fine." is offering false reassurance. Informing the client that the information is not difficult is demeaning. Instilling fear into the client by asking who will take care of the client is nontherapeutic.

The health care provider notified the client and the spouse that the client's condition was terminal. The spouse has been crying since the interaction with the health care provider. The nurse is going to talk with the spouse about the spouse's feelings. What action(s) would the nurse do to promote a positive impression with the spouse? Select all that apply.

-Sit at eye level with the spouse. -Maintain eye contact more than half of the time. Tilt the head to the side. -Lean forward slightly. -Hold the spouse's hands during the interaction. Explanation: To promote a positive impression with the client, there are actions the nurse can take. In this situation, the nurse sits at eye level with the spouse, has eye contact, and leans forward. These actions show interest in the spouse. The nurse holds the head level, both horizontally and vertically, not tilted. Again, by maintaining a stable head position, the nurse shows interest in the spouse. Holding the spouse's hands also shows interest.

Which developmental consideration is a nurse assessing when determining that an 8-year-old child is not equipped to understand the scientific explanation of the child's disease?

Intellectual development Explanation: Piaget's theory of intellectual development is a major learning theory. By understanding how children and adolescents develop learning abilities, the nurse can use this knowledge when teaching clients. School-age children are capable of logical reasoning and should be included in the teaching-learning process whenever possible. Teaching strategies that include clear explanations and reasons for procedures, stated in a simple and logical manner, are most successful. These children are open to new learning experiences but need learning to be reinforced by either a parent or health care personnel as they become more involved with their friends and school activities. Motor development would be focused on a hands-on skill for example, not the scientific explanation of the disease. Psychosocial development looks at stages of development and goals or tasks for different stages.

A nurse is discussing the benefits of smoking cessation with a client. The nurse informs the client that smoking cessation will reduce the client's risk for cancer, improve respiratory status, and enhance the quality of life. The nurse also shares a personal story of smoking cessation, provides information on other individuals who have successfully quit, and encourages the client to attend a support group for smoking cessation. The client discusses feelings on smoking cessation and verbalizes a desire to quit smoking. What type of counseling did the nurse provide to this client?

Motivational Explanation: Motivational counseling involves discussing feelings and incentives with the client. Long-term counseling extends over a period of time. Developmental counseling occurs when a client is going through a developmental stage or passage. Situational counseling occurs when a client faces an event or situational crisis.

When caring for a diabetic client, the nurse notes that the client learns better when practicing the self-administration of the insulin injection alone. In which learning domain does this client's learning style fall?

Psychomotor Explanation: Because the client learns better by practicing the self-administration of the insulin injection alone, the client's learning style falls in the psychomotor domain. The psychomotor domain is a style of processing that focuses on learning by doing. The client's learning style does not fall in the cognitive, affective, or interpersonal domain. The cognitive domain is a style of processing information by listening to, or reading, facts and descriptions. The affective domain is a style of processing that appeals to a person's feelings, beliefs, or values. The interpersonal domain is a style of processing that focuses on learning through social relationships.

The nurse has provided teaching for a client with a sinus infection who has been prescribed antibiotics and a decongestant. The client states, "I'm not sure how many days I'm supposed to take this antibiotic." What is the nurse's appropriate response?

Reteach the length of time to take the prescription. Explanation: Client teaching requires a circular approach, specifically if the client has not understood the teaching. The nurse needs to reteach the information that has not been understood. Asking the client to restate the teaching, telling the client to take the antibiotic, and proceeding with teaching about the decongestant are not effective teaching methods.

A nurse may attempt to help a client solve a situational crisis during what type of counseling session?

Short-term counseling Explanation: Short-term counseling would help a client solve a situational crisis. A client experiencing a developmental crisis, for example, might need long-term counseling. Motivational counseling is an evidence-based counseling approach that involves discussing feelings and incentives with the client. Professional counseling is a general term.

When teaching a client, the nurse notices the client tends to lose focus easily. The nurse would adapt client teaching in which way?

Talk with animation and vocal inflection to stimulate the client aurally. Explanation: Talking with animation and vocal inflection to stimulate the client is effective for keeping the client's attention when the client loses focus. It is not appropriate to request family members to serve as translators, provide less teaching due to communication barriers, or elongate the teaching session.

The nurse is providing instructions to a client about performance of breast self-examination. What learning outcome would be most appropriate regarding this education?

The client will be able to perform proper breast self-examination for breast cancer detection and prevention. Explanation: This client education is focused on teaching the client a psychomotor skill for the purpose of early detection of breast cancer. Therefore, an appropriate learning outcome would be that the client is able to perform the skill properly. This client does not have any self-image problems, breast dysfunction, or poor coping skills, so outcomes related to these issues would not be appropriate.

When a nurse is planning for learning, who must decide who should be included in the learning sessions?

The nurse and the client Explanation: The nurse and the client should be the individuals who decide who should be included in the learning sessions. The nurse cannot assume that family members are wanted by the client to be included. The client must always be included in the learning session.

A nurse is providing teaching to clients in a short-term rehabilitation facility. Which examples are common teaching mistakes made by health care professionals? Select all that apply.

The nurse fails to accept that clients have the right to change their minds. The nurse uses medical jargon frequently when discussing the teaching plan. The nurse ignores the restrictions of the client's environment. Explanation: Common teaching mistakes made by health care professionals would include the following: the nurse failing to accept that clients have the right to change their minds; the nurse using medical jargon frequently when discussing the teaching plan; and the nurse ignoring the restrictions of the client's environment. The nurse does negotiate goals with the client. The nurse would evaluate what the client had learned. The nurse would review educational media when planning learner objectives.

A nurse is writing learner objectives for a client who was recently diagnosed with type 2 diabetes. Which statement best describes the proper method for writing objectives?

The nurse writes one long-term objective for each diagnosis, followed by several specific objectives. Explanation: The statement that best describes the proper method for writing objectives would be that the nurse writes one long-term objective for each diagnosis, followed by several specific objectives. The nurse would not use general statements that could be accomplished in any amount of time because this action is not addressing the specific needs of the client, and the setting in which the client is in. The nurse would not plan learner objectives with another nurse and would not always obtain input from the family of the client. The objectives need to be specific so the outcomes can be measured in the evaluation phase.

The nurse needs to understand the teaching-learning process when administering

educational interventions. Explanation: Educational interventions require the application of the teaching-learning process. The other interventions listed would not, as their primary goal is not to educate the client.