Week 24: Teaching & Learning (Chapter 25)

The nurse evaluates which of the following statements as an indication that the client is not ready to learn at this time? 1. "I need to understand more about the reason for the colostomy." 2. "I will find out more about that when the support group meets." 3. "There's no sense in showing me that now. I'm too sick right now." 4. "Please be sure to tell me if I am completing all the steps correctly."

"There's no sense in showing me that now. I'm too sick right now."

Races for Low Health Literacy

*Hispanic - lowest* African/Native American/Alaska Native White and Asian Pacific Islander - highest

Reinforcement can be... (3 types and examples of reinforcement..)

*Positive* or Negative 1. Social (ex. smiles, compliments, words of encouragement) 2. Material: works well with children (ex. food, toys, music) 3. Activity (ex. acquiring more *freedom*)

Affective Learning

*feelings, attitude, opinions* *receiving (simplest) *responding *valuing *organizing *characterizing (most complex)

Patient Education (promotes ___) (reduces ___)

-Promotes optimal levels of health -Reduce health care costs and hardships

Nursing diagnoses that address the learning needs of clients

-deficient knowledge -health seeking behaviors -ineffective therapeutic regimens -noncompliance

Importance of Quality Patient Education: 1. 2. 3. 4.

1. Shorter hospital stays 2. increase # of ill patients 3. increase demand on nurses' time 4. give patients good info

Restoration of Health

1. pt needs inormation & skills 2. identify willigness & motivation to learn. 3. Include famlily but don't expect the to do it.

Good teaching plans: 1. 2. 3.

1. reduce health care costs 2. improve quality of care 3. change behaviors to improve pt outcomes

The Ideal Teaching Duration is..

10-15 minutes

Different topics are presented in the information sessions that are held in the outpatient clinic. In planning for a session on health maintenance/illness prevention, the nurse should select a topic on: 1. Use of assistive devices, such as canes 2. Self-help devices for post-CVA clients 3. Stress management techniques for working parents 4. Environmental alterations for clients in wheelchairs

3. Stress management techniques for working parents

A nurse is teaching a 27-year-old gentleman how to adjust his insulin dosages based on his blood sugar results. What type of learning is this? A) Cognitive B) Affective C) Adaptation D) Psychomotor

A) Cognitive Cognitive learning requires thinking; learning how to adjust insulin requires analysis, synthesis, and evaluation, which are all types of cognitive learning.

The nurse has completed an assessment on the client and identified the following nursing diagnoses. Which one of the following nursing diagnoses indicates a need to postpone teaching that was planned? 1. Activity intolerance related to pain 2. Ineffective management of treatment regimen 3. Noncompliance with prescribed exercise plan 4. Knowledge deficit regarding impending surgery

Activity intolerance related to pain

Which Domain? Role playing how the client can respond to friends when they *ask* about her situation

Affective Domain

Which domain? Explaining blood pressure by comparing it to the flow of water in a hose

Analogy

The nurse is planning to teach a patient about the importance of exercise. When is the best time for teaching to occur? (Select all that apply.) A. When there are visitors in the room B. When the patients pain medications are working. C. Just before lunch when the patient is most awake and alert D. When the patient is talking about current stressors in his or her life

Answer: B. When the patients pain medications are working. C. Just before lunch when the patient is most awake and alert

A client, after being taught of the clinical manifestations of inflammation to enable early detection of a complication of a surgical wound states, "I will look at the wound four times a day and tell my surgeon if it looks red or swollen." Her statement is an example of: 1. Attitudes 2. Application 3. Analysis 4. Evaluation

Application

The nurse is preparing the discharge teaching materials on newly prescribed drugs to a client diagnosed to be in the early stage of Alzheimer's disease. The nurse best deals with the client's cognitive deficits by: 1. Providing written material to supplement the discussion 2. Arranging for family to be present during the discussion 3. Presenting the material in two short but focused sessions 4. Requiring the client to restate the information in her own words

Arranging for family to be present during the discussion

Nursing Process: Assessment (identify ___)

Ask questions to *identify motivation to learn*

3 Types of Learning *Domains*

Cognitive Affective Psychomotor

A patient needs to learn to use a walker. Which domain is required for learning this skill? A. Affective domain B. Cognitive domain C. Attentional domain D. Psychomotor domain

D. Psychomotor domain Rationale: Using a walker requires the integration of mental and muscular activity.

Appropriate Time to Implement Teaching is when..

During a similar activity (ex. teach proper skin care techniques when performing skin care)

teaching process: Assessment

Gather data about clients learning needs, motivation, ability to learn

The client continues to ask questions about a surgical wound. The client states, "I think I would like help the first time I look at my wound." This is an example of: 1. Adaptation 2. Perception 3. Organizing 4. Guided response

Guided response

A nurse is teaching a group of young college-age women the importance of using sunscreen when going out in the sun. What type of content is the nurse providing? A) Simulation B) Restoring health C) Coping with impaired function D) Health promotion and illness prevention

Health promotion and illness prevention

Nursing process: Evaluation

Identify success in meeting desired outcomes and goals of nursing care.

Teaching process: Plan

Identify type of teaching method to use

For a functionally illiterate client, the nurse particularly focuses on: 1. Using intricate analogies and examples 2. Avoiding lengthy return demonstrations 3. Incorporating familiar nonmedical terminology 4. Providing longer learning sessions with the client

Incorporating familiar nonmedical terminology

In preparing a teaching plan for adult clients in a cancer support group, the nurse incorporates evidence-based information. The nurse recognizes that evidence obtained about adult learners has identified that this group prefers: 1. Computer-assisted instruction 2. Traditional classroom settings 3. Long sessions with plenty of technical information 4. Interesting personal communication techniques

Interesting personal communication techniques

3 Types of Basic Learning *Principles*

Motivation Ability Environment

In order for therapy to have an effect the patient must.. (example)

Patient must believe the tissue is important enough to change. (ex. patient with lung disease who continues to smoke)

Motivation to Learn (requires these three things..)

Patient's desire or willingness to learn 1. *Self-Efficacy* 2. Attentional Set 3. Motivation

The nurse is teaching a parenting class to a group of pregnant adolescents. The nurse pretends to be the baby's father, and the adolescent mother is asked to show how she would respond to the father if he gave her a can of beer. Which teaching approach did the nurse use? A) Role play B) Discovery C) An analogy D) A demonstration

Role play

Differences between teaching and learning

Teaching produces learning. Learning is a change in behavior.

Which statements by the nurse indicate a good understanding of patient education/teaching? (Select all that apply.) a. "Patient education is a standard for professional nursing practice." b. "Patient teaching falls within the scope of nursing practice." c. "Patient education is an essential component of safe, patient-centered care." d. "Patient education is not effective with children." e. "Patient teaching can increase health care costs." f. "Patient teaching should be documented in the chart."

a. "Patient education is a standard for professional nursing practice." b. "Patient teaching falls within the scope of nursing practice." c. "Patient education is an essential component of safe, patient-centered care." f. "Patient teaching should be documented in the chart."

A nurse is preparing to teach a kinesthetic learner about exercise. Which technique should the nurse use? a. Let the patient touch and use the exercise equipment. b. Provide the patient with pictures of the exercise equipment. c. Let the patient listen to a podcast about the exercise equipment. d. Provide the patient with a case study about the exercise equipment.

a. Let the patient touch and use the exercise equipment. Kinesthetic learners learn best while they are moving and participating in hands-on activities.

A nurse provides teaching about coping with long-term impaired functions. Which situation serves as the best example? a. Teaching a family member to give medications through the patient's permanent gastric tube b. Teaching a woman who recently had a hysterectomy about her pathology reports c. Teaching expectant parents about physical and psychological changes in childbearing women d. Teaching a teenager with a broken leg how to use crutches

a. Teaching a family member to give medications through the patient's permanent gastric tube New knowledge and skills are often necessary for patients and/or family members to continue activities of daily living. Teaching family members to help the patient with health care management (e.g., giving medications through gastric tubes, doing passive range-of-motion exercises) is an example of coping with long-term impaired functions.

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

a. The client may be unable to read the instructions 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.

Which learning objective/outcome has the highest priority for a patient with life-threatening, severe food allergies that require an EpiPen (epinephrine)? a. The patient will administer epinephrine. b. The patient will identify the main ingredients in several foods. c. The patient will list the side effects of epinephrine. d. The patient will learn about food labels.

a. The patient will administer epinephrine. Once you assist in meeting patient needs related to basic survival (how to give epinephrine), you can discuss other topics, such as nutritional needs and side effects of medications. For example, a patient recently diagnosed with coronary artery disease has deficient knowledge related to the illness and its implications. The patient benefits most by first learning about the correct way to take nitroglycerin and how long to wait before calling for help when chest pain occurs. Thus, in this situation, the patient benefits most by first learning about the correct way to take epinephrine. "The patient will learn about food labels" is not objective and measurable and is not correctly written.

Learning

acquire new knowledge, attitudes, behaviors and skills.

Which action best indicates that learning has occurred? a. A nurse presents information about diabetes. b. A patient demonstrates how to inject insulin. c. A family member listens to a lecture on diabetes. d. A primary care provider hands a diabetes pamphlet to the patient.

b. A patient demonstrates how to inject insulin. Learning is the purposeful acquisition of new knowledge, attitudes, behaviors, and skills. Complex patterns are required if the patient is to learn new skills, change existing attitudes, transfer learning to new situations, or solve problems.

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

b. A well-lit, ventilated room 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 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

d. The patient stating that eating yogurt is better than eating cake 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.

Risk for Low Health Literacy

elderly minority immigrant low income chronic mental/physical health conditions

Motivation 1. 2. 3.

force that acts within person to cause the person to behave in a particular way: 1. social motive - need to connect, approval or self-esteem 2. task mastery motive - based on achievement and competence 3. physical motive - return to level of normalcy *none have an effect unless the person believes health is important

Functional Illiteracy

inability to read above 5th grade level

Cognitive Learning

includes all intellectual behaviors, requires *thinking*: *knowledge (easiest) *comprehension *application *analysis *synthesis - break down create something new *evaluation - (hardest)

Teaching Process requires ____ communication

interpersonal

Implementation Teaching Process

involve pt in learning activities, include family caregiver

Teaching is an _____

is an interactive process that *promotes* learning.

Lower Health Literacy Scores

older adults men no English before entering school below poverty level no h.s. education

Teaching Process focuses on..

patient's learning needs and ability to learn

Nursing Process focuses on..

patient's total health care needs

Social Learning Theory

people attempt to control events that affect their lives

Teaching process: Implementation

use teaching methods. involve client and family participation as appropriate.

Which of the following statement best reflects the nurse's appropriate attention to a client's need for self-efficacy? 1. "What can I do to help you lose the weight?" 2. "Are you really ready to start a regular exercise regimen?" 3. "After you watch me demonstrate this inhaler, you will have no problems using it at all." 4. "Come on; with all the self-help products out there, you will be able to stop smoking."

"After you watch me demonstrate this inhaler, you will have no problems using it at all."

Learner characteristics that may be barriers to the teaching/learning process

-acute Illness: all energy concentrate to cope illness -pain: decrease ability to concentrate -prognosis: client focused in getting better -emotions: fear, anger, depression -age: special needs, shorter attention span -language: foreing language, education level -culture/religion: different beliefs, restrictions -physical disability: impairments (hearing, vision, etc) -mental disability

Purpose of Patient Education 1. Maintainence ______ 2. Restoration _____ 3. Coping with _____

1. Maintainence & Promotion of Health and Illness Program 2. Restoration of Health (get back to baseline) 3. Coping with Impaired Functions

Self-Efficacy (4 sources and examples of self-efficacy are..)

1. Enactive *Mastery Experiences* (pt completes skill) 2. Vicarious *(Demonstrative) Experiences* (demonstration) 3. *Verbal Persuasion* (express belief in pt's ability) 4. *Physiological State* (positive effects from skill promote repeated use)

Factors that affect Ability to Learn include.. (6 types [1 big one])

1. Physical Strength 2. Sensory Deficit 3. Reading Level 4. Developmental Level 5. Cognitive Function 6. Pain, Fatigue, *Anxiety*

While teaching the client about management of his heart disease, a nurse might use a strategy that is implemented to promote learning in the affective domain such as: 1. Asking the client what he believes he needs to know about the diagnosis 2. Providing brochures both on current exercises and on nutrition guidelines 3. Encouraging the client to personally discuss his feelings about his health status 4. Having the client return-demonstrate self-measurement of his own blood pressure

3. Encouraging the client to personally discuss his feelings about his health status (Affective means to ask/discuss - verbalize)

A client whose neck is swollen with cellulitis refuses to have visitors or look in the mirror and is not sleeping well or eating healthy foods. You would most expect this client to have which of the following nursing diagnoses? 1. defensive coping 2. ineffective denial 3.situational low self-esteem 4. disturbed body image

4. Disturbed body image The client who has a body-image disturbance may hide or not look at or touch a body part that is significantly changed in structure by illness or trauma. A person who has an unhealthy body image will likely be overly concerned about minor illness and neglect sleep and a healthy diet. The other defense mechanisms are not as likely in this client.

A nurse needs to teach a young woman newly diagnosed with asthma how to manage her disease. Which of the following topics does the nurse teach first? A) How to use an inhaler during an asthma attack B) The need to avoid people who smoke to prevent asthma attacks C) Where to purchase a medical alert bracelet that says she has asthma D) The importance of maintaining a healthy diet and exercising regularly

A) How to use an inhaler during an asthma attack It is important to start with essential life-saving information when teaching people because they usually remember what you tell them first.

A patient with chest pain is having an emergency cardiac catheterization. Which teaching approach does the nurse use in this situation A. Telling approach B. Selling approach C. Entrusting appraoch D. Participating approach Answer

A. Telling approach Rationale: Telling approach is most appropriate when preparing a patient for an emergency procedure

Learning Environment (3/3 of Basic Learning Principles) (importance) *(6 requirements)* (when using groups...)

Allows a person to focus on the learning task *Lighting, Ventilation, Furniture, Temperature, Noise, Privacy* Position groups so everyone is facing each other

A client has been recently told that the primary cancer has metastasized and the cancer is considered terminal. When the nurse offers to discuss palliative care options the client replies, "I can't understand why you all want to upset me by bringing the topic up. Now please just leave me alone." The nurse recognizes this response as: 1. Anger 2. Disbelief 3. Bargaining 4. Acceptance

Anger

When a nurse is teaching a patient about how to administer an epinephrine injection in case of a severe allergic reaction, he or she tells the patient to hold the injection like a dart. Which of the following instructional methods did the nurse use? A. Telling B. Analogy C. Demonstration D. Simulation

B. Analogy Rationale: Again really? its an analogy

A patient who is hospitalized has just been diagnosed with diabetes. He is going to need to learn how to give himself injections. Which teaching method does the nurse use? A. Simulation B. Demonstration C. Group instruction D. One-on-one

B. Demonstration Rationale: Demonstration is used to teach patients psychomotor skills

A patient needs to learn how to administer a subcutaneous injection. Which of the following reflects that the patient is ready to learn? A. Describing difficulties a family member has had in taking insulin B. Expressing the importance of learning the skill correctly C. Being able to see and understand the markings on the syringe D. Having the dexterity needed to prepare and inject the medication.

B. Expressing the importance of learning the skill correctly Rationale: Patients are ready to learn when they understand the importance of learning and are motivated to learn

A patient needs to learn how to administer a subcutaneous injection. Which of the following reflects that the patient is ready to learn? A. Describing difficulties a family member has had in taking insulin B. Expressing the importance of learning the skill correctly C. Being able to see and understand the markings on the syringe D. Having the dexterity needed to prepare and inject the medication

B. Expressing the importance of learning the skill correctly Rationale: Patients are ready to learn when they understand the importance of learning and are motivated to learn.

A nurse is planning a teaching session about healthy nutrition with a group of children who are in first grade. The nurse determines that after the teaching session the children will be able to name three examples of foods that are fruits. This is an example of: A. A teaching plan B. Learning objective C. Reinforcement of content D. Enhancing the children's self efficacy

B. Learning objective Rationale: A learning objective describes what the learner will do after the teaching session

When is the best time for teaching to occur? (Select all that apply.) A. When there are visitors in the room B. When the patients pain medications are working. C. Just before lunch when the patient is most awake D. When the patient is talking about current stressors in his or her life

B. When the patients pain medications are working. C. Just before lunch when the patient is most awake

The nurse is preparing to present a teaching session on skin protection for a group of older adults at a senior center. A principle that has been found to be most effective in teaching older adults is: 1. Moving the group along at a predetermined pace 2. Providing information in longer teaching sessions 3. Speaking very slowly and in a louder tone of voice 4. Beginning and ending each session with important information

Beginning and ending each session with important information

A nurse is going to teach a patient how to perform breast self-examination. Which behavioral objective does the nurse set to best measure the patient's ability to perform the examination? A) The patient will verbalize the steps involved in breast self-examination within 1 week. B) The nurse will explain the importance of performing breast self-examination once a month. C) The patient will perform breast self-examination correctly on herself before the end of the teaching session. D) The nurse will demonstrate breast self-examination on a breast model provided by the American Cancer Society.

C) The patient will perform breast self-examination correctly on herself before the end of the teaching session. Return demonstration provides an excellent source of feedback and reinforcement to evaluate learning.

The school nurse is about to teach a freshman-level high school health class about nutrition. What is the best instructional approach to ensure that the students meet the learning outcomes? A. Provide information in a lecture B. Use simple words to promote understanding C. Develop topics for discussion that require problem solving D. Complete an extensive literature search focusing on eating disorders

C. Develop topics for discussion that require problem solving Rationale: Adolescents learn best when they are able to use problem solving to help them make choices

A patient newly diagnosed with cervical cancer is going home. The patient is avoiding discussion of her illness and postoperative orders. What is the nurse's best plan in teaching this patient? A. Teach the patient's spouse B. Focus on the knowledge that the patient will need in a few weeks C. Provide only the information that the patient needs to go home D. convince the patient that learning about her health is necessary

C. Provide only the information that the patient needs to go home Rationale: patient is in denial only give her information that is needed immediately

A nurse is going to teach a patient how to perform breast self-examination. Which behavioral objective does the nurse set to best measure the patient's ability to perform the examination? A. The patient will verbalize the steps involved in breast self-examination within 1 week. B. The nurse will explain the importance of performing breast self examination once a month. C. The patient will perform breast self-examination correctly on herself before the end of the teaching session. D. The nurse will demonstrate breast self-examination on a breast model provided by the American Cancer Society. Answer

C. The patient will perform breast self-examination correctly on herself before the end of the teaching session. Rationale: Return demonstration provides an excellent source of feedback and reinforcement to evaluate teaching.

A nurse is going to teach a patient how to perform breast self-examination. Which behavioral objective does the nurse set to best measure the patient's ability to perform the examination? A. The patient will verbalize the steps involved in breast self-examination within 1 week. B. The nurse will explain the importance of performing breast self examination once a month. C. The patient will perform breast self-examination correctly on herself before the end of the teaching session. D. The nurse will demonstrate breast self-examination on a breast model provided by the American Cancer Society.

C. The patient will perform breast self-examination correctly on herself before the end of the teaching session. Rationale: Return demonstration provides an excellent source of feedback and reinforcement to evaluate teaching.

Clients give various responses to teaching sessions. For the nurse, an example of an evaluation of a psychomotor skill is: 1. Client states side effects of a medication 2. Client responds appropriately to eye contact 3. Client independently plans an exercise program 4. Client demonstrates the proper use of a walking cane

Client demonstrates the proper use of a walking cane

The nurse is evaluating the responses of clients to teaching sessions. An example of an evaluation of a client's attainment of a cognitive skill is: 1. Client explains that the medication should be taken with meals 2. Client looks at the surgical incision without requiring prompting 3. Client uses crutches appropriately to move both up and down stairs 4. Client independently capable of dressing self after eating breakfast

Client explains that the medication should be taken with meals

Which Domain? Asking a client what he *thinks* might happen at home and how he might respond

Cognitive Domain

When a client newly diagnosed with type 2 diabetes mellitus selects a lunch menu that correlates with the number of carbohydrates he is allowed for that meal, this is an example of: 1. Cognitive learning 2. Affective learning 3. Impaired learning 4. Psychomotor learning

Cognitive learning

There are a variety of teaching methodologies that may be utilized to meet the client's needs. Which teaching method is best applied to a cognitive learning need? 1. Modeling of behavior 2. Discussion of feelings 3. Computer-assisted instruction 4. Demonstration of a procedure

Computer-assisted instruction

An older adult is being started on a new antihypertensive medication. In teaching the patient about the medication, the nurse: A. Speaks loudly B. Presents the information once C. Expects patient to understand information quickly D. allows the patient time to express himself/herself and ask questions

D. allows the patient time to express himself/herself and ask questions Rationale: In older patients its important to establish rapport, involve them in their care, and allow them to progress at their own pace

A client has been recently told that the primary cancer has metastasized, and the cancer is considered terminal. When the nurse offers to discuss palliative care options, the client replies, "I'm going to have the reports reevaluated by another doctor; I feel fine and I think a mistake has been made." The nurse recognizes this response as: 1. Anger 2. Disbelief 3. Bargaining 4. Acceptance

Disbelief

The nurse established the following objective for the client who was unable to void: The client's intake will be at least 1000 mL between 7 AM and 3:30 PM. Feedback showing success is indicated by the client: 1. Voiding at least 1000 mL during the shift 2. Verbalizing abdominal comfort without pressure 3. Having adequate fluid intake and urinary output 4. Drinking 240 mL of fluid five or six times during the shift

Drinking 240 mL of fluid five or six times during the shift

In planning to teach an older adult client, the nurse should incorporate which teaching method or principle into the plan? 1. Keep teaching sessions short. 2. Teach in the early morning or late evening. 3. Put as much as possible into each teaching session. 4. Focus on teaching a family member or caregiver instead.

Keep teaching sessions short.

Teaching tools appropriate for use in the pediatric patient

Let kids play dress-up and play with equipment (stethoscope, tongue blade). Use simple language.

Which of the following actions is the primary nursing responsibility regarding client education? 1. Providing accurate, current, relevant information 2. Answering the client's questions regarding health-related issues 3. Assessing the individual client's readiness and motivation to learn 4. Identifying areas where clients are in need of educational information

Providing accurate, current, relevant information

Which Domain? Demonstrating and *practicing* how to perform a procedure

Psychomotor

When a client newly diagnosed with type 2 diabetes mellitus assumes responsibility for checking her blood glucose level four times a day, this is an example of: 1. Cognitive learning 2. Affective learning 3. Impaired learning 4. Psychomotor learning

Psychomotor learning

Nurse must establish ___ before teaching

Report with patient/learner

There are a variety of teaching methodologies fro a nurse to choose from to use with clients. For a toddler, the nurse should use: 1. Role-playing 2. Problem-solving 3. Independent learning 4. Simple explanations and pictures

Simple explanations and pictures

The client has been informed that he can be discharged once he can irrigate his colostomy independently. The client requests the nurse to observe his irrigation technique. Which of the following learning motives is the client displaying? 1. Physical need 2. Social activity 3. Task mastery 4. Evaluation stance

Task mastery

The nurse has important information to share with a parent who has brought his child to the emergency department. The nurse discovers that the parent, who appears very anxious, has just learned his son will require surgery. The most effective teaching approach in this situation is: 1. Telling 2. Trusting 3. Participating 4. Group teaching

Telling

The nurse recognizes that the client's teaching plan is most directly driven by: 1. The client's identified learning needs 2. The complexity of the client's health needs 3. The client's readiness and motivation to learn 4. The presence of cultural or physical barriers

The client's identified learning needs

The nurse recognizes that the primary goal of a client's teaching plan is to: 1. Facilitate a knowledge-based client decision-making process 2. Provide information that brings about informed client consent 3. Enhance the client's sense of personal control regarding his or her health care 4. Therapeutically affect the client's health, wellness, and independence

Therapeutically affect the client's health, wellness, and independence

The nurse is demonstrating to the client how to put on anti-embolitic stockings. In the middle of the lesson the client asks, "Why have my feet been swelling?" The nurse stops and responds to the client. Which of the following is the teaching principle that the nurse should follow? 1. Timing 2. Setting priorities 3. Building on existing knowledge 4. Organizing the teaching materials

Timing

An industrial nurse is planning to give an informative talk on hypertension to employees in honor of "heart month." He plans to teach individuals how to take their blood pressure measurements. Which information is important for him to ask the planning committee before this presentation? 1. Ages of all employees involved 2. Names of employees who are married 3. Number of employees with high blood pressure 4. Type of room available and number of participants

Type of room available and number of participants

Which of the following teaching topics is an example of restoration of health? 1. Glucose monitoring at home 2. Living with rheumatoid arthritis 3. Stress management's impact on depression 4. What to expect after hip replacement surgery

What to expect after hip replacement surgery

There are many factors are assessed before teaching the client to learn insulin injection sites, but the most important factor for the nurse to assess first is the: 1. Previous knowledge level of the client 2. Willingness of the client to want to learn the injection sites 3. Financial resources available to the client for the equipment 4. Intelligence and developmental level of the individual client

Willingness of the client to want to learn the injection sites

While preparing a teaching plan, the nurse described what the learner will be able to accomplish after the teaching session. Which action did the nurse complete? a. Developed learning objectives b. Provided positive reinforcement c. Implemented interpersonal communication d. Presented facts and knowledge

a. Developed learning objectives Learning objectives describe what the learner will be able to do after successful instruction. Positive reinforcement follows feedback and involves the use of praise and acknowledgment of new attitudes, behaviors, or knowledge. Interpersonal communication is necessary for the teaching/learning process, but describing what the learner will be able to do after successful instruction constitutes learning objectives. Facts and knowledge will be presented in the teaching session.

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

a. Developmental capabilities and physical capabilities 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.

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

a. Helping clients accept the need for daily injections 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.

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

a. Return demonstration 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.

When the nurse describes a patient's perceived ability to successfully complete a task, which term should the nurse use? a. Self-efficacy b. Motivation c. Attentional set d. Active participation

a. Self-efficacy Self-efficacy, a concept included in social learning theory, refers to a person's perceived ability to successfully complete a task. Motivation is a force that acts on or within a person (e.g., an idea, an emotion, a physical need) to cause the person to behave in a particular way. An attentional set is the mental state that allows the learner to focus on and comprehend a learning activity. Learning occurs when the patient is actively involved in the educational session

A patient had a stroke and must use a cane for support. A nurse is preparing to teach the patient about the cane. Which learning objective/outcome is most appropriate? a. The patient will walk to the bathroom and back to bed using a cane. b. The patient will understand the importance of using a cane. c. The patient will learn how to use a cane. d. The patient will know the correct use of a cane.

a. The patient will walk to the bathroom and back to bed using a cane. Outcomes often describe a behavior that identifies the patient's ability to do something on completion of teaching such as will empty colostomy bag, or will administer an injection. Understand, learn, and know are not behaviors that can be observed or evaluated.

A nurse is asked about the goal of patient education. What is the nurse's best response? The goal of educating others is to help people a. Meet standards of the Nurse Practice Act. b. Achieve optimal levels of health. c. Become dependent on the health care team. d. Provide self-care only in the hospital.

b. Achieve optimal levels of health. The goal of educating others about their health is to help individuals, families, or communities achieve optimal levels of health. Although all state Nurse Practice Acts acknowledge that patient teaching falls within the scope of nursing practice, this is the nurse's standard, not the goal of education. Patient education helps patients make informed decisions about their care and become healthier and more independent, not dependent. Nurses provide patients with information needed for self-care to ensure continuity of care from the hospital to the home.

Which nursing action is most appropriate for assessing a patient's learning needs? a. Assess the patient's total health care needs. b. Assess the patient's health literacy. c. Assess all sources of patient data. d. Assess the goals of patient care.

b. Assess the patient's health literacy. Because health literacy influences how you deliver teaching strategies, it is critical for you to assess a patient's health literacy before providing instruction. The nursing process requires assessment of all sources of data to determine a patient's total health care needs. Evaluation of the teaching process involves determining outcomes of the teaching/learning process and the achievement of learning objectives, not patient care. Assessing the goal of meeting patient care is the evaluation component of the nursing process.

A patient with heart failure is learning to reduce salt in the diet. When would be the best time for the nurse to address this topic? a. At bedtime, when the patient is relaxed b. At lunchtime while the nurse is preparing the food tray c. At bath time, when the nurse is cleaning the patient d. At medication time, when the nurse is administering patient medication

b. At lunchtime while the nurse is preparing the food tray Appropriate times to talk about food/diet changes during routine nursing care are at breakfast, lunch, and dinner times or when the patient is completing the menu. Many nurses find that they are able to teach more effectively while delivering nursing care. For example, while hanging blood, you explain to the patient why the blood is necessary and the symptoms of a transfusion reaction that need to be reported immediately. In this situation, because the teaching is about food, coordinating it with routine nursing care that involves food can be effective. At bedtime would be a good time to discuss routines that enhance sleep. At bath time would be a good time to describe skin care and how to prevent pressure ulcers. At medication time would be a good time to explain the purposes and side effects of the medication.

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

b. Cognitive 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 who is applying behaviorist learning theory offers a block of information on risk factors for heart disease in a straightforward, non-distracting way. What teaching strategies are appropriate for the nurse applying this learning theory to use next? a. Encourage positive teacher-learner relationships, and select multisensory delivery methods b. Give a short test, and provide positive feedback c. Assess clients' developmental and individual learning readiness, and adapt teaching strategies accordingly d. Encourage clients to establish goals, and promote self-directed learning

b. Give a short test, and provide positive feedback Rationale: Nurses applying behaviorist theory should include: careful identification of material to be taught; strategies that avoid distracting information; immediate and repeat testing; positive feedback; and role modeling. Strategies in choice "1" and "3" are consistent with cognitive theory. Strategies in choice "4" are consistent with humanism.

A nurse is teaching a patient about the Speak Up Initiatives. Which information should the nurse include? a. The nurse is the center of the health care team. b. If you still do not understand, ask again. c. Ask a nurse to be your advocate or supporter. d. Inappropriate medical tests are the most common mistakes.

b. If you still do not understand, ask again. If you still do not understand, ask again is part of the S portion of the Speak Up Initiatives. Speak up if you have questions or concerns. You (the patient) are the center of the health care team, not the nurse. Ask a trusted family member or friend to be your advocate (advisor or supporter), not a nurse. Medication errors are the most common health care mistakes, not inappropriate medical tests.

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.

b. Refer to an ostomy specialist. 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.

The nurse is teaching a client about reducing blood cholesterol levels through dietary management. The most appropriate learning outcome for the teaching would be: a. The client will understand benefits of a low-fat diet for cholesterol reduction b. The client will accurately select low-fat foods from a list of common foods c. The nurse will teach the client about low-fat foods and cholesterol reduction d. The client will list some common low-fat foods

b. The client will accurately select low-fat foods from a list of common foods Rationale: Learning outcomes should state expected client behavior; should reflect an observable, measurable activity; and may have conditions or modifiers stating conditions of performance. Words such as know, understand, feel, and believes are not measurable.

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.

b. The patient is fatigued. d. The patient is hurting. e. The patient is febrile (high fever).

Which situation indicates to the nurse that the patient is ready to learn? a. A patient has sufficient upper body strength to move from a bed to a wheelchair. b. A patient has the ability to grasp and apply the elastic bandage. c. A patient with a below-the-knee amputation is motivated about how to walk with assistive devices. d. A patient has normal eyesight to identify the markings on a syringe and coordination to handle a syringe.

c. A patient with a below-the-knee amputation is motivated about how to walk with assistive devices.

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.

c. Apply a bandage to a doll's ear. 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.

A nurse is going to teach a patient about hypertension. Which action should the nurse implement first? a. Set mutual goals for knowledge of hypertension. b. Teach what the patient wants to know about hypertension. c. Assess what the patient already knows about hypertension. d. Evaluate the outcomes of patient education for hypertension.

c. Assess what the patient already knows about hypertension. Assessment is the first step of any teaching session, then diagnosing, planning, implementation, and evaluation. An effective assessment provides the basis for individualized patient teaching. Assessing what the adult patient currently knows improves the outcomes of patient education.

The nurse is planning an educational program on cancer detection for a community group. What should be included in the plan to assure that the program will address various learning styles of clients? a. Multicolored posters with bright colors b. Lecture to the group, using many examples c. Audiovisuals, examples, group discussions, and activities d. A game board, with clients matching terms

c. Audiovisuals, examples, group discussions, and activities Rationale: When teaching a group, utilize strategies to address visual, auditory, manipulative, group, and problem-solving types of learners. Using varying techniques and varying activities is a good way to match the varying learning styles of group participants.

A nurse is teaching an older adult patient about strokes. Which teaching technique is most appropriate for the nurse to use? a. Use a pamphlet about strokes with large font in blues and greens. b. Speak in a high tone of voice to describe strokes. c. Begin and end each teaching session with the most important information about strokes. d. Provide specific information about strokes in frequent, large amounts.

c. Begin and end each teaching session with the most important information about strokes.

Prior to beginning a teaching session on self-care of a colostomy, the nurse will assess the client's readiness to learn by assessing: a. Client's recognition of a need to learn, and belief that learning will lead to self-care ability b. Client's knowledge and previous experience with colostomies c. Client's pain and comfort levels, and willingness to learn d. Client's cognitive and sensory abilities

c. Client's pain and comfort levels, and willingness to learn Rationale: Readiness involves both willingness to learn and ability to learn at a specific time. Pain or discomfort may make it difficult for a client to learn, and must be addressed prior to teaching. The other factors should be assessed as well, but are not indicative of readiness.

A nurse is teaching a culturally diverse patient about nutritional needs. What must the nurse do first before starting the teaching session? a. Obtain pictures of food. b. Get an interpreter. c. Establish a rapport. d. Refer to a dietitian.

c. Establish a rapport. Establishing a rapport is important for all patients, especially culturally diverse patients, before starting teaching sessions. Obtaining pictures of food, getting an interpreter, and referring to a dietitian all occur after rapport is established.

A nurse wants the patient to begin to accept the chronic nature of diabetes. Which teaching technique should the nurse use to enhance learning? a. Lecture b. Demonstration c. Role play d. Question and answer session

c. Role play Affective learning deals with expression of feelings and acceptance of attitudes, opinions, or values. Role play and discussion (one-on-one and group) are effective teaching methods for the affective domain. Lecture and question and answer sessions are effective teaching methods for the cognitive domain. Demonstration is an effective teaching method for the psychomotor domain.

After a teaching session on taking blood pressures, the nurse tells the patient, "You took that blood pressure like an experienced nurse." What type of reinforcement did the nurse use? a. Material b. Activity c. Social d. Entrusting

c. Social Three types of reinforcers are social, material, and activity. When a nurse works with a patient, most reinforcers are social and are used to acknowledge a learned behavior (e.g., smiles, compliments, words of encouragement). Examples of material reinforcers include food, toys, and music. Activity reinforcers rely on the principle that a person is motivated to engage in an activity if he or she has the opportunity to engage in a more desirable activity after completion of the task. The entrusting approach is a teaching approach that provides the patient the opportunity to manage self-care. It is not a type of reinforcement.

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%.

c. The client willingly learns about diabetes treatment and follows the treatment plan. 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.

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."

d. "Please read this handout and tell me what it means." 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

Which statement indicates that the nurse has a good understanding of teaching/learning? a. "Teaching and learning can be separated." b. "Learning is an interactive process that promotes teaching." c. "Learning consists of a conscious, deliberate set of actions designed to help the teacher." d. "Teaching is most effective when it responds to the learner's needs."

d. "Teaching is most effective when it responds to the learner's needs." Teaching is most effective when it responds to the learner's needs. It is impossible to separate teaching from learning. Teaching is an interactive process that promotes learning. Teaching consists of a conscious, deliberate set of actions that help individuals gain new knowledge, change attitudes, adopt new behaviors, or perform new skills.

A client presents with the following: recent medical diagnosis of congestive heart failure, four new medications, and reduced activity levels due to shortness of breath. The most appropriate nursing diagnosis based upon this information is: a. Health-Seeking Behavior (exercise and activity) related to desire to improve health status b. Noncompliance with medical treatment plan related to lack of energy for activity c. Risk for ineffective coping related to deficient knowledge d. Deficient Knowledge (medication) related to inexperience with newly ordered therapy

d. Deficient Knowledge (medication) related to inexperience with newly ordered therapy Rationale: Deficient Knowledge is used as a diagnostic label when the client is seeking health information or the nurse has identified a learning need. The area of deficiency should be included in the diagnosis.

A nurse is teaching the staff about nursing and teaching processes. Which information should the nurse include regarding the teaching process? During the teaching process, what should the nurse do? a. Assess all sources of data. b. Identify that it is the same as the nursing process. c. Perform nursing care therapies. d. Focus on a patient's learning needs.

d. Focus on a patient's learning needs. The teaching process focuses on the patient's learning needs and willingness and capability to learn. Nursing and teaching processes are not the same. All the rest are components of the nursing process: Assess all sources of data and perform nursing care therapies.

A client who is doing a return demonstration of how to change a wound dressing to the leg contaminates the dressing after appropriately cleansing the wound. The best nursing response is to: a. Say, "You have done this all wrong! Let me show you again." b. Remove the dressing, cleanse the wound again, and apply a new dressing c. Say and do nothing to avoid upsetting the client d. Say, "You did a good job of cleansing the wound. Let's look at ways to best put the dressing on."

d. Say, "You did a good job of cleansing the wound. Let's look at ways to best put the dressing on." Rationale: Clients need positive feedback on performance to enhance learning. Positive feedback can include praise, positively worded corrections, and suggestions of alternate methods. Negative feedback is often viewed as punishment, and may cause the client to avoid the nurse or refuse to participate further.

Teaching process: Diagnosis

learning needs on basis of three domains of learning