Chapter 25 Patient Education
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 cant 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
1. anger In this example, the client blames others and complains. The client often directs anger toward the nurse or others. The remaining options are other stages of the grieving process.
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
1. activity intolerance related to pain Pain, fatigue, or anxiety can interfere with the ability to pay attention and participate. The nursing diagnosis of activity intolerance related to pain indicates a need to postpone teaching. Teaching may be delayed until the nursing diagnosis is resolved or the health problem is controlled. Ineffective management of treatment regimen does not indicate a need to postpone teaching. Ineffective management of treatment regimen reinforces the need for teaching. Noncompliance with prescribed exercise plan does not indicate a need to postpone teaching. The client who is noncompliant may require further teaching. Knowledge deficit regarding impending surgery does not indicate a need to postpone teaching. A knowledge deficit reinforces the need for teaching.
The nurse is evaluating the responses of clients to teaching sessions. An example of an evaluation of a clients 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
1. client explains that medication should be taken with meals The client who is able to explain that the medication should be taken with meals is demonstrating attainment of a cognitive skill. The client who is able to look at the surgical incision without prompting is demonstrating attainment of affective learning. The client who uses crutches appropriately is demonstrating attainment of a psychomotor skill. The client who dresses self after breakfast is most likely demonstrating attainment of psychomotor learning.
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 larning 3. impaired learning 4. psychomotor learning
1. cognitive learning Cognitive learning includes all intellectual behaviors and requires thinking. The remaining options are involved with expression of feelings and acceptance of attitudes, opinions, or values or acquiring skills that require the integration of mental and muscular activity. Impairing learning involves alteration to the normal learning process that requires alterations in methods and techniques.
Which of the following teaching topics is an example of health maintenance and promotion and illness prevention? 1. glucose monitoring at home 2. living with rheumatoid arthritis 3. stress managements impact on depression 4. what to expect after hip replacement surgery
1. glucose monitoring at home Promoting healthy behavior through education allows clients to assume more responsibility for their health. Greater knowledge results in better health maintenance habits. When clients become more health conscious, they are more likely to seek early diagnosis of health problems. The remaining options address restoration of health and coping with impaired functioning, whereas stress management is a topic that relates to the promotion of health and the prevention of illness.
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
1. keep teaching sessions short Keeping teaching sessions short is an appropriate method when teaching an older adult client. The older adult should be taught when the client is alert and rested, not early morning or late evening. The teaching session should not be filled with numerous topics. The older adult client is capable of learning and should be the focus. A family member or caregiver may be included in teaching, but the older adult client should not be excluded.
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 to this situation is: 1. telling 2. trusting 3. participating 4. group teaching
1. telling The telling approach is useful when limited information must be taught. If a client is highly anxious but it is vital for information to be given, telling can be effective. The entrusting approach provides the client the opportunity to manage self-care. The nurse observes the client's progress and remains available to assist without introducing more new information. This would not be the most effective teaching approach in this situation. Participating involves the nurse and client setting objectives and becoming involved in the learning process together. This would not be the most effective teaching approach in this emergency situation. Group teaching would not be the most effective in this emergency situation. Group teaching would not be the most effective teaching approach in this situation. A person who is anxious would benefit from individual instruction.
The nurse recognizes that the clients 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
1. the client's identified learning needs Teaching is most effective when it responds to the learners needs. While assessing and diagnosing a clients health care problems, the nurse identifies the need for education that in turn generates the teaching plan. The remaining options reflect factors that will affect both the teaching plan and the clients learning.
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
1. timing The nurse who stops a demonstration of applying anti-embolitic stockings to answer a clients question is following the teaching principle of timing. If the client has a question, it is important to answer the question immediately, so the client may return his or her focus to the task being taught. Setting priorities is important to conserve the time and energy of the client and nurse. The nurse who stops to answer a question is not setting priorities. A client learns best on the basis of preexisting cognitive abilities and knowledge. This situation is not an example of building on existing knowledge. Organizing teaching materials means the nurse considers the order of information to present. This is not an example of organizing teaching materials
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 4 times a day and tell my surgeon if it looks red or swollen". Her statement is an example of 1. attitude 2. application 3. analysis 4. evaluation
2. application Application involves using abstract, newly learned ideas in a concrete situation. The client who is taught the clinical manifestations of inflammation and who will assess for signs such as redness or edema is using newly learned information in a concrete manner. Attitude has to do with affective learning. The client is not expressing an attitude, but is applying new knowledge in a concrete way. Analysis involves breaking down information into organized parts. The client is not demonstrating analysis. Evaluation is a judgment of the worth of a body of information for a given purpose.
The nurse is preparing the discharge teaching materials on newly prescribed drugs to a client diagnosed to be in the early stage of Alzheimers disease. The nurse best deals with the clients 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
2. arranging for family to be present during the discussion The clients family needs to understand and accept many changes in the patients physical and/or cognitive capabilities. The familys ability to provide support results in part from education, which begins as soon as the nurse identifies the clients needs and the family displays a willingness to help. The remaining options may support retention of material but not as effectively as including family in the educational sharing.
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, Im 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
2. disbelief In this example, the client avoids discussion of the illness, choosing to believe a mistake has been made. The remaining options are other stages of the grieving process.
Which of the following statement best reflects the nurses appropriate attention to a clients need for self-efficacy? 1. what can I do to help you lose weight? 2. are you really read 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
3. after you watch me demonstrate this inhaler, you will have no problems using it at all Self-efficacy refers to a persons perceived ability to successfully complete a task. When people believe that they are able to execute a particular behavior, they are more likely to actually perform the behavior consistently and correctly. Although the other options are related to behavioral change to achieve a goal, they do not support the client by both encouragement and providing the skills necessary to be successful.
There are a variety of teaching methodologies that may be utilized to meet the clients 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
3. computer assisted instruction An independent project such as computer-assisted instruction is an appropriate teaching method for cognitive learning. Modeling of behavior is an appropriate teaching method for psychomotor learning. Discussion of feelings is an appropriate teaching method for affective learning. Demonstration is an appropriate teaching method for psychomotor learning.
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 An intervention to promote learning in the affective domain would be encouraging the client to discuss his feelings about his health status. Asking the client what he believes he needs to know about the diagnosis would be an intervention to promote learning in the cognitive domain. Providing brochures on current exercises and nutrition guidelines would be an intervention to promote learning in the cognitive domain. Having the client return-demonstrate self- measurement of his blood pressure would be an intervention to promote learning in the psychomotor domain.
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
3. incorporating familiar nonmedical terminology When teaching a functionally illiterate client, the nurse should use simple terminology, avoiding medical jargon. The nurse should incorporate familiar terminology to enhance the clients understanding. The nurse should use simple analogies and real life examples. The nurse should ask for return demonstrations as this provides the opportunity to clarify instructions and time to review procedures. Although teaching sessions may be kept short, they should be scheduled at more frequent intervals.
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-hep devices for post CVA patients 3. stress management techniques for working parents 4. environmental alterations for clients in wheelchairs
3. stress management techniques for working parents Stress management techniques for working parents is an appropriate topic for health maintenance/illness prevention. Use of assistive devices, such as canes, is not a health maintenance/illness prevention topic. It is a coping with impaired function topic. Self-help devices for post-CVA clients is not a health maintenance/illness prevention topic. It is a coping with impaired function topic. Environmental alterations for clients in wheelchairs is not a health maintenance/illness prevention topic. It is a coping with impaired function topic.
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
3. task mastery Task mastery motives are based on needs such as achievement and competence. The client who must demonstrate irrigating his colostomy independently in order to be discharged is displaying the learning motive of task mastery. A physical motive may be seen in the client who desires to return to a level of physical normalcy. A social motive is the need for connection, social approval, or self esteem. An evaluation stance would be determining whether the outcomes of the teaching learning process met the client's goals.
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 in a louder tone of voice 4. beginning and ending each session with important information
4. beginning and ending each session with important information The nurse should begin and end each teaching session with important information because clients are more likely to remember information that is taught early in the teaching session, and key points can be summarized at the end. Repetition also reinforces learning. The group should not be moved along at a predetermined pace. Clients may have questions that would go unanswered if there were a predetermined pace. Or, sometimes teaching sessions have to be stopped after the nurse observes a clients loss of concentration such as nonverbal cues of poor eye contact or slumped posture. Shorter (approximately 20 minutes), frequent sessions are more easily tolerated and retain the clients interest in the material. The nurse should face the client and speak in a low tone of voice for the older adult with a hearing problem.
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
4. client demonstrates the proper use of a walking cane Determining whether the client is able to demonstrate a newly learned skill is an example of an evaluation of a psychomotor skill. Psychomotor learning involves acquiring skills that require the integration of mental and muscular activity, such as walking with a cane. Having the client state side effects of a medication is an example of an evaluation of cognitive learning. Determining whether a client responds appropriately to eye contact is an example of evaluation of affective learning. The client who planned an exercise program is demonstrating cognitive learning
The nurse established the following objective for the client who is unable to void: The client's intake will be at least 1000 mL between 7am-330pm. Feedback showing success is indicated by 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 5-6 times during the shift
4. drinking 240 mL of fluid 5-6 times during the shift The nurse evaluates success by observing the client's performance of each expected behavior. Feedback indicating success in this situation is the client drinking 240 mL of fluid 5-6 times during the shift. This would be a fluid intake of 1200-1400mL, meeting the objective of at least 1000 mL during the designated time period. Voiding at least 1000 mL is not the objective. Verbalizing the abdominal comfort without pressure is not an evaluation of the objective regarding specific fluid intake. Having adequate intake and output is not accurate feedback indicating success. The term adequate is not quantified.
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. adaption 2. pereception 3. organizing 4. guided response
4. guided response A guided response is the performance of an act under the guidance of an instructor. The client who is seeking help is demonstrating a guided response. Adaptation occurs when a person is able to change a motor response when unexpected problems arise. The client is not exhibiting adaptation. Perception is being aware of objects or qualities through the use of sense organs. This situation is not an example of perception. Organizing is developing a value system by identifying and organizing values and resolving conflicts. This situation is not an example of organizing.
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
4. interesting personal communication techniques Adults have a wide variety of personal and life experiences to employ. Therefore adult learning is enhanced when they are encouraged to use these experiences to solve problems. Evidence- based information indicates that adult clients prefer interactive, personal communication with nurses or physicians. Evidence-based information indicates computer-assisted learning is not a preferred method of instruction by many adult learners. As clients become more comfortable with computers, this preference may change. Evidence-based information indicates that not all clients are comfortable in class settings or in support groups. Other educational opportunities should be available. Adult learners prefer short teaching sessions without a great deal of technical information
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
4. psychomotor learning Psychomotor learning involves acquiring skills that require the integration of mental and muscular activity. The remaining options are involved with expression of feelings and acceptance of attitudes, opinions, or values or the acquisition of knowledge. Impaired learning involves alteration to the normal learning process that requires alterations in methods and techniques.
There are a variety of teaching methodologies for 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
4. simple explanations and pictures Effective teaching methodologies for the toddler include simple explanations and picture books that describe a story of children in a hospital or clinic. Role playing is an appropriate teaching methodology for a preschooler. Problem solving is an appropriate teaching methodology for an adolescent. Independent learning is best used as a teaching methodology for the young or middle adult.
The nurse recognizes that the primary goal of a clients 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
4. therapeutically affect the client's health, wellness and independence Creating a well-designed, comprehensive teaching plan that fits a clients unique learning needs ultimately helps clients make informed decisions about their care and results in clients becoming healthier and more independent. The remaining options affect the primary goal by enhancing decision making, providing for informed consent, and bringing about a sense of personal control.
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 his presentation? 1. ages of 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
4. type of room available and number of participants The number of persons being taught, the need for privacy, the room temperature, the room lighting, noise, the room ventilation, and the room furniture are important factors when choosing the setting. The ideal setting helps the client focus on learning the task.
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
4. what to expect after hip replacement surgery Injured or ill clients need information and skills to help them regain or maintain their levels of health. The remaining options address health maintenance and promotion and illness prevention and coping with impaired functioning while what to expect after hip replacement surgery is a topic that relates to the restoration of health and function.
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
1. providing accurate, current, relevant information Nurses have an ethical responsibility to teach their clients (Redman, 2005, 2007). The information needs to be accurate, complete, and relevant to the clients needs. The remaining options are factors that affect learning and so require the nurses attention but are not as primary as providing information that is accurate, current, and relevant to the clients needs.
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 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
2. willingness of the client to want to learn injection sites f a person does not want to learn, it is unlikely that learning will occur. Motivation is the first factor the nurse should assess before teaching. To determine learning needs, the nurse should assess the clients previous knowledge level. However, this would not be the most important factor for the nurse to assess first. Assessing the financial resources available to the client for obtaining equipment is important; however, it is not the most important factor for the nurse to assess first. Assessing the clients physical and cognitive ability to learn is important. However, it is not the most important factor for the nurse to assess first.
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 colonoscopy. 2. I will find out more about that when the support group meets. 3. There is 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.
3. There is no sense in showing me right now. I'm too sick right now. Readiness to learn is related to the stage of grieving. This response by the client is demonstrating anger. The client is unwilling to learn at this time. The client has not yet reached the acceptance state of grieving in which learning can occur. This statement indicates the client is ready to learn and desires to find out more to gain understanding. This statement indicates the client is willing to learn. The client who requests feedback is expressing readiness to learn.
