Chapter 9 Prep U

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 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.

Which response from the client enables the nurse to determine the effectiveness of a recent medication teaching session for an older adult client who is diagnosed with tuberculosis (TB)?

"I will be taking the TB medication for at least 6 months, because it takes a long time to kill the TB germs." The response about taking TB medication for at least 6 months points to an effective teaching session because clients diagnosed with TB have to take TB medication for 6 months or longer. In order to be effective, the client cannot skip medication doses. While having a responsible family member dispense the TB medication to the client is acceptable, it is an indicator that the client may not understand the medication instructions, and that a family member should be included in the teaching.

The nurse has provided education to a client about home care for an open surgical wound on the lower left extremity. When evaluating learning through the cognitive domain, what statement by the nurse would be appropriate?

"Tell me about what signs of infection you will report to the health care provider.

A 56-year-old client meets with the nurse for education about a recently diagnosed atrial fibrillation. The client verbalizes concerns about being away from work too long and doubts about the necessity of having blood tests every week, as the client has no symptoms. Which is the best motivational statement by the nurse for this client?

"The medicine and blood work can help prevent blood clots, which can lead to strokes. What do you know about warfarin therapy?" Adults learn best when the information given to them will be used immediately, is presented as important to the client, and when the client's autonomy is preserved. As with all learners, the teaching approach must reflect respect for what the client already knows. By presenting the facts in a way that gives the client control over a health alteration, and by assessing current knowledge, these qualities that are important to forming a learning plan for an adult are met. When education plans take control out of the client's hands (such as stating the doctor wants compliance) or when the lifestyle change is presented as a burden, motivation may be low. If the nurse shows interest in working with and discussing issues with the client, a partnership is formed that can boost motivation.

A couple has just learned that their newborn infant has a congenital cardiac anomaly that will require many lifestyle modifications, surgical corrections, and hospital stays. Place the following aspects of the couple's client education in the correct order that nurses should conduct them.

- Determine their emotional readiness to learn. - Draft learning outcomes. - Select educational strategies. - Implement various educational techniques. - Revise the learning plan if needed. The education process parallels the learning process. It begins with assessment of variables such as readiness to learn and learning needs, which lead to a determination of learning outcomes. Teaching strategies are selected, implemented, evaluated, and then revised if necessary.

A client states to the nurse, "I understand that I need a mastectomy for the treatment of my breast cancer, but I am fearful of learning about the drains I will need to empty." When responding to the client, the nurse will need to address which type of learning?

Affective This client is clearly expressing a negative feeling about the upcoming treatment: fear. Therefore, the nurse needs to provide teaching that addresses the client's emotional learning needs, or affective learning. Affective refers to emotions or feelings, and affective learning changes beliefs, attitudes, or values. Cognitive learning involves the client's critical thinking and reason. Psychomotor learning involves physically performing a task--learning by doing. Behavioral learning involves learning new, helpful behaviors and unlearning old, unhelpful ones.

When preparing client teaching materials, how does the nurse best assess a client's preferred learning style?

Ask the client, "Do you learn best by observing, valuing, or doing?" One way to determine the client's preferred learning style is to ask the client about the client's personal learning preference--whether cognitive, affective, or psychomotor. Simply observing the client's behavior or considering the client's age and hearing ability would not provide as much information about the client's preferred learning style as would directly asking the client. Providing teaching using a broad-based approach would not help determine the client's preferred learning style and would not be as effective as providing teaching that is tailored to the client's preferred learning style.

The nurse is caring for a 60-year-old client with an improper bowel movement regimen. Which is the most appropriate method for the nurse to use in teaching this client?

Begin the session with a reference to the client's actual experience. Beginning the session with a reference to the client's actual experience will help provide a link to which the new learning can connect. Although it may be appropriate to refer the client to online resources on proper bowel health, to encourage the client to join a support group, and to consult the client's family regarding the client's history, the nurse should first engage with the client to find out the client's experience and specific issues.

A nurse is educating a 4-year-old client about cast care following a tibia-fibula fracture. Which action is not developmentally appropriate to include in the nurse's teaching?

Blocking 30 minutes of time for skill teaching Preschool age children (2 to 5 years) have short attention spans. Five- to ten-minute blocks of time are age appropriate. A 30-minute block is more appropriate for an older client. The other answers are developmentally appropriate for a 4-year-old.

A client states, "I understand when the nurse explains the possible complications of my illness. I am appreciative of what insulin does to my body, and I can now give myself insulin." Which domains of learning does the nurse identify for this client as having been successfully addressed by education?

Cognitive, affective, and psychomotor "I understand when the nurse explains the possible complications of my illness. I am appreciative of what insulin does to my body, and I can now give myself insulin" is an example of the cognitive, affective, and psychomotor domains, respectively. Pedagogy is the science of teaching children and is not a domain of learning. Andragogy is the principle of teaching adults and is not a domain of learning. Gerogogy enhances learning among older adults and is not a domain of learning.

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. 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.

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. 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.

A nurse is preparing to teach a 6-year-old client with a broken arm and the client's mother about caring for the child's cast. Which statement reflects the best education plan for these clients?

Include the child in the education; ask questions of both the mother and the child. School-age children are able to make decisions and provide care for themselves. Focusing mainly or only on the mother fails to validate the child's abilities, and teaching the mother and the child separately does not make good use of time.

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 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.

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 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 a client says, "I don't care if I get better; I have nothing to live for, anyway," which type of counseling would be appropriate?

Motivational counseling The most appropriate counseling for the situation at hand would be motivational counseling. With motivational counseling, the nurse would discuss feelings and incentives with the client. Short-term counseling focuses on the immediate problem or concern of the client or family. It can be a relatively minor concern or a major crisis, but in any case, it needs immediate attention. Long-term counseling extends over a prolonged period. A client might need the counsel of the nurse at daily, weekly, or monthly intervals. A client experiencing a developmental crisis, for example, might need long-term counseling. Professional counseling is a general term.

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 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.

A 46-year-old obese client has been diagnosed with hypertension and type 2 diabetes. The client acknowledges the need to lose weight. The client recently visited a local fitness club, obtained a membership, and has signed up for their next water aerobics class. According to the Transtheoretical Model of Change, what stage of change is this client in related to her weight loss?

Preparation This client is in the preparation stage, as the client is actively making changes to lose weight. During the precontemplation stage, the client is not even thinking about or considering making a change. During the contemplation stage, the client is considering making a change. During the preparation stage, the client has decided to make a change and is preparing for it. During the maintenance stage, the client attempts to maintain the change in lifestyle begun in an earlier stage.

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 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. 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 evaluates whether a middle-age client with chronic back pain has been performing the different exercises and physiotherapy procedures recommended by the physician. What would the nurse most likely use to evaluate the client?

Return demonstration The nurse is evaluating psychomotor skills; thus, a return demonstration, which is a method of testing skill performance, would be the most appropriate method for evaluating the client's learning. Written tests are time-consuming, intimidating, and not always specific to the client. Oral tests can be useful in testing cognitive learning. Simulation evaluates whether the client can apply learning in different situations, but not the ability to perform the exercises.

A client is reluctant to learn to do finger sticks for home international normalized ratio (INR) monitoring. What is the best statement by the nurse?

Tell me what you know about these tests. Saying something to encourage the client to openly discuss personal issues is the best option. Assessing worry about pain narrows the client's answer to only addressing pain. Asking "why" questions may be considered probing or accusatory and tends to block communication. Generalizing the client's fear is belittling. Assessing the client's perceptions about checking the INR opens up the discussion about the client's barrier to learning to perform this test.

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. 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.

A nurse is educating a client with a new diagnosis of diabetes. Which example demonstrates cognitive learning by the client?

The client describes signs and symptoms of hypoglycemia. The client's ability to describe the signs and symptoms of hypoglycemia demonstrates cognitive learning (the storing and recalling of new knowledge in the brain). Demonstrating a skill, such as insulin injection, is an example of psychomotor learning. Affective learning includes changes in attitudes, values, and feelings (e.g., desire to lose weight).

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. 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.

While applying dressings to a client's wound, the nurse teaches the client about wound care. To promote the most effective teaching-learning relationship with this client, what would be most important for the nurse to keep in mind?

The nurse and client relationship is based on mutual sharing and negotiation. When providing nursing care, the teaching-learning relationship between the nurse and client is special, characterized by mutual sharing, advocacy, and negotiation. Effective learning occurs when clients and health care professionals are equal participants in the teaching-learning process. Unlike some traditional views, nurses are not experts who generously bestow knowledge upon clients, nor do they barter knowledge for compliance. Both images represent the relationship as a power imbalance in which nurses, because of their knowledge and expertise, control the situation.

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

The nurse and the client 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.

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." 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.

Which statement made by a client who was recently admitted to the medical unit with a diagnosis of pneumonia indicates a physical inability to learn?

"I am having difficulty breathing." The statement "I am having difficulty breathing" indicates that the client is not physically well and that the client is unable to learn effectively until comfort is restored. "The pain in my chest has gone" and "May I have something to eat?" is suggesting that the client is physically well and is ready to learn. "Finally, I am getting medical attention" is suggesting that the client is psychologically ready to learn.

While the nurse is caring for a hearing impaired client, and a family member of the client states, "What do you think is the best way to communicate?" What is the best response by the nurse?

"Use flash cards and writing pads." Using flash cards and writing pads to communicate is a good substitute for verbal instructions for persons with hearing impairment. Speaking words that begin with "f," "s," "k," and "sh" typically requires forming high-pitched sounds, which are difficult for clients with hearing impairment to discriminate. Do not limit communication, because it will alienate the client from family and friends. Lowering (rather than increasing) the vocal pitch is better, as hearing loss is generally in the higher pitch ranges.

A nurse is trying to encourage a client with paraplegia who is depressed and not adhering to the treatment program to join a support group. Which statement by the nurse is most appropriate?

"What do you know about support groups?" By asking the client an open-ended question the nurse can find out what the client knows about support groups. With the client's permission, the nurse can further educate on this topic. The nurse should acknowledge the client's ability to accept or reject the material to empower the client and lead to more healthy decision-making. The nurse cannot make the decision for the client by signing the client up for a support group. Although frustrating, the choice to follow suggestions in the end is the client's and the nurse must respect it as such. The nurse who states emphatically that the nurse is correct and that the client's views are misguided and skewed loses all credibility and influence. The nurse should be nonjudgmental and nonthreatening and should not be more assertive than the client. However, the nurse should listen carefully to what the client values and work from there. Each type of support group has different goals and values.

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." 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.

The nurse is discharging several clients from an acute surgical unit on the same day. The nurse will prioritize discharge teaching based on how much time is required for each client. Place the clients in order, from the client requiring the longest teaching time to the shortest teaching time. Use all options.

*client who is learning to draw up and inject insulin for the first time *client who indicates the live-in partner is a registered nurse *client who is being discharged to a long-term care facility *client who is being transferred to another unit in the hospital

A nurse and client are working together to help the client make lifestyle changes to promote improved health. The nurse is having the client sign a contractual agreement for the work they will do together. Which statements by the nurse reflect the proper purposes of such agreements? Select all that apply.

- "Our goals are defined, as are ways to meet them." - "With this contract, we show that we are both dedicated to improving your health." A contractual agreement is not a formal document, nor is it legally binding. It lists common goals to client and nurse and ways to meet them, but does not require completion of those goals. It is a document of partnership between the client and nurse to reach the goals they are both trying to meet, which are intended to improve the client's health.

A nurse caring for clients in a skilled nursing facility assesses client motivation to participate in care. Based on the health belief model, which clients would be most motivated? Select all that apply.

- A client who views a disease as a serious threat - A client who believes there are actions that will reduce the probability of contracting the disease - A client who believes that the risks of taking action against a disease are not as great as the risks posed by the disease itself The individuals who would be most motivated to participate in care based on the health belief model would be a client who views a disease as a serious threat, a client who believes that there are actions that will reduce the probability of contracting the disease, and a client who believes that the risks of taking action against a disease are not as great as the risks posed by the disease itself. Clients who would not be as motivated to participate in care include the client who does not view oneself as susceptible to the disease; the client who believes that noncompliance is not an option; and the client who believes that doing nothing is preferable to painful treatments.

The client has Alzheimer disease and is a new admission to the nursing home. The client was transferred from the hospital. When first meeting the client, what technique(s) will the nurse use to facilitate communication with this client? Select all that apply.

- Approach the client from the front of the client. - Call the client by the client's preferred name. - Use simple words and short sentences when talking with the client. When communicating with a client who has Alzheimer disease, the nurse must use techniques that will facilitate communication. The nurse will approach from the front of the client to obtain the attention of the client. Coming from the side or the back of the client may startle or agitate the client. Using the client's preferred name will also gain the client's attention. The nurse will use simple words and short sentences to allow the client to understand the nurse. The nurse must show patience and allow the client time to respond. The client may have difficulty finding the correct words or expressing thoughts. Correcting the client or providing information may confuse or agitate the client even more.

A nurse is using the teaching-learning process to teach new parents how to care for their infants. Which nursing actions reflect recommended steps of this process? Select all that apply.

- The nurse assesses the learning needs and readiness of the parents. - The nurse formulates a verbal or written contract with clients. - The nurse relates new learning material to clients' past life experiences to help them to assimilate new knowledge. The nurse would use critical thinking skills to assess the learning needs and learning readiness of the parents. The nurse would formulate a verbal or written contract with the clients. The nurse would relate new learning material to the clients' past life experiences to help them assimilate new knowledge, which is an adult learning principle. Goals should be specific, not general in focus. The nurse would not have to include group teaching and formal teaching in every education plan. The nurse must allow time constraints, schedules, and the physical environment to influence the choice of teaching strategies.

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. 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 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 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. 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.

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. 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.

A nurse is working with a 15-year-old client with sickle cell anemia. The client was started on a new pain management plan today, and the nurse is evaluating the effectiveness of the plan. Which is not appropriate to include in the nursing care?

Asking only the client's parents to be present at the education session Peers are often more influential than parents, nurses, or teachers at this age. It is often appropriate to include a close friend in on the education session. The other answers are developmentally appropriate for a 15-year-old.

When caring for a client at the health care facility, the nurse observes that the client is having difficulty understanding the health education. Which action is most appropriate?

Assess for cultural differences. When the client is having difficulty learning, it may be possible that the client does not understand the language that the nurse speaks. In such a case, the nurse should take the necessary steps to break the cultural barrier and then proceed with the education. Written materials can enhance many clients' learning, but will not necessarily overcome many of the common barriers to understanding, including cultural and linguistic factors. The nurse should take action to overcome any barriers to the learning process before delegating to a colleague. The client's morale is not pertinent to the client's difficulty understanding the teaching.

The nurse must instruct a 35-year-old client with Down syndrome about the use of an albuterol rescue inhaler. Which documentation demonstrates appropriate individualization of the education plan for this client?

Assessed the client's understanding of illness; assessed motor skills and developmental stage; provided clarification Distractions to learning, such as the television being on or the client being at meal time, diminish the effectiveness of any education plan. An authoritarian style of teaching does not honor the client as a partner in the learning process. Age does not necessarily determine developmental stage. Assessing the client's developmental stage and understanding of the health problem, clarifying information that is difficult for the client to understand, and ensuring that the client is physically able to perform the task are all aspects of a well-planned education session for all clients.

When caring for a client, the nurse observes that the client enjoys reading books and magazines. In which learning domain does the client's learning style fall?

Cognitive As the client enjoys reading books and magazines, the client's learning style would fall in the cognitive domain, where information is processed by listening or reading facts and descriptions. The affective domain is a style of processing that appeals to a person's feelings, beliefs, or values. The psychomotor domain is a style of processing that focuses on learning by doing. The interpersonal domain is a style of processing that focuses on learning through social relationships.

The nurse has educated the client on the pathophysiology of osteoarthritis and degenerative joint disease. This type of teaching best illustrates which learning theory?

Cognitive learning theory Cognitive learning theory is the result of people wanting to make sense of the world around them by assimilating and processing information to gain new understandings and insights. Developmental learning theory focuses on considering the patient's physical maturation and abilities, psychosocial development, and cognitive capacity when providing education. Behavioral learning theory focuses on how one learns and unlearns behaviors. Adaptive learning theory explains how learning is optimized when teaching is adapted to the particular learning style of the learner.

A nurse is working with an older adult client, educating the client on how to ambulate with the aid of a walker. The nurse notes that the client appears to lack the motivation to learn how to use the device. The client states, "I'm just too old to learn." What would be most appropriate for the nurse to do to motivate this client?

Describe how the walker can improve the client's quality of life. Motivating the older adult client can be done by showing the client how the new knowledge will improve the client's quality of life, regardless of how long that may be. It will also demonstrate how the new knowledge could improve the client's level of independence. Although demonstrating the use of the walker and explaining how the walker assists with ambulation (and the rationale for its use) can be used to educate the client, these actions would not promote motivation for the client to learn.

An active, otherwise healthy, older adult client presents to the clinic with severe osteoarthritis in both knees. The nurse knows this client does not want to be a burden on the family, and the client remains stoic despite reporting the pain as severe. The client avoids the topic of surgery and attends church weekly. The client's family is supportive of any decisions the client makes regarding health. Which of the assessment data is most important to forming an individualized education plan for this client concerning treatment for osteoarthritis?

Personal perception of health and aging Knowing about the client's orthopedic history, religious beliefs, and barriers to mobility in the home are all helpful for an overall plan of care, but do not address individualism. Gaining insight into the client's own perceptions of health and aging, however, will allow the nurse to tailor the plan of care to the client's personal needs.

A home health nurse states to her client, "I am very proud of you. You gave your first insulin injection without a problem. You have done wonderfully and are learning fast." What technique is the nurse using to compliment the client's progress?

Positive feedback Important keys to success when evaluating learning are consistent, immediate, and frequent positive reinforcement, and teaching a small number of skills at any one time, thus creating a high possibility that the learner will master them. Positive reinforcement is also known as positive feedback, which is what the nurse is providing in this case. Negative reinforcement or feedback would be attempting to change a client's behavior by pointing out and criticizing or even punishing mistakes or undesirable behaviors. Motivation refers to the client's desire to learn or make a change. Health promotion is a topic that may be covered in client teaching and that pertains to optimizing one's health through maintaining proper nutrition, exercise, and hygiene.

A nurse assisting a new mother in the act of breastfeeding represents which form of learning?

Psychomotor Psychomotor refers to the muscular movements learned to perform new skills and procedures, such as breastfeeding. Affective learning involves engagement of the client's emotions. Cognitive learning involves engagement of the client's critical thinking and reason. Simplistic is not a formal type of learning, and assisting a new mother with breastfeeding is not simplistic.

Which diagnosis would best describe a situation in which a parent has a knowledge deficit concerning child safety for a toddler who is currently being treated for burns and was previously treated for a fracture from a fall?

Risk for Injury, related to mother's lack of knowledge about child safety The best answer would be "Toddler at High Risk for Injury, related to mother's lack of knowledge about child safety". The question states the woman has a knowledge deficit, and this is what the focus of the plan of care would be. However, the mother's lack of knowledge puts the toddler at high risk for injury, which is a critical component to include in the diagnosis and which is omitted in the other answer options.

The nurse has completed teaching. Which client behavior demonstrates understanding within the affective domain?

States, "I feel comfortable using my walker" A client's learning style refers to how a person prefers to acquire knowledge. Learning styles fall within three general domains: cognitive, affective, and psychomotor. The cognitive domain is a style of processing information by listening or reading facts and descriptions (such as verbalizing key points of a brochure or describing wound healing). The affective domain is a style of processing information that appeals to a person's feelings, beliefs, or values. The psychomotor domain is a style of processing information that focuses on learning by doing (such as demonstrating the use of an inhaler). In this scenario, the client has shown learning in the affective domain by expressing feelings.

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. 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. 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.

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. 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.

An experienced nurse is educating a client about the client's disease and how best to promote optimal health. The nurse is focusing the education on the cognitive domain of learning. Given this focus, the nurse would incorporate the client's:

critical thinking. Cognitive learning refers to rational thought or critical thinking. Affective learning is influenced by emotions or feelings. Psychomotor learning refers to the muscular movements learned to perform new skills and procedures; for example, when a mother successfully and independently breastfeeds an infant, the mother has physically demonstrated psychomotor learning.

The nurse is caring for a client who demonstrates a health literacy concern. The nurse adjusts client teaching in which way?

uses videos, diagrams, and pictures rather than focusing on verbal teaching To address health literacy concerns, the nurse should avoid technical language, limit information to three to five key points, and be specific rather than general. Using medical terminology to help the client feel smarter, providing general teaching instead of specific teaching, and giving instructions in multiple ways are not effective ways to adjust client teaching for those who demonstrate low health literacy.