Chapter 9: Teaching and Counseling
The nurse is coaching a client who stated a desire to stop smoking without medication. At several sessions to assess the client's success with agreed-upon interventions, the client reports barriers to each action and continues to smoke. What is the best action of the nurse?
Discuss the client's case with a colleague.
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."
A pediatric nurse provides education to numerous clients in their care. Which group of children benefits most from being involved in the teaching-learning process?
School-age children
A nurse may attempt to help a client solve a situational crisis during what type of counseling session?
Short-term counseling
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.
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 executive meets with the nurse for education about recently diagnosed atrial fibrillation. He verbalizes concerns about the time he will spend away from his work, and that he is not sure it is necessary to have blood tests every week. He feels it is a waste of time when he does not have any symptoms. Which is the best motivational statement by the nurse for this client?
"The medicine and blood work for atrial fibrillation can help prevent blood clots that have the potential to cause debilitating strokes. What have you heard about warfarin therapy?"
A nurse is discussing the benefits of smoking cessation with a client. The nurse informs the client that smoking cessation will reduce his risk for cancer, improve his respiratory status, and enhance the quality of his life. The nurse also shares her 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 his feelings on smoking cessation and verbalizes a desire to quit smoking. What type of counseling did the nurse provide to this client?
motivational counseling
The nurse is preparing to teach a client about postsurgical care after a laparoscopic cholecystectomy. What determining factors demonstrates that the client is ready and able to learn?
physical condition
The nurse is caring for a 60-year-old client with an improper bowel movement regimen. Which of the following is the most appropriate method the nurse should use to conduct new learning?
Begin the session with a reference to the client's actual experience.
The parents of a school-age child are meeting with the nurse for health promotional education for their child. The child has the following assessment data: 7-year-old male, diabetes mellitus type 1 with a hemoglobin A1C of 8.3%, BMI of 31.7, BMI percentile of 99. What are the most appropriate learning diagnoses for this first session?
Deficient Knowledge: Imbalanced nutrition: more than body requirements, and ineffective health maintenance.
A nurse is developing a contractual agreement with a client. Which statement is true of a contractual agreement?
The contract serves to meet the client's learning outcomes.
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 has completed teaching. Which client behavior demonstrates understanding within the cognitive domain? Select all that apply.
Verbalizes key points of a brochure about diabetes that was read. Provides a description of what appropriate wound healing should look like.
An older adult female client who is recovering from a stroke is scheduled to be transferred to the rehabilitation unit in the morning. She is tearful and verbalizes that she feels lonely and abandoned in the hospital unit. The nurse noticed that family visits daily and that there are flowers and cards in the room. Documentation in the chart indicates that the client's pastor has been by twice in the past week to visit. Which nursing diagnosis and outcome criteria need to be addressed immediately for this client?
Ineffective Coping; verbalizes support systems.
Which developmental consideration is a nurse assessing when determining that an 8-year-old boy is not equipped to understand the scientific explanation of his disease?
Intellectual development
Which statement best describes the client most motivated to learn?
a 70-year-old female; learning care so spouse can come home
The nurse is conducting a teaching session regarding HIV/AIDS for hotel workers in the community. Which nursing actions are appropriate for the adult learning? Select all that apply.
identifying the length of the session beginning with basic concepts about HIV/AIDS providing adequate lighting and comfortable temperature identifying the time, place, and content for the next teaching session
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.
The nurse needs to understand the teaching-learning process when administering
Educational interventions
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 client rate pain level and reschedule the teaching session.
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
An active, otherwise healthy, older adult client presents to the clinic with severe osteoarthritis in the bilateral knees. The nurse knows this client does not want to be a burden on his family, and he remains stoic even though he reports the pain as severe. He avoids the topic of surgery and attends church weekly. His family is supportive of any decisions he makes regarding his health. Which of the assessment data are most important to forming an individualized education plan for this client concerning treatment for his osteoarthritis?
Personal perception of health and aging
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 nurse is providing instrcutions to a client about performance of breast self-examination. What outcome does the nurse evaluate regarding this education?
The client will use the self-examination for breast cancer detection and prevention.
Before starting the education process, the nurse should determine the preferred learning style, age and developmental level, capacity to learn, motivation level, readiness to learn, and learning needs of the client. How does this help the nurse in the client's health education?
by implementing effective teaching
The nurse has educated the client on the pathophysiology of osteoarthritis and degenerative joint disease. This is an example of what learning theory?
cognitive learning theory
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
The nurse must instruct a 35-year-old client with Down syndrome about use of an albuterol rescue inhaler. Which of the following demonstrates individualization of the education plan for this client?
client understanding of illness, motor skills and developmental stage assessed, clarification provided
A 20-year-old client reads the nutritional chart and follows it accurately. The nurse also notes that the client understands the need of a balanced diet and its relationship with a quick recovery. Which domain correctly identifies the client's learning style?
cognitive domain
When caring for a client, the nurse observes that the client enjoys reading books and magazines. In which of the following learning domains does the client's learning style fall?
cognitive domain
Mrs. Shields is a 46-year-old obese woman diagnosed with hypertension and type 2 diabetes. She tells the nurse that she knows she needs to lose weight. She recently visited her 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 Mrs. Shields in related to her weight loss?
preparation
A nurse assisting a new mother in the act of breastfeeding is represented by which form of learning?
psychomotor
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
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 nurse is discussing the use of the patient-controlled analgesia pump with the postoperative patient. Which of the following statements by the patient indicate a need for additional education?
"I should not press the button more often than every 3-4 hours."
The nurse is providing education for a client that will be providing self-care at home. The client states, "I just don't think I can do all of this. It's too much to learn." What is the best response by the nurse?
"I understand that you feel overwhelmed with all of the information. Tell me what I can do to help."
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 him immobile. As the nurse enters the home, the client braces his hands on the arms of his 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."
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; works nights, willing to try, asking about insurance coverage of 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.
When preparing client teaching materials, how does the nurse best assess a client's preferred learning style?
Ask the client, "Do you learn better by seeing how to use an inhaler, believing how the inhaler works, or showing me how to use the inhaler after I show you?"
A client is reluctant to learn to do finger sticks for home INR monitoring. What is the best statement by the nurse?
Tell me what you know about these tests.
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.
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.
A parish nurse is preparing to provide a health promotion class to a group of adults in the parish. In preparing to meet the learning needs of this group, the nurse recognizes which of the following as a characteristic of an adult learner?
Their readiness to learn is often related to a developmental task or social role.
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 education?
blocking 30 minutes of time for skill teaching
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.