Chapter 9: Teaching and Counseling

Factors affecting pt leaning

age and developmental level, family support networks, financial resources, cultural influences, language deficits, and health literacy level

Affective learning domain

changing attitudes, values, and feelings

3 learning domains

cognitive, affective, and psychomotor

A nurse is showing an older adult pt with severe diabetes the correct method of self-administering insulin injection. What should be the nurse's comment if the pt continues making mistakes when learning how to self-administer an insulin injection? (select all that apply) A. lots of people have the same concern B. it will be better if you ask someone responsible to administer the injection C. why are you repeatedly holding the injection at the wrong angle D. you've just about figured out how to give yourself an injection E. try to angle the syringe a little more this way

A, D, and E

The nurse is providing instructions to a pt about performance of breast self-examination. What outcomes does the nurse evaluate regarding this education? A. the pt will use the self-examination for breast cancer detection and prevention B. the pt will demonstrate improved coping skills C. the pt will have restoration of breast function D. the pt will demonstrate self-efficacy and improved body image

A.

The nurse is using teach back to evaluate the pt's understanding of new information given during discharge. Which statement indicates the use of this technique? A. Please repeat to me the different signs and symptoms of stroke. B. Will you promise to read these instructions when you go home? C. Is someone able to review the instructions with you? D. Use the instructions on this paper to clean your wounds at home.

A.

A nurse is discussing the benefits of smoking cessation with a pt. The nurse informs the pt that smoking cessation will reduce his risk for cancer, improve respiratory status, and enhance quality of life. The nurse also shares her story of smoking cessation, provides info on other individuals who have successfully quit, and encourages the pt to attend a support group for smoking cessation. The pt discusses his feelings on smoking cessation and verbalizes a desire to quit smoking. What type of counseling did the nurse provide to this pt? A. motivational counseling B. situational counseling C. long-term counseling D. developmental counseling

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

A pt is meeting with the nurse to discuss options for smoking cessation. Which statement by the nurse is most appropriate for this pt? A. What do you see as your biggest hurdle to stopping? B. Did you know that smoking can cause lung cancer? C. I think you should just go cold turkey. D. Reduce your stress and it will be easy.

A. Rationale: When counseling a pt, the focus should be on assisting them to make their own decisions, find ways to reach goals, and support the pt.

A nurse assisting a new mother in the act of breastfeeding is represented by which form of learning? A. psychomotor B. cognitive C. affective D. simplistic

A. Rationale: psychomotor refers to the muscular movements learned to perform new skills and procedures

A Chinese pt who was previously treated at the healthcare facility for an open wound has been admitted again because the wound has become gangrenous. It has been identified that the pt failed to understand proper wound care. What is the probable reason for the pt failing to understand the instruction? A. the pt is not interested B. the pt belongs to a different culture C. the pt is a passive learner D. the pt has a short attention span

B.

A female pt has recently been diagnosed with early stage Alzheimer's disease and her husband has asked the nurse to recommend websites that may supplement his learning about her diagnosis. How should the nurse respond with the husband's request? A. encourage the husband to avoid online resources due to the unregulated nature of the internet B. identify and recommend some credible websites appropriate to his learning needs C. provide the husband with print based materials that are clearly referenced and reflect his learning style D. direct the husband to online databases such as the cumulative index to nursing and Allied health literature (CINAHL)

B.

Which learning domain is the focus for instruction when the nurse educates a new mother about the breast and its role in milk production for feeding the newborn? A. affective B. cognitive C. behavioral D. psychomotor

B.

A pt 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." This is an example of what kind of learning? A. cognitive learning B. affective learning C. behavioral learning D. psychomotor learning

B. affective learning Rationale: Affective refers to emotions or feelings. Affective learning changes beliefs, attitudes, or values.

An experienced nurse is educating a pt about his disease and how best to promote his optimal health. The nurse is focusing the education on the cognitive domain of learning. The nurse would focus the education on: A. physical demonstration B. critical thinking C. muscular movements D. emotions or feelings

B. critical thinking Rationale: Cognitive learning refers to rational thought or critical thinking. Affective learning is influenced by emotions or feelings. Psychomotor learning refers to muscular movements learned to perform new skills and procedures. For example, when a other successfully and independently breast feeds her infant, she has physically demonstrated psychomotor learning.

COPE model

C- creativity O- optimism P- planning E- expert information

A nurse evaluates whether a middle-age pt 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 pt? A. oral test B. simulation C. return demonstration D. written test

C.

Which principle of teaching-learning is an accurate guideline for the nurse/teacher? A. past life experience should not be a factor when helping pts assimilate new knowledge B. pt education should occur independently of the nursing process C. the teaching-learning process can be facilitated by a helping relationship D. planning learner objectives should be done by the teacher alone

C.

While applying dressings to a pt's wound, the nurse teaches the pt about his wound care. To promote the most effective teaching-learning relationship with this pt, what would be most important for the nurse to keep in mind? A. nurses are experts who generously bestow knowledge upon pts B. nurses have control over the pt because of their knowledge and expertise C. the nurse and pt relationship is based on mutual sharing and negotiation D. nurses barter knowledge of medicate with the pt for compliance

C.

A nurse is caring for an older adult pt with arthritis. Which action is the priority for the nurse when conducting the health education for the pt? A. provide an environment that promotes learning B. identity how long the education sessions will last C. find out what the pt wants to know D. divide information into manageable amounts

C. Rationale: Finding out what the pt wants to know helps the nurse show personal interest, which facilitates better learning in an adult pt. All of the other options can be done but only when the assessment of the pt is complete.

The nurse has educated the pt on the pathophysiology of osteoarthritis and degenerative joint disease. This is an example of what learning theory? A. behavioral B. developmental C. cognitive D. adaptive

C. Rationale: 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 insight

When caring for a diabetic pt, the nurse notes that the pt learns better when he practices the self administration of the insulin injection by himself. In which learning domain does this pt's learning style fall? A. affective domain B. cognitive domain C. psychomotor domain D. interpersonal domain

C. Rationale: the psychomotor domain focuses on learning by doing. Cognitive domain is processing info by listening, reading, facts and descriptions. Interpersonal domain is a style of processing that focuses on learning through social relationships.

A pt has received a temporary ostomy during her treatment for colon cancer. Which technique is most likely to facilitate the pt's ability to independently empty and change the ostomy after discharge? A. a brochure B. lecture C. demonstration D. discussion

C. demonstation Rationale: Demonstration allows for cognitive, psychomotor, and effective learning to simultaneously ask place.

Educating women on diet and exercise is an example of what kind of pt education? A. health protection B. health restoration C. health promotion D. disease prevention

C. health promotion Rationale: health promotion activities are general recommendations and concentrate on improving someone's overall well-being.

A nurse is documenting assessment data for a new pt. What is the best source of assessment information for the nurse? A. family and friends B. physician C. pt D. nursing plan of care

C. pt

A female adolescent is being taught about changing her abdominal dressing as part of the education for her care at home. When she removes the dressing, she becomes tearful when she sees her surgical incision. What knowledge deficit is best to address for this pt at the moment? A. infection related to surgical incision B. pain related to surgical incision C. self-care deficit secondary to surgical incision D. altered body image related to surgical incision

D.

The nurse is conducting a community health promotion class and has developed scenarios that will involve active participation by the class attendees. What type of education strategy is the nurse incorporating into her class? A. programmed instruction B. panel discussion C. role modeling D. role-playing

D.

When caring for a pt at the healthcare facility, the nurse observes that the pt is having difficulty understanding the health education. Which action is most appropriate? A. replace one on one teaching with written materials B. delegate the health education to a colleague C. boost the morale of the pt D. assess for cultural differences

D.

Teaching outcomes

disease prevention or early detection, quick recovery from trauma or illness, enhanced ability to adjust to developmental life changes, and pt and family acceptance of lifestyle necessitated by illness or disability

Considerations for successful pt teaching

forming contractual agreements, considering time constraints, scheduling, group v individual teaching, formal v informal teaching, and manipulating the physical environment

Teaching plans for older adults

identity learning barriers, allow extra time, plan short teaching sessions, accommodate for sensory deficits, reduce environmental distractions, and relate new information to familiar activities or information

Assessment parameters

knowledge, attitudes, and skills needed to be independent, readiness to learn, ability to learn, and learning strengths

Psychomotor learning domains

learning a new physical skill

Teaching strategies

lecture, discussion, demonstration, discovery, role playing, printed materials, and web based instruction

Aims of teaching and counseling

maintaining and promoting health, preventing illness, restoring health, and facilitating coping

Guidelines to pt counseling

make everyone feel comfortable, can be informal or formal, use interpersonal skills of warmth, friendliness, openness, and empathy and caring

Obtaining feedback about learning

reinforcing and celebrating learning, evaluating teaching, and revising the plan

Types of counseling

short term (for situational crisis), long term (for developmental crisis), and motivational interviewing (discussing feelings and incentives with our pts)

Cognitive learning domain

storing and recalling of new knowledge in the brain

Documentation of the teaching-learning process

summary of the learning need, the plan, the implementation of the plan, and evaluation results