Chapter 9 Teaching and Counseling

A client is admitted to the health center with chronic diarrhea. When should the nurse begin imparting health teaching about the benefits of proper diet to the client so that the risk of diarrhea is minimized?

When admitting the client

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 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."

Which statement describes the person who is likely the most motivated to learn?

A 70-year-old female who is the client's spouse and is learning the care so the client can come home

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?"

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

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

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: a 7-year-old male with diabetes mellitus type 1 with a hemoglobin A1C level of 8.3%, a body mass index (BMI) of 31.7, and a 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 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

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

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

The nurse and the client

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 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

The nurse is caring for a client who has been admitted for a new diagnosis of hypertension. When should the nurse begin client teaching?

During the admission process

The nurse is conducting a teaching session regarding HIV/AIDS for hotel workers in the community. Which nursing actions are appropriate for providing this type of 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 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.

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.

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

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

Psychomotor

A pediatric nurse provides education to numerous clients. 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

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 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.

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.

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 using teach-back to evaluate the client's understanding of new information given during discharge. Which statement indicates the use of this technique?

"Please repeat to me the different signs and symptoms of stroke."

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."

The nurse is teaching an 80-year-old client how to instill eye drops for glaucoma. The client's daughter asks, "How do you know that my mother understands what to do?" What is the appropriate nursing response?

"When 15 minutes have passed, I will ask your mother to show me how to instill the drops."

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."

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.

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

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 as a characteristic of an adult learner?

Their readiness to learn is often related to a developmental task or social role.

The nurse is preparing to teach a client from Generation X about hypertension. Which teaching approach should the nurse plan to implement?

Demonstrate the MyFoodPyramid phone app, to show the best food choices on a lunch tray.

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?

Cognitive

A nurse is assessing a client who has come to the clinic for a follow-up appointment. The client was diagnosed with asthma several months ago and has missed several appointments since that time. The client also has not been following the medication plan and has not kept the appointment for allergy testing. The nurse suspects that the client may be experiencing problems with health literacy. The nurse teaches the client about the condition and prescribed treatment. Which question from the nurse would help to assess the client's health literacy about the condition?

"How are you supposed to take your medication?"

The client reports to the clinic as ordered by the primary care provider for counseling on weight loss to improve overall health. The client received printed information in the mail to review before the session, and reports having read through it before the appointment. Which client statement alerts the nurse to a need for clarification and further education?

"I will be doing well if I lose between 5 and 10 lb (2.3 and 4.5 kg) per week."

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.

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

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 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.

An older adult client who is recovering from a stroke is scheduled to be transferred to the rehabilitation unit in the morning. The client is tearful and reports feeling lonely and abandoned in the hospital unit. The family visits daily, and flowers and cards are 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 child is not equipped to understand the scientific explanation of the child's disease?

Intellectual development

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

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

Which strategy should the nurse use when providing education to the older adult client?

Remain calm and conduct the teaching session in a quiet environment.

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.

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.