NU370 PrepU: Teaching and Counseling (week 2)
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? a) Allow ample time for psychomotor skills. b) Keep the session at 2 to 3 hours. c) Allow for long-term memory loss. d) Provide information in a structured format.
a) 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.
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? a) Cognitive b) Affective c) Psychomotor d) Interpersonal
c) 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 is completing documentation after an education session with a client. Which statement best demonstrates detailed documentation of an effective teaching plan? a) Demonstrated cord care to mother, who stated understanding and performed return demonstration using correct technique. b) Discussed wet-to-dry dressing changes, and client stated understanding. c) Spouse taught to flush feeding tube before and after medication. Denied further instruction needed. d) Lecture provided about infection, and client stated understanding what infection is.
a) 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.
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? a) Asking only the client's parents to be present at the education session b) Including a note about who was taught this new information in the client's chart c) Assuring the client that the conversation is confidential except under extreme circumstances d) Answering questions openly and honestly
a) 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? a) Assess for cultural differences. b) Boost the morale of the client. c) Delegate the health education to a colleague. d) Replace one-on-one teaching with written materials.
a) 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.
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? a) Ineffective Coping; verbalizes support systems. b) Impaired Walking; unilateral neglect. c) Altered Mobility; able to tie shoes. d) Dysfunctional Family Processes; family contact daily.
a) Ineffective Coping; verbalizes support systems. - When considering appropriate evaluation criteria, be certain they relate directly to the diagnosis and the diagnosis relates to the assessment data. There are no data to support unilateral neglect. Tying shoes evaluates a client's abilities, not mobility. The nurse assesses that the family visits daily, so the family process is functional. Ineffective coping is appropriately evaluated by identification of coping mechanisms, such as support systems.
The nurse is preparing discharge teaching for a client with diabetes. Which information should the nurse include? Select all that apply. a) Meal planning b) Community resources c) Appropriate use of a glucometer d) Instructions to follow up with the health care provider d) Ways to pay for hospitalization and outpatient care charges
a) Meal planning b) Community resources c) Appropriate use of a glucometer d) Instructions to follow up with the health care provider - The nurse should teach the client with diabetes about meal planning, community resources, appropriate use of a glucometer, and instructions for follow-up care. The social worker will work with the client on methods of payment, if necessary.
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? a) Preparation b) Maintenance c) Precontemplation d) Contemplation
a) 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.
Which strategy should the nurse use when providing education to the older adult client? a) Remain calm and conduct the teaching session in a quiet environment. b) Avoid the use of colorful materials and keep the session short. c) Teach in a monotone voice in a quiet environment. d) Teach from books only and remain calm.
a) Remain calm and conduct the teaching session in a quiet environment. - Remaining calm and conducting the teaching session in a quiet environment would decrease anxiety or distractions that interfere with learning for the older adult. Keeping the session short will increase concentration, but is not unique to older adults. The nurse is to use colorful materials in a variety of ways and the nurse's tone and pitch should vary.
A client is experiencing difficulty in adjusting to a new prosthesis despite conscientious client education by numerous members of the health care team. How should the team respond to the client's lack of learning to this point? a) Revise the education plan that has guided education. b) Refer the client to outside sources of information. c) Explore alternatives to prosthesis. d) Scale back the scope and detail of client education.
a) Revise the education plan that has guided education. - If evaluation of client education indicates that client learning has not met outcomes, it is appropriate to revise the education plan. This does not necessarily entail reducing the detail or referring the client to outside information sources. Exploring alternatives to prosthesis does not address the client's learning needs.
A nurse is educating a client with a new diagnosis of diabetes. Which example demonstrates cognitive learning by the client? a) The client describes signs and symptoms of hypoglycemia. b) The client demonstrates proper technique for injecting insulin. c) The client expresses a desire to improve nutritional intake and lose weight. d) The client prepares the skin for the administration of an insulin injection.
a) 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).
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? a) Their readiness to learn is often related to a developmental task or social role. b) Peer group acceptance is a critical issue for this age group. c) The material presented should focus on future application. d) Previous experiences have little impact on learning.
a) Their readiness to learn is often related to a developmental task or social role. - An adult's readiness to learn is often related to a developmental task or social role. The previous experience of the adult is a rich resource for learning. Most adults' orientation to learning is that material should be useful immediately. Peer group acceptance is a critical issue for the adolescent group and not adults.
A client is scheduled for an outpatient procedure and will be discharged the same day. Why will it be important for the nurse to initiate teaching immediately? a) There is limited hospitalization time. b) The client may not be in the condition to learn afterward. c) The client may take a longer time to learn. d) The client doesn't think there is anything to learn.
a) There is limited hospitalization time. - It is important for a nurse to begin teaching as soon as possible after admission of the client because there is the possibility of limited hospitalization time. The nurse should avoid making assumptions about the client's condition in the future, the client's learning style, and the time needed for learning before the teaching begins.
During the health education session at the health care facility, the nurse notes that a client is able to recognize, describe to others, and explain the information learned. What is the final learning stage of the client in this case? a) Recall of the information being taught b) Independent use of new learning c) Involvement in the education in an active way d) Repetition of information for memorization
b) Independent use of new learning - The final learning stage for the client in this case is the independent use of the new learning. The client demonstrates the ability to recall the information being taught by describing it to others. Involvement of the client in the health education in an active way is required to maintain the attention and the concentration of the client. Repetition of information for memorization is a technique to teach illiterate clients.
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? a) Ask the client to restate the teaching that was provided. b) Reteach the length of time to take the prescription. c) Tell the client to take the antibiotic until symptoms subside. d) Proceed with teaching about the decongestant.
b) 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.
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? a) "May I have something to eat?" b) "The pain in my chest has gone." c) "I am having difficulty breathing." d) "Finally, I am getting medical attention."
c) "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.
When preparing client teaching materials, how does the nurse best assess a client's preferred learning style? a) Observe the client's behaviors. b) Provide teaching that works for the broadest base of clients. c) Ask the client, "Do you learn best by observing, valuing, or doing?" d) Determine client learning needs based on age and ability to hear effectively.
c) 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 going to teach the parent of a toddler to do cardiopulmonary resuscitation (CPR). What information would be the most important to prepare this education? a) Reasons for learning CPR b) Preferred learning style c) Baseline knowledge d) Access to technology
c) Baseline knowledge - It is important for the nurse to assess the client's baseline knowledge. Although it is important to consider preferred learning style, understanding the client's knowledge base allows the nurse to tailor the education as well as the type of learning that will best benefit the client. Technology is not necessary to learn to perform CPR.
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? a) Refer the client to internet resources on proper bowel health. b) Have the client join a small group of other clients with the same problem and facilitate group discussions. c) Begin the session with a reference to the client's actual experience. d) Talk to the client's relatives and get a detailed account of the client's history.
c) 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.
The nurse has educated the client on the pathophysiology of osteoarthritis and degenerative joint disease. This type of teaching best illustrates which learning theory? a) Adaptive learning theory b) Behavioral learning theory c) Cognitive learning theory d) Developmental learning theory
c) 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.
Which nursing action is applicable to the psychomotor domain of learning when conducting a teaching session for breastfeeding mothers? a) Telling the mothers to avoid taking over-the-counter drugs while breastfeeding b) Showing charts to the mothers that illustrate the types of breast milk c) Observing a mother expressing the breast milk d) Advising the mothers to drink plenty of water
c) 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.
When a nurse is planning for learning, who must decide who should be included in the learning sessions? a) The health care team b) The doctor and nurse c) The nurse and the client d) The client and the client's family
c) 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? a) "Told client to take antibiotic as ordered." b) "Client return demonstrated how to use glucometer." c) "Taught client about peak flows; client verbalized understanding." d) "Client and spouse taught how to use phone app to count carbohydrates; client return demonstrated carb counting for a hypothetical meal."
d) "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.
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? a) "I can lower my blood pressure by losing weight." b) "Osteoarthritis in my knees may be because of my weight." c) "I can monitor my caloric intake by measuring portions." d) "I will be doing well if I lose between 5 and 10 lb (2.3 and 4.5 kg) per week."
d) "I will be doing well if I lose between 5 and 10 lb (2.3 and 4.5 kg) per week." - Blood pressure can be reduced with weight loss. Osteoarthritis may be caused by destruction of cartilage from the pressure on the knee joints caused by excessive weight. Measuring portions is essential to understanding caloric intake. Healthy weight loss is generally accepted as 1 to 2 lb (0.45 to 0.90 kg) per week, or a reduction of 500 to 1,000 calories per day, which includes decreased intake of foods and burning calories with exercise.
The nurse is preparing to teach four clients. Which client will the nurse plan to teach using principles associated with gerogogy? a) 4-year-old who likes to play with blocks b) 31-year-old who continuously used the internet c) 56-year-old who likes to take notes on paper d) 79-year-old who has slight cognitive changes
d) 79-year-old who has slight cognitive changes - Gerogogy is the unique techniques that enhance learning among older adults. Therefore, the nurse will use gerogogy with the 79-year-old client. Pedagogy is the science of teaching children or those with cognitive ability comparable to children, and would be appropriate for the 4-year-old client. Andragogy is the principles of teaching adult learners, and would be appropriate for the 31-year-old client and the 56-year-old client.
A nurse is counseling several clients for depression. Four of them do not seem to be improving, which leads the nurse to suggesting a referral to a psychiatric nurse practitioner. Which of these clients would be most likely to attend the scheduled appointment? a) A 45-year-old female; unsure of the benefit of psychiatric care, on a fixed income, good family support. b) A 51-year-old male; walks to most places because of no transportation, low income, works days. c) A 36-year-old male; uses public transportation, unable to read, wants to confer with pastor. d) A 28-year-old female; works nights, willing to try, asking about insurance coverage of appointment.
d) A 28-year-old female; works nights, willing to try, asking about insurance coverage of appointment. - Cultural issues, poor family support, or lack of transportation may cause 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 educated well about the importance of the referral, understand the benefit to seeing a specialist, and those who 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.
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? a) Reinforcement b) Motivation c) Health promotion d) Positive feedback
d) 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.
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? a) Taught lesson at a school-age developmental level in an authoritarian style while the client was at meal time b) Taught lesson at a school-age developmental level in an authoritarian style while the client was at meal time c) Assessed the client's understanding of health and answered questions on an age-appropriate level while the television was on in the room d) Assessed the client's understanding of illness; assessed motor skills and developmental stage; provided clarification
d) 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 teaching a client, the nurse notices the client tends to lose focus easily. The nurse would adapt client teaching in which way? a) Request family members to serve as translators. b) Provide less health teaching because of the language barrier. c) Elongate the teaching session to be sure the client understands. d) Talk with animation and vocal inflection to stimulate the client aurally.
d) 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.
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? a) Are you worried about the pain? b) Why don't you want to do this? c) Most people are afraid of sticking themselves. d) Tell me what you know about these tests.
d) 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.
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? a) The nurse writes one or two broad objectives rather than several specific objectives. b) The nurse writes general statements for learner objectives that could be accomplished in any amount of time. c) The nurse plans learner objectives with another nurse before obtaining input from the client and family. d) The nurse writes one long-term objective for each diagnosis, followed by several specific objectives.
d) 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.
The nurse is caring for a client who demonstrates a health literacy concern. The nurse adjusts client teaching in which way? a) uses medical terminology to help the client feel smarter b) provides general teaching instead of specificity regarding diagnosis c) gives instructions in multiple ways so the client will understand d) uses videos, diagrams, and pictures rather than focusing on verbal teaching
d) 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.
