Nur 102 Patient Education and Health Promotion Chapter 9

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." Explanation: 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.

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." 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.

An RN enters a client's room and observes the unlicensed assistive personnel (UAP) forcefully pushing a client down on the bed. The client starts crying and informs the UAP of the need to go to the bathroom. What action is the RN witnessing that should be immediately reported to the supervisor?

Battery Explanation: The UAP is engaging in battery, which is an assault that is carried out and includes willful, angry, and violent or negligent touching of another person's body or clothes or anything attached to (or held by) that other person. Assault is a threat or an attempt to make bodily contact with another person without that person's consent. Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. Defamation of character is an intentional tort in which one party makes derogatory remarks about another that harm the other party's reputation.

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.

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. Explanation: 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 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 teach-back method assesses health literacy, seeking to confirm that the learner understands the health information received from the health professional. The question about how to take the medication reflects this method. Clients and caregivers have the opportunity to repeat back to the health care provider the key points they understand from a teaching session. Asking whether the client understands, has questions, or is having trouble getting the medications are "yes" or "no" type questions, which do not allow the nurse to determine the client's ability to obtain, read, understand, and act on health information.

A nurse is caring for a slightly overweight client whose lipid panel revealed elevated cholesterol levels. The client was prescribed a statin by the health care provider. Which statement by the client would indicate a health literacy level that would enable the client to make appropriate health decisions to lower cholesterol levels?

"In addition to this cholesterol medication, I plan to reduce my consumption of red meat and other saturated fats and start walking again." Health literacy is evidenced by the client's ability to acquire and understand health information to make appropriate health decisions. Understanding that diet and exercise is needed in addition to the medication indicates an appropriate health literacy level. Taking the statin, as needed, for digestion of fatty foods; switching from butter to margarine; and not worrying about diet or exercise indicates a health literacy deficit.

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." Cognitive domain learning may be evaluated through oral questioning. The return demonstration is an excellent way of evaluating psychomotor domain learning. Providing an opportunity for and encouraging clients to change their own dressing, for example, provides concrete evidence of satisfactory or unsatisfactory performance of the procedure.

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.

The nurse has been working with a client for several days during the client's recovery from a femoral head fracture. How should a nurse best evaluate whether client education regarding the prevention of falls in the home has been effective?

"What changes will you make around your house to reduce the chance of future falls?" An open-ended question that requires the client to apply the information that has been taught is often the most accurate way to evaluate the effectiveness of client education. Yes/no questions are much less effective ("Do you have any questions?"; "Do you think that the safety measures I taught you are clear and realistic?"). Asking the client about the importance of preventing falls related to throw rugs does not directly assess what the client will actually do to prevent falls.

A nurse is preparing a discharge education plan for a client who has had abdominal surgery. What would be most important for the nurse to include in this plan?

Activity limitations Discharge provides opportunities to educate the client about any limitations on activity or diet, procedures such as wound care, and information about when to call the physician. Deep breathing techniques would be taught usually prior to surgery and reinforced in the postoperative period. The nurse would most likely educate the client about ordered treatments upon admission as well as throughout the client's stay. Educating about testing restrictions would be done prior to any diagnostic procedure.

The nurse is providing education to a group of clients with diabetes about the benefits of healthy food choices. What type of learning is the nurse using with this client group?

Affective The education that the nurse is providing is designed to influence the value that the clients place on their food choices. This is the definition of affective learning. Cognitive learning involves teaching facts about a topic and appealing to logic and reason. Psychomotor involves the client performing physical actions to learn a new skill. Technical is not a domain of learning.

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.

A nurse is caring for a client with diabetes and foot gangrene who is scheduled for surgery that involves amputation of the affected foot. What would be most effective in helping the client cope with the fear and pain of surgery?

Explain the surgery and its importance to the client. The nurse should explain the surgery and its importance to the client before the surgery, as it will help the client to cope with the loss of a foot. It will prepare the client for the surgery, improve coping, lessen anxiety, and improve client outcomes by minimizing what is unknown. Informing the client about the complications of gangrene will scare the client even further; instead, the nurse should patiently listen to the client and explain the surgery. Refraining from telling the client about the disability would promote even greater anxiety and fear, especially fear about the unknown. Having the client practice with the walking device might help the client begin to experience the changes that will occur postoperatively, but it would most likely add to the client's current anxiety level and fears about the reality of losing a foot.

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

Provides return demonstration of use of inhaler. The psychomotor domain is a style of processing information that focuses on learning by doing. In this scenario, the client has shown learning in the psychomotor domain by providing a hands-on return demonstration. Other options demonstrate other learning domains.

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.

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. Explanation: 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.

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. Explanation: A contractual agreement is a pact between two people setting out mutually agreed-upon goals. The contracts are usually informal and not legally binding. The contract can serve to motivate the client and nurse to do what is necessary to meet the learning needs of the client; the contract does not serve to meet nursing goals.

A nurse is providing client care in a hospital setting. Who has full legal responsibility and accountability for the nurse's actions?

The nurse Explanation: In modern practice, nurses assess and diagnose clients and plan, implement, and evaluate nursing care. Full legal responsibility and accountability for these nursing actions rest with the nurse. The physician is responsible for the physician's own actions, and the hospital is responsible for the health care that all the professions provide. The head nurse or nurse manager is responsible for evaluating the performance of staff nurses, providing feedback and mentoring, developing education programs, contributing to staff professional development, interviewing and hiring nurses and medical staff, developing departmental budgets, and maintaining inventory of supplies on the division.

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.

A nurse is engaged in primary prevention activities as part of an education plan about heart disease for a client. Which activity would be most appropriate?

explaining the need for regular exercise and stress management For primary prevention of heart attack, the client should do regular exercise and learn to manage stress. This is a method to maintain health and prevent illness. Checking for blood pressure abnormalities or getting a blood lipid profile screening test helps identify any abnormalities. These are classified as secondary prevention measures. Tertiary prevention is directed toward minimizing individual disability from disease or dysfunction. High blood cholesterol is an abnormality that has been detected. By controlling the high blood cholesterol level with proper diet, the client will be able to minimize the individual damage done. It is thus tertiary prevention, not primary prevention.