NURS: Ch 22 NCLEX
Which of the nurse's following actions is most likely to promote a patient's compliance with her antiretroviral drug regimen for the treatment of human immunodeficiency virus (HIV)? a) Use interactive and learner-appropriate teaching techniques. b) Refer to the characteristics of the HIV virus when explaining how antiretrovirals treat HIV. c) Emphasize the consequences of noncompliance at various points in patient teaching. d) Ensure that teaching materials are evidence-based and explicitly referenced.
a) Use interactive and learner-appropriate teaching techniques. Noncompliance has serious consequences for the health of patients. It can often be prevented by ensuring that patient teaching is interactive and appropriate to the needs and development of each individual learner. Patient education should indeed be evidence-based, but this does not necessarily enhance compliance. Overemphasizing the negative and grounding the education in virology or other forms of science will also not guarantee compliance.
A patient has received a temporary ostomy during her treatment for colon cancer. Which of the following techniques is most likely to facilitate the patient's ability to independently empty and change the ostomy after discharge? a) demonstration b) lecture c) discussion d) a brochure
a) demonstration Demonstration of a technique allows for cognitive, psychomotor, and effective learning to simultaneously take place. Lectures, brochures, and discussions can foster cognitive learning but have significant limitations in the psychomotor domain and, to a lesser degree, in effective learning.
A nurse is preparing to teach a 45-year-old patient with asthma how to use his inhaler. One of the best methods to teach the patient this skill is by: a) demonstration b) lecture c) discussion d) panel session
a) demonstration Demonstration of techniques, procedures, exercises, and the use of special equipment is an effective patient teaching strategy.
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 teaching strategy is the nurse incorporating into her class? a) role-playing b) panel discussion c) role modeling d) programmed instruction
a) role-playing Role-playing allows the learner to experience, relive, or anticipate an event. The nurse explains the scenario and then allows the individual to play out the scene. Role modeling involves the nurse behaviors and the patient observing and learning from these behaviors. Programmed instruction incorporates the use of books as the instructor, independent of study with a teacher. A panel discussion involves a presentation of information by two or more people.
A 61-year-old male patient has been admitted to a medical unit with a diagnosis of pancreatitis secondary to alcohol use. Which of the patient's following statements suggests that nurses' teaching has resulted in effective learning? a) "My intravenous drip will keep me from getting dehydrated right now." b) "I'm starting to see how my lifestyle has caused me to end up here." c) "I can see how things could have been much worse if I hadn't got to the hospital when I did." d) "I understand why they're not letting me eat anything for the time being."
b) "I'm starting to see how my lifestyle has caused me to end up here." The patient's understanding of his contribution to his problem demonstrates a shift in attitude and feelings that is characteristic of effective learning. Understanding the treatment, course, and prognosis of his illness are aspects of cognitive learning.
The nurse has been working with a patient for several days during the patient's recovery in hospital from a femoral head fracture. How should a nurse best evaluate whether patient education regarding falls prevention in the home has been effective? a) "Do you have any questions about the fall prevention measures that we've talked about?" b) "What changes will you make around your house to reduce the chance of future falls?" c) "In light of what we've talked about, why is it important that you remove the throw rugs i your house?" d) "Do you think that the safety measures I taught you are clear and realistic?"
b) "What changes will you make around your house to reduce the chance of future falls?" An open-ended question that requires the patient to apply the information that has been taught is often the most accurate way to evaluate the effectiveness of patient teaching. 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 patient about the importance of falls prevention does not directly assess what the patient will actually do to prevent falls.
A 20-year-old pregnant patient is visibly distraught when the labor and delivery nurse tells her that she requires a urinary catheter. The patient is embarrassed by her anxiety and eventually tells the nurse that this is because of "what my father used to do to me." In addition to fulfilling any legal obligation to report the patient's statement, which of the nurse's following actions is most appropriate? a) Thank the patient for her candor and explore the possibility of the nurse providing long-term counseling. b) Acknowledge the significance of the patient's statement and facilitate a counseling referral. c) Explore the matter in greater detail with the patient and encourage her to report this to the authorities. d) Begin motivational counseling to help the patient overcome her difficult past.
b) Acknowledge the significance of the patient's statement and facilitate a counseling referral. The gravity of the patient's statement indicates a need for professional counseling that is beyond the scope of the labor and delivery nurse. Acknowledgement of the patient's statement is necessary, and there is a legal responsibility for the nurse to report the matter in most jurisdictions; it would be inappropriate to place this onus solely on the patient.
A nurse has taught a diabetic patient how to administer his daily insulin. The nurse should evaluate the teaching-learning process by: a) Determining the patient's motivation to learn. b) Deciding if the learning outcomes have been achieved. c) Allowing the patient to practice the skill he has just learned. d) Documenting the teaching session in the patient's medical record.
b) Deciding if the learning outcomes have been achieved. The nurse cannot assume that the patient has actually learned the content unless there is some type of proof of learning. The key to evaluation is meeting the learner outcomes stated in the teaching plan.
A couple has just learned that their newborn infant has a congenital cardiac anomaly that will require many lifestyle modifications, surgical corrections, and hospital stays. Place the following aspects of the couple's patient education in the correct order that nurses should conduct them. a) Draft learning outcomes. b) Determine their emotional readiness to learn. c) Implement various educational techniques. d) Revise the learning plan if needed. e) Select teaching strategies. f) Determine what the couple has learned.
b) Determine their emotional readiness to learn. a) Draft learning outcomes. e) Select teaching strategies. c) Implement various educational techniques. f) Determine what the couple has learned. d) Revise the learning plan if needed. The teaching process parallels the learning process. It begins with assessment of variables such as readiness to learn and learning needs that lead to a determination of learning outcomes. Teaching strategies are selected, implemented, evaluated, and then revised if necessary.
Nurses play a vital role in patient teaching because of their: a) Need for self-actualization b) Expertise in healthcare c) Desire to help others d) Ability to provide illness care
b) Expertise in healthcare Nurses who are skilled educators and counselors can improve patients' health and well-being. This is a function of their education and experience and their use of cognitive, technical, interpersonal, and ethical/legal skills.
Mr. Singh's wife has recently been diagnoses with early-stage Alzheimer's disease and he has asked the nurse to recommend websites that may supplement his learning about her diagnosis. How should the nurse respond to Mr. Singh's request? a) Direct Mr. Singh to online databases such as Cumulative Index to Nursing and Allied Health Literature (CINAHL) b) Identify and recommend some credible websites appropriate to his learning needs. c) Provide Mr. Singh with print-based materials that are clearly referenced and reflect his learning style. d) Encourage Mr. Singh to avoid online resources due to the unregulated nature of the internet.
b) Identify and recommend some credible websites appropriate to his learning needs. Web-based resources can be a useful tool in patient education, but suitability and accuracy need to be carefully considered. Many online databases exist for health professionals, but these are less likely to be accessible or appropriate for those outside the health professions.
The primary purpose of a contractual agreement between nurses and patients when beginning a teaching plan is to: a) Create a formal and legal bond between the nurse and patient. b) Motivate both the patient and nurse to do what is necessary to meet the patient's learning outcomes. c) Outline the patient's learning outcomes. d) Limit the scope of the teaching session.
b) Motivate both the patient and nurse to do what is necessary to meet the patient's learning outcomes. A contractual agreement is a pact two people make setting out mutually agreed-on goals.
A nurse is developing a contractual agreement with a patient. Which of the following statements is true of a contractual agreement? a) The contract serves to meet nursing goals. b) The contract serves to meet the patient's learning outcomes. c) The contract is legally binding. d) The contract is a formal agreement.
b) The contract serves to meet the patient's learning outcomes. A contractual agreement is a pact between two people setting out mutually agreed-on goals. The contracts are usually informal and not legally binding. The contract can serve to motivate the patient and nurse to do what is necessary to meet the learning needs of the patient and not nursing goals.
The nurse is writing learner outcomes for a patient admitted with heart failure. Which learner outcomes statement is correctly written? a) The patient will understand the relationship between sodium intake and fluid retention. b) The patient will describe symptoms of hypokalemia associated with diuretic use. c) The patient will know how to weigh himself daily at home. d) The patient will comprehend the signs and symptoms of heart failure.
b) The patient will describe symptoms of hypokalemia associated with diuretic use. An appropriately constructed learner outcome statement will include verbs from the cognitive, effective, or psychomotor domains. The verb "describe" is a cognitive domain verb and allows the nurse to measure a patient's understanding of information. Verbs such as "understand," "know how to," and comprehend" are not found in these domains, and measurability is difficult to determine.
A nurse has been working with a patient whose vision has been deteriorating as a result of glaucoma. The patient is reluctant to participate in education surrounding adaptations and home modifications that could aid in her adjustment to sensory loss, stating, "What's the point of even fighting the inevitable?" The nurse would recognize the potential for which of the following nursing diagnoses? a) disturbed body image b) hopelessness c) situational low self-esteem d) fear
b) hopelessness The patient's statements of hopelessness and fatalism demonstrate that counseling is likely appropriate. Fear, low self-esteem, and disturbed body image are all possibilities for this patient, but her statement most clearly suggests that she feels hopeless.
A pediatric nurse provides teaching to numerous patients in her care. Which group of children benefits most from being involved in the teaching-learning process? a) toddlers b) school-aged children c) infants d) preschoolers
b) school-aged children Teaching related to infants, toddlers, and preschool children should be directed at the parents. School-aged children are capable of logical reasoning and should be included in the teaching-learning process whenever possible.
A patient is experiencing difficulty in adjusting to a new prosthesis despite conscientious patient teaching by numerous members of the healthcare team. How should the team respond to the patient's lack of learning to this point? a) Scale back the scope and detail of patient teaching. b) Explore alternatives to prosthesis. c) Revise the teaching plan that has guided education. d) Refer the patient to outside sources of information.
c) Revise the teaching plan that has guided education. If evaluation of patient teaching indicates that patient learning has not met outcomes, it is appropriate to revise the teaching plan. This does not necessarily entail reducing the detail or referring the patient to outside information sources. Exploring alternatives to prosthesis does not address the patient's learning needs.
When preparing a health promotion program for patients in an adult daycare center, what is the first step the nurse must take? a) develop learning outcomes b) develop a teaching plan c) assess the patients' learning needs and learning readiness d) diagnose the patients' learning needs
c) assess the patients' learning needs and learning readiness The first step of the teaching-learning process is to assess the patient's learning needs and learning readiness.
It is important for the nurse to distinguish a patient's readiness to learn and ability to learn. An example of a patient's ability to learn includes: a) culture. b) emotional health. c) physical condition. d) social and economic stability.
c) physical condition. The readiness to learn focuses on a patient's willingness to engage in the teaching-learning process. Readiness to learn includes emotional readiness and experiential readiness such as social and economic stability, culture, attitudes toward learning, and past experiences with learning. The ability to learn focuses on physical condition, acuity of senses, cognitive abilities, literacy, level of education, and communication skills.
One of the best ways to affirm the efforts of patients who master new knowledge, attitudes, or skills is through: a) dialogue and discussion b) a grading scale c) positive reinforcement d) encouraging the family to learn with the patient
c) positive reinforcement People feel encouraged and supported when their efforts are acknowledged by another person, especially when they trust and value that other person.
A nurse instructs a group of parents about how to make their home safe for their toddlers. This is an example of teaching aimed toward which of the following? a) restoring health b) facilitating coping c) preventing illness d) promoting health
c) preventing illness Thorough assessment of the patients' learning needs may reveal the need for vehicular safety, home safety, domestic-violence recognition, recreational safety, occupational safety and health education. This type of patient education is aimed at enhancing health-protecting behaviors.
When using facts from the patient's medical record as part of the necessary information to assess learning needs, the nurse is using which type of data source? a) primary b) historic c) secondary d) hospital-owned
c) secondary Past and current patient medical records are considered secondary sources of information and can provide a history of medical problems, as well as documentation of nursing assessments, diagnoses, and interventions.
A nurse who provides care in a campus medical clinic is conducting a follow-up assessment of a 21-year-old female student who recently contracted genital herpes. Which of the following actions best demonstrates that the nurse is attempting to facilitate the student's coping with her diagnosis? a) Teaching the student how to ensure that she does not infect future partners. b) Explaining the risks and benefits of daily suppressive therapy during outbreaks. c) Assessing the measures that the student takes to protect her overall health. d) Discussing ways that she could broach the subject of her diagnosis in future relationships.
d) Discussing ways that she could broach the subject of her diagnosis in future relationships. Discussing strategies that the student could use to tell others about her diagnosis in a clear but appropriate manner shows a recognition of the psychosocial ramifications of the student's diagnosis and promotes her coping with potential embarrassment. Discussing therapies, health promotion, and ways of protecting others are relevant, but these do not directly address the student's coping with her diagnosis.
With which of the following groups should the nurse apply the COPE (Creativity; Optimism; Planning; Expert Information) model to facilitate learning? a) Infection control nurses who conduct hand washing audits in a hospital. b) A group of junior high school students who are being taught about nutrition. c) Nurses who provide home healthcare in an inner-city setting. d) The parents of a teenager who has just been diagnoses with type 2 diabetes.
d) The parents of a teenager who has just been diagnoses with type 2 diabetes. The COPE model is specifically aimed at helping family members become effective problem solvers and support a nurse's teaching efforts. Consequently, the parents of a child who has a new diagnosis are appropriate subjects for this model.
A nurse is teaching a patient with a new diagnosis of diabetes. Which example demonstrates cognitive learning by the patient? a) The patient expresses a desire to improve his nutritional intake and lose weight. b) The patient demonstrates proper technique for injecting insulin. c) The patient prepares the skin for the administration of an insulin injection. d) The patient describes signs and symptoms of hypoglycemia.
d) The patient describes signs and symptoms of hypoglycemia. The patient'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. Effective 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 of the following as a characteristic of an adult learner? a) The material presented should focus on future application. b) Previous experiences have little impact on learning. c) Peer group acceptance is a critical issue for this age group. d) Their readiness to learn is often related to a developmental task or social role.
d) 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.
A nurse is using the health belief model to assess a patient. Using this model, what should the nurse begin to understand? a) Which clinical and financial resources the patient requires to improve his lifestyle. b) What motivates the patient to learn new behaviors. c) The effects the health delivery system has on the patient's health patterns. d) Whether the patient is willing to take actions to support health.
d) Whether the patient is willing to take actions to support health. The health belief model is designed to explain why persons are willing to take action to support their health.
Noncompliance with a therapeutic regimen can be a significant problem for elderly people. Which of the following is one of the common reasons for noncompliance in the elderly? a) lack of time b) religious practice c) childlike behavior d) inadequate financial resources
d) inadequate financial resources Noncompliance is often associated with inadequate finances, along with factors suck as patient confusion, disappointment, misunderstanding, or fear.
A nurse is discussing the benefits of smoking cessation with a patient. The nurse informs the patient that smoking cessation will reduce his risk for cancer, improve his respiratory status, and enhance the quality of his life. The nurse also shared her story of smoking cessation, provides information on other individuals who have successfully quit, and encourages the patient to attend a support group for smoking cessation. The patient discusses his feelings on smoking cessation and verbalizes a desire to quit smoking. What type of counseling did the nurse provide to this patient? a) long-term counseling b) situational counseling c) developmental counseling d) motivational counseling
d) motivational counseling Motivational counseling involves discussing feelings and incentives with the patient. Long-term counseling extends over a period of time. Developmental counseling occurs when a patient is going through a developmental stage or passage. Situational counseling occurs when a patient faces an event or situational crisis.
A school nurse is discussing bike and outdoor safety measures with a group of Boy Scouts. What type of health teaching and counseling is the nurse providing to this group of children? a) restoring health b) facilitating coping c) promoting health d) preventing illness
d) preventing illness Preventing illness includes first aid, safety, immunizations, screening, and identification and management of risk factors. Promoting health focuses on developmental and maturation issues, hygiene, nutrition, exercise, mental health, and spiritual health. Restoring health focuses on developing self-care practices that promote recovery. Facilitating coping assists the patient in learning to cope with permanent health alterations.
