Chapter 25 Client Education

Test Bank Chapter 25: Client Education MULTIPLE CHOICE 1. The client has been informed that he can be discharged once he can irrigate his colostomy independently. The client requests the nurse to observe his irrigation technique. Which of the following learning motives is the client displaying? 1. Physical need 2. Social activity 3. Task mastery 4. Evaluation stance ANS: 3 Task mastery motives are based on needs such as achievement and competence. The client who must demonstrate irrigating his colostomy independently in order to be discharged is displaying the learning motive of task mastery. A physical motive may be seen in the client who desires to return to a level of physical normalcy. A social motive is the need for connection, social approval, or self-esteem. An evaluation stance would be determining whether the outcomes of the teaching-leaning process met the client’s goal. Evaluation is not a learning motive. DIF: A REF: 366-367 TOP: Nursing Process: Evaluation OBJ: Comprehension 2. An industrial nurse is planning to give an informative talk on hypertension to employees in honor of “heart month.” He plans to teach individuals how to take their blood pressure measurements. Which information is important for him to ask the planning committee before this presentation? 1. Ages of all employees involved 2. Names of employees who are married 3. Number of employees with high blood pressure 4. Type of room available and number of participants ANS: 4 The number of persons being taught, the need for privacy, the room temperature, the room lighting, noise, the room ventilation, and the room furniture are important factors when choosing the setting. The ideal setting helps the client focus on the learning task. Knowing the specific ages of all the people involved is not as important as providing an environment conducive to learning. It is not necessary to know the names of employees who are married to teach individuals how to take their blood pressure. Whether an employee has high blood pressure should not be as important to the teacher as providing an environment conducive to learning. Having high blood pressure may be a motivating factor for employees to learn how to take their blood pressure, because of its personal relevance. Test Bank DIF: A REF: 369 TOP: Nursing Process: Planning 25-2 OBJ: Comprehension 3. The nurse established the following objective for the client who was unable to void: The client’s intake will be at least 1000 mL between 7 AM and 3:30 PM. Feedback showing success is indicated by the client: 1. Voiding at least 1000 mL during the shift 2. Verbalizing abdominal comfort without pressure 3. Having adequate fluid intake and urinary output 4. Drinking 240 mL of fluid five or six times during the shift ANS: 4 The nurse evaluates success by observing the client’s performance of each expected behavior. Feedback indicating success in this situation is the client drinking 240 mL of fluid five or six times during the shift. This would be a fluid intake of 1200-1440 mL, meeting the objective of at least 1000 mL during the designated time period. Voiding at least 1000 mL is not the objective. The objective is to have the client drink at least 1000 mL. Verbalizing abdominal comfort without pressure is not an evaluation of the objective regarding specific fluid intake. Having adequate intake and output is not accurate feedback indicating success. The term adequate is not quantified. DIF: A REF: 381 TOP: Nursing Process: Evaluation OBJ: Comprehension 4. There are a variety of teaching methodologies fro a nurse to choose from to use with clients. For a toddler, the nurse should use: 1. Role-playing 2. Problem-solving 3. Independent learning 4. Simple explanations and pictures ANS: 4 Effective teaching methodologies for the toddler include simple explanations and picture books that describe a story of children in a hospital or clinic. Role-playing is an appropriate teaching methodology for the preschooler. Problem-solving is an appropriate teaching methodology for the adolescent. Independent learning is best used as a teaching methodology for the young or middle adult. DIF: A REF: 368 TOP: Nursing Process: Planning OBJ: Comprehension Test Bank 25-3 5. The nurse has important information to share with a parent who has brought his child to the emergency department. The nurse discovers that the parent, who appears very anxious, has just learned his son will require surgery. The most effective teaching approach in this situation is: 1. Telling 2. Trusting 3. Participating 4. Group teaching ANS: 1 The telling approach is useful when limited information must be taught. If a client is highly anxious but it is vital for information to be given, telling can be effective. The entrusting approach provides the client the opportunity to manage self-care. The nurse observes the client’s progress and remains available to assist without introducing more new information. This would not be the most effective teaching approach in this situation. Participating involves the nurse and client setting objectives and becoming involved in the learning process together. This would not be the most effective teaching approach in this emergency situation. Group teaching would not be the most effective teaching approach in this situation. A person who is anxious would benefit more from individual instruction. DIF: A REF: 376 TOP: Nursing Process: Planning OBJ: Comprehension 6. A client, after being taught of the clinical manifestations of inflammation to enable early detection of a complication of a surgical wound states, “I will look at the wound four times a day and tell my surgeon if it looks red or swollen.” Her statement is an example of: 1. Attitudes 2. Application 3. Analysis 4. Evaluation ANS: 2 Application involves using abstract, newly learned ideas in a concrete situation. The client who is taught the clinical manifestations of inflammation and who will assess for signs such as redness or edema is using newly learned information in a concrete manner. Attitude has to do with affective learning. The client is not expressing an attitude, but is applying new knowledge in a concrete way. Analysis involves breaking down information into organized parts. The client is not demonstrating analysis. Evaluation is a judgment of the worth of a body of information for a given purpose. The client is not expressing judgment. DIF: A REF: 365 TOP: Nursing Process: Evaluation OBJ: Comprehension Test Bank 25-4 7. The client continues to ask questions about a surgical wound. The client states, “I think I would like help the first time I look at my wound.” This is an example of: 1. Adaptation 2. Perception 3. Organizing 4. Guided response ANS: 4 A guided response is the performance of an act under the guidance of an instructor. The client who is seeking help is demonstrating a guided response. Adaptation occurs when a person is able to change a motor response when unexpected problems arise. The client is not exhibiting adaptation. Perception is being aware of objects or qualities through the use of sense organs. This situation is not an example of perception. Organizing is developing a value system by identifying and organizing values and resolving conflicts. This situation is not an example of organizing. DIF: C REF: 449 TOP: Nursing Process: Assessment OBJ: Comprehension 8. There are many factors are assessed before teaching the client to learn insulin injection sites, but the most important factor for the nurse to assess first is the: 1. Previous knowledge level of the client 2. Willingness of the client to want to learn the injection sites 3. Financial resources available to the client for the equipment 4. Intelligence and developmental level of the individual client ANS: 2 If a person does not want to learn, it is unlikely that learning will occur. Motivation is the first factor the nurse should assess before teaching. To determine learning needs, the nurse should assess the client’s previous knowledge level. However, this would not be the most important factor for the nurse to assess first. Assessing the financial resources available to the client for obtaining equipment is important; however, it is not the most important factor for the nurse to assess first. Assessing the client’s physical and cognitive ability to learn is important. However, it is not the most important factor for the nurse to assess first. DIF: A REF: 364 TOP: Nursing Process: Assessment OBJ: Comprehension 9. The nurse is demonstrating to the client how to put on anti-embolitic stockings. In the middle of the lesson the client asks, “Why have my feet been swelling?” The nurse stops and responds to the client. Which of the following is the teaching principle that the nurse should follow? 1. Timing Test Bank 25-5 2. Setting priorities 3. Building on existing knowledge 4. Organizing the teaching materials ANS: 1 The nurse who stops a demonstration of applying anti-embolitic stockings to answer a client’s question is following the teaching principle of timing. If the client has a question, it is important to answer the question immediately, so the client may return his or her focus to the task being taught. Setting priorities is important to conserve the time and energy of the client and nurse. The nurse who stops to answer a question is not setting priorities. A client learns best on the basis of preexisting cognitive abilities and knowledge. This situation is not an example of building on existing knowledge. Organizing teaching materials means the nurse considers the order of information to present. This is not an example of organizing teaching materials. DIF: A REF: 375 TOP: Nursing Process: Implementation OBJ: Comprehension 10. Clients give various responses to teaching sessions. For the nurse, an example of an evaluation of a psychomotor skill is: 1. Client states side effects of a medication 2. Client responds appropriately to eye contact 3. Client independently plans an exercise program 4. Client demonstrates the proper use of a walking cane ANS: 4 Determining whether the client is able to demonstrate a newly learned skill is an example of an evaluation of a psychomotor skill. Psychomotor learning involves acquiring skills that require the integration of mental and muscular activity, such as walking with a cane. Having the client state side effects of a medication is an example of an evaluation of cognitive learning. Determining whether a client responds appropriately to eye contact is an example of evaluation of affective learning. The client who planned an exercise program is demonstrating cognitive learning. DIF: A REF: 366 TOP: Nursing Process: Evaluation OBJ: Comprehension 11. Different topics are presented in the information sessions that are held in the outpatient clinic. In planning for a session on health maintenance/illness prevention, the nurse should select a topic on: 1. Use of assistive devices, such as canes 2. Self-help devices for post-CVA clients 3. Stress management techniques for working parents 4. Environmental alterations for clients in wheelchairs ANS: 3 Test Bank 25-6 Stress management techniques for working parents is an appropriate topic for health maintenance/illness prevention. Use of assistive devices, such as canes, is not a health maintenance/illness prevention topic. It is a coping with impaired function topic. Selfhelp devices for post-CVA clients is not a health maintenance/illness prevention topic. It is a coping with impaired function topic. Environmental alterations for clients in wheelchairs is not a health maintenance/illness prevention topic. It is a coping with impaired function topic. DIF: A REF: 362 TOP: Nursing Process: Planning OBJ: Comprehension 12. The nurse is evaluating the responses of clients to teaching sessions. An example of an evaluation of a client’s attainment of a cognitive skill is: 1. Client explains that the medication should be taken with meals 2. Client looks at the surgical incision without requiring prompting 3. Client uses crutches appropriately to move both up and down stairs 4. Client independently capable of dressing self after eating breakfast ANS: 1 The client who is able to explain that the medication should be taken with meals is demonstrating attainment of a cognitive skill. The client who is able to look at the surgical incision without prompting is demonstrating attainment of affective learning. The client who uses crutches appropriately is demonstrating attainment of a psychomotor skill. The client who dresses self after breakfast is most likely demonstrating attainment of psychomotor learning. DIF: A REF: 365 TOP: Nursing Process: Evaluation OBJ: Comprehension 13. The nurse evaluates which of the following statements as an indication that the client is not ready to learn at this time? 1. “I need to understand more about the reason for the colostomy.” 2. “I will find out more about that when the support group meets.” 3. “There’s no sense in showing me that now. I’m too sick right now.” 4. “Please be sure to tell me if I am completing all the steps correctly.” ANS: 3 Readiness to learn is related to the stage of grieving. This response by the client is demonstrating anger. The client is unwilling to learn at this time. The client has not yet reached the acceptance state of grieving in which learning can occur. This statement indicates the client is ready to learn and desires to find out more to gain understanding. This statement indicates the client is willing to learn. The client who requests feedback is expressing readiness to learn. DIF: A REF: 362 OBJ: Comprehension Test Bank 25-7 TOP: Nursing Process: Evaluation 14. In planning to teach an older adult client, the nurse should incorporate which teaching method or principle into the plan? 1. Keep teaching sessions short. 2. Teach in the early morning or late evening. 3. Put as much as possible into each teaching session. 4. Focus on teaching a family member or caregiver instead. ANS: 1 Keeping teaching sessions short is an appropriate method when teaching an older adult client. The older adult should be taught when the client is alert and rested, not early morning or late evening. The teaching session should not be filled with numerous topics. The older adult client is capable of learning and should be the focus. A family member or caregiver may be included in teaching, but the older adult client should not be excluded. DIF: A REF: 376 TOP: Nursing Process: Planning OBJ: Comprehension 15. The nurse has completed an assessment on the client and identified the following nursing diagnoses. Which one of the following nursing diagnoses indicates a need to postpone teaching that was planned? 1. Activity intolerance related to pain 2. Ineffective management of treatment regimen 3. Noncompliance with prescribed exercise plan 4. Knowledge deficit regarding impending surgery ANS: 1 Pain, fatigue, or anxiety can interfere with the ability to pay attention and participate. The nursing diagnosis of activity intolerance related to pain indicates a need to postpone teaching. Teaching may be delayed until the nursing diagnosis is resolved or the health problem is controlled. Ineffective management of treatment regimen does not indicate a need to postpone teaching. Ineffective management of treatment regimen reinforces the need for teaching. Noncompliance with prescribed exercise plan does not indicate a need to postpone teaching. The client who is noncompliant may require further teaching. Knowledge deficit regarding impending surgery does not indicate a need to postpone teaching. A knowledge deficit reinforces the need for teaching. DIF: A REF: 366 TOP: Nursing Process: Assessment OBJ: Comprehension 16. There are a variety of teaching methodologies that may be utilized to meet the client’s needs. Which teaching method is best applied to a cognitive learning need? 1. Modeling of behavior Test Bank 25-8 2. Discussion of feelings 3. Computer-assisted instruction 4. Demonstration of a procedure ANS: 3 An independent project such as computer-assisted instruction is an appropriate teaching method for cognitive learning. Modeling of behavior is an appropriate teaching method for psychomotor learning. Discussion of feelings is an appropriate teaching method for affective learning. Demonstration is an appropriate teaching method for psychomotor learning. DIF: A REF: 365 TOP: Nursing Process: Evaluation OBJ: Comprehension 17. For a functionally illiterate client, the nurse particularly focuses on: 1. Using intricate analogies and examples 2. Avoiding lengthy return demonstrations 3. Incorporating familiar nonmedical terminology 4. Providing longer learning sessions with the client ANS: 3 When teaching a functionally illiterate client, the nurse should use simple terminology, avoiding medical jargon. The nurse should incorporate familiar terminology to enhance the client’s understanding. The nurse should use simple analogies and real life examples. The nurse should ask for return demonstrations as this provides the opportunity to clarify instructions and time to review procedures. Although teaching sessions may be kept short, they should be scheduled at more frequent intervals. DIF: A REF: 378-379 TOP: Nursing Process: Planning OBJ: Comprehension 18. In preparing a teaching plan for adult clients in a cancer support group, the nurse incorporates evidence-based information. The nurse recognizes that evidence obtained about adult learners has identified that this group prefers: 1. Computer-assisted instruction 2. Traditional classroom settings 3. Long sessions with plenty of technical information 4. Interesting personal communication techniques ANS: 4 Test Bank 25-9 Adults have a wide variety of personal and life experiences to employ. Therefore adult learning is enhanced when they are encouraged to use these experiences to solve problems. Evidence-based information indicates that adult clients prefer interactive, personal communication with nurses or physicians. Evidence-based information indicates computer-assisted learning is not a preferred method of instruction by many adult learners. As clients become more comfortable with computers, this preference may change. Evidence-based information indicates that not all clients are comfortable in class settings or in support groups. Other educational opportunities should be available. Adult learners prefer short teaching sessions without a great deal of technical information. DIF: A REF: 369 TOP: Nursing Process: Planning OBJ: Comprehension 19. While teaching the client about management of his heart disease, a nurse might use a strategy that is implemented to promote learning in the affective domain such as: 1. Asking the client what he believes he needs to know about the diagnosis 2. Providing brochures both on current exercises and on nutrition guidelines 3. Encouraging the client to personally discuss his feelings about his health status 4. Having the client return-demonstrate self-measurement of his own blood pressure ANS: 3 An intervention to promote learning in the affective domain would be encouraging the client to discuss his feelings about his health status. Asking the client what he believes he needs to know about the diagnosis would be an intervention to promote learning in the cognitive domain. Providing brochures on current exercises and nutrition guidelines would be an intervention to promote learning in the cognitive domain. Having the client return-demonstrate self-measurement of his blood pressure would be an intervention to promote learning in the psychomotor domain. DIF: A REF: 365 TOP: Nursing Process: Planning OBJ: Comprehension 20. The nurse is preparing to present a teaching session on skin protection for a group of older adults at a senior center. A principle that has been found to be most effective in teaching older adults is: 1. Moving the group along at a predetermined pace 2. Providing information in longer teaching sessions 3. Speaking very slowly and in a louder tone of voice 4. Beginning and ending each session with important information ANS: 4 Test Bank 25-10 The nurse should begin and end each teaching session with important information because clients are more likely to remember information that is taught early in the teaching session, and key points can be summarized at the end. Repetition also reinforces learning. The group should not be moved along at a predetermined pace. Clients may have questions that would go unanswered if there were a predetermined pace. Or, sometimes teaching sessions have to be stopped after the nurse observes a client’s loss of concentration such as nonverbal cues of poor eye contact or slumped posture. Shorter (approximately 20 minutes), frequent sessions are more easily tolerated and retain the client’s interest in the material. The nurse should face the client and speak in a low tone of voice for the older adult with a hearing problem. DIF: A REF: 380-381 TOP: Nursing Process: Planning OBJ: Comprehension 21. The nurse is preparing the discharge teaching materials on newly prescribed drugs to a client diagnosed to be in the early stage of Alzheimer’s disease. The nurse best deals with the client’s cognitive deficits by: 1. Providing written material to supplement the discussion 2. Arranging for family to be present during the discussion 3. Presenting the material in two short but focused sessions 4. Requiring the client to restate the information in her own words ANS: 2 The client’s family needs to understand and accept many changes in the patient’s physical and/or cognitive capabilities. The family’s ability to provide support results in part from education, which begins as soon as the nurse identifies the client’s needs and the family displays a willingness to help. The remaining options may support retention of material but not as effectively as including family in the educational sharing. DIF: C REF: 381 TOP: Nursing Process: Planning OBJ: Analysis 22. The nurse recognizes that the client’s teaching plan is most directly driven by: 1. The client’s identified learning needs 2. The complexity of the client’s health needs 3. The client’s readiness and motivation to learn 4. The presence of cultural or physical barriers ANS: 1 Teaching is most effective when it responds to the learner’s needs. While assessing and diagnosing a client’s health care problems, the nurse identifies the need for education that in turn generates the teaching plan. The remaining options reflect factors that will affect both the teaching plan and the client’s learning. DIF: C REF: 363 OBJ: Analysis Test Bank 25-11 TOP: Nursing Process: Planning 23. The nurse recognizes that the primary goal of a client’s teaching plan is to: 1. Facilitate a knowledge-based client decision-making process 2. Provide information that brings about informed client consent 3. Enhance the client’s sense of personal control regarding his or her health care 4. Therapeutically affect the client’s health, wellness, and independence ANS: 4 Creating a well-designed, comprehensive teaching plan that fits a client’s unique learning needs ultimately helps clients make informed decisions about their care and results in clients becoming healthier and more independent. The remaining options affect the primary goal by enhancing decision making, providing for informed consent, and bringing about a sense of personal control. DIF: C REF: 363 TOP: Nursing Process: Planning OBJ: Analysis 24. Which of the following teaching topics is an example of health maintenance and promotion and illness prevention? 1. Glucose monitoring at home 2. Living with rheumatoid arthritis 3. Stress management’s impact on depression 4. What to expect after hip replacement surgery ANS: 1 Promoting healthy behavior through education allows clients to assume more responsibility for their health. Greater knowledge results in better health maintenance habits. When clients become more health conscious, they are more likely to seek early diagnosis of health problems. The remaining options address restoration of health and coping with impaired functioning, whereas stress management is a topic that relates to the promotion of health and the prevention of illness. DIF: A REF: 362-363 TOP: Nursing Process: Planning OBJ: Comprehension 25. Which of the following teaching topics is an example of restoration of health? 1. Glucose monitoring at home 2. Living with rheumatoid arthritis 3. Stress management’s impact on depression 4. What to expect after hip replacement surgery ANS: 4 Test Bank 25-12 Injured or ill clients need information and skills to help them regain or maintain their levels of health. The remaining options address health maintenance and promotion and illness prevention and coping with impaired functioning while what to expect after hip replacement surgery is a topic that relates to the restoration of health and function. DIF: A REF: 363 TOP: Nursing Process: Planning OBJ: Comprehension 26. Which of the following actions is the primary nursing responsibility regarding client education? 1. Providing accurate, current, relevant information 2. Answering the client’s questions regarding health-related issues 3. Assessing the individual client’s readiness and motivation to learn 4. Identifying areas where clients are in need of educational information ANS: 1 Nurses have an ethical responsibility to teach their clients (Redman, 2005, 2007). The information needs to be accurate, complete, and relevant to the client’s needs. The remaining options are factors that affect learning and so require the nurse’s attention but are not as primary as providing information that is accurate, current, and relevant to the client’s needs. DIF: C REF: 363 TOP: Nursing Process: Planning OBJ: Analysis 27. When a client newly diagnosed with type 2 diabetes mellitus assumes responsibility for checking her blood glucose level four times a day, this is an example of: 1. Cognitive learning 2. Affective learning 3. Impaired learning 4. Psychomotor learning ANS: 4 Psychomotor learning involves acquiring skills that require the integration of mental and muscular activity. The remaining options are involved with expression of feelings and acceptance of attitudes, opinions, or values or the acquisition of knowledge. Impaired learning involves alteration to the normal learning process that requires alterations in methods and techniques. DIF: A REF: 366 TOP: Nursing Process: Evaluation OBJ: Comprehension Test Bank 25-13 28. When a client newly diagnosed with type 2 diabetes mellitus selects a lunch menu that correlates with the number of carbohydrates he is allowed for that meal, this is an example of: 1. Cognitive learning 2. Affective learning 3. Impaired learning 4. Psychomotor learning ANS: 1 Cognitive learning includes all intellectual behaviors and requires thinking. The remaining options are involved with expression of feelings and acceptance of attitudes, opinions, or values or acquiring skills that require the integration of mental and muscular activity. Impairing learning involves alteration to the normal learning process that requires alterations in methods and techniques. DIF: A REF: 365 TOP: Nursing Process: Evaluation OBJ: Comprehension 29. Which of the following statement best reflects the nurse’s appropriate attention to a client’s need for self-efficacy? 1. “What can I do to help you lose the weight?” 2. “Are you really ready to start a regular exercise regimen?” 3. “After you watch me demonstrate this inhaler, you will have no problems using it at all.” 4. “Come on; with all the self-help products out there, you will be able to stop smoking.” ANS: 3 Self-efficacy refers to a person’s perceived ability to successfully complete a task. When people believe that they are able to execute a particular behavior, they are more likely to actually perform the behavior consistently and correctly. Although the other options are related to behavioral change to achieve a goal, they do not support the client by both encouragement and providing the skills necessary to be successful. DIF: C REF: 367 TOP: Nursing Process: Planning OBJ: Analysis 30. A client has been recently told that the primary cancer has metastasized, and the cancer is considered terminal. When the nurse offers to discuss palliative care options, the client replies, “I’m going to have the reports reevaluated by another doctor; I feel fine and I think a mistake has been made.” The nurse recognizes this response as: 1. Anger 2. Disbelief 3. Bargaining 4. Acceptance Test Bank 25-14 ANS: 2 In this example, the client avoids discussion of the illness, choosing to believe a mistake has been made. The remaining options are other stages of the grieving process. DIF: A REF: 368 TOP: Nursing Process: Planning OBJ: Comprehension 31. A client has been recently told that the primary cancer has metastasized and the cancer is considered terminal. When the nurse offers to discuss palliative care options the client replies, “I can’t understand why you all want to upset me by bringing the topic up. Now please just leave me alone.” The nurse recognizes this response as: 1. Anger 2. Disbelief 3. Bargaining 4. Acceptance ANS: 1 In this example, the client blames others and complains. The client often directs anger toward the nurse or others. The remaining options are other stages of the grieving process. DIF: A REF: 368 TOP: Nursing Process: Planning OBJ: Comprehension