Question 1

After the nurse provides diet instructions for a patient with diabetes,the patient can restate the information but fails to make the recommended diet changes. How would the nurse best evaluate the patient's situation?

Accepted Answer

Although the patient behavior has not changed,the patient's ability to restate the information indicates that learning has occurred,and the patient is choosing at this time not to change the diet. The patient may be in the contemplation or preparation stage in the transtheoretical model. The nurse should reinforce the need for change and continue to provide information and assistance with planning for change.

Question 2

A patient with diabetic neuropathy requires teaching about foot care. Which learning goal should the nurse include in the teaching plan?

Accepted Answer

Learning goals should state clear,measurable outcomes of the learning process. Demonstrating technique for trimming toenails and providing instructions on foot care are actions that the nurse will take rather than behaviors that indicate that patient learning has occurred. A learning goal that states that the patient will understand the rationale for proper foot care is too vague and nonspecific to measure whether learning has occurred.

Question 3

An older Asian patient,who is seen at the health clinic,is diagnosed with protein malnutrition. What priority action should the nurse include in the teaching plan?

Accepted Answer

Assessment is the first step in assisting a patient with health changes. The other answers may be appropriate for the patient,but the nurse will not be able to determine this until the assessment of the patient is complete.

Question 4

The nurse plans to teach a patient and the caregiver how to manage high blood pressure (BP). Which action should the nurse take first?

Accepted Answer

Because adults learn best when given information that they view as being needed immediately,asking the caregiver and patient to prioritize learning needs is likely to be the most successful approach to home management of health problems. The other actions may also be appropriate,depending on what learning needs the caregiver and patient have,but the initial action should be to assess what the learners feel is important.

Question 5

A patient who is morbidly obese states,"I've recently made some changes in my life. I've decreased my fat intake,and I've stopped smoking." Which statement,if made by the nurse,is the best initial response?

Accepted Answer

Positive reinforcement of the learner's achievements is critical in making lifestyle changes. This patient is in the action stage of the Transtheoretical Model when reinforcement of the changes being made is an important nursing intervention. The other responses are also appropriate but are not the best initial response.

Question 6

A patient states,"I told my husband I wouldn't buy as much prepared food snacks,so I will go the grocery store to buy fresh fruit,vegetables,and whole grains." When using the Transtheoretical Model of Health Behavior Change,the nurse identifies that this patient is in which stage of change?

Accepted Answer

The patient's statement indicating that the plan for change is being shared with someone else indicates that the preparation stage has been achieved. Contemplation of a change would be indicated by a statement like "I know I should exercise." Maintenance of a change occurs when the patient practices the behavior regularly. Termination would be indicated when the change is a permanent part of the lifestyle.

Question 7

A middle-aged patient who has diabetes tells the nurse,"I want to know how to give my own insulin so I don't have to bother my wife all the time." What is the priority action of the nurse?

Accepted Answer

Adult education is most effective when focused on information that the patient thinks is needed right now. All of the indicated information will need to be included when planning teaching for this patient,but the teaching will be most effective if the nurse starts with the patient's stated priority topic.

Question 8

The nurse and the patient who is diagnosed with hypertension develop this goal: "The patient will select a 2-gram sodium diet from the hospital menu for the next 3 days." Which evaluation method will be best for the nurse to use when determining whether teaching was effective?

Accepted Answer

All of the answers address the patient's sodium intake,but the desired patient behaviors in the learning objective are most clearly addressed by evaluating the sodium content of the patient's menu choices.

Question 9

A patient with newly diagnosed colon cancer has a nursing diagnosis of deficient knowledge about colon cancer. The nurse should initially focus on which learning goal for this patient?

Accepted Answer

Adults learn best when given information that can be used immediately. The first action the patient will need to take after a cancer diagnosis is to explore and choose a treatment option. The other goals may be appropriate as treatment progresses.

Question 10

While admitting a patient to the medical unit,the nurse determines that the patient has a hearing impairment. How should the nurse use this information to plan teaching and learning strategies?

Accepted Answer

The information that the patient has a hearing impairment indicates that the nurse should use written and verbal materials in teaching along with other strategies. The patient does not indicate a lack of motivation or an inability to understand new information. The patient's decreased hearing does not necessarily imply that the family must be included in the teaching process.

Question 11

A patient who was admitted to the hospital with hyperglycemia and newly diagnosed diabetes mellitus is scheduled for discharge the second day after admission. When implementing patient teaching,what is the priority action for the nurse?

Accepted Answer

When time is limited,the nurse should focus on the priorities of teaching. In this situation,the patient should know how to test blood glucose and administer medications to control glucose levels. The patient will need further teaching about the role of diet,exercise,various medications,and the many potential complications of diabetes,but these topics can be addressed through planning for appropriate referrals.

Question 12

The nurse is planning a teaching session with a patient newly diagnosed with migraine headaches. To assess a patient's readiness to learn,which question should the nurse ask first?

Accepted Answer

Motivation and readiness to learn depend on what the patient values and perceives as important. The other questions are also important in developing the teaching plan,but do not address what information most interests the patient at present.

Question 13

The nurse prepares written handouts to be used as part of the standardized teaching plan for patients who have been recently diagnosed with diabetes. What statement would be most appropriate to include in the handouts?

Accepted Answer

The reading level for patient teaching materials should be at the fifth grade level. The other responses have words with three or more syllables,use many medical terms,or are too long.

Question 14

A patient needs to learn how to instill eye drops. Which teaching strategy,if implemented by the nurse,would be most effective?

Accepted Answer

Demonstration with return demonstration (show back)is best used to teach a patient how to learn to perform a skill. Lecture-discussion,peer teaching,and printed materials are more useful for other learning needs.

Question 15

The nurse considers a nursing diagnosis of ineffective health maintenance related to low motivation for a patient with diabetes. Which finding would the nurse most likely use to support this nursing diagnosis?

Accepted Answer

The patient's motivation to follow a diabetic diet will be decreased if the patient believes that dietary changes do not affect symptoms. The other responses do not indicate that the ineffective health maintenance is caused by lack of motivation.

Question 16

A postoperative patient and caregiver need discharge teaching. Which actions included in the teaching plan can the nurse delegate to unlicensed assistive personnel (UAP)?

Accepted Answer

Providing a pamphlet to a patient to reinforce previously taught material does not require nursing judgment and can safely be delegated to UAP. Demonstration of how to take a temperature accurately,determining the best time for teaching,and evaluation of the success of patient teaching all require judgment and critical thinking and should be done by the registered nurse.

Question 17

A patient who smokes a pack of cigarettes per day tells the nurse,"I enjoy smoking and have no plans to quit." Which nursing diagnosis is most appropriate?

Accepted Answer

The patient's statement indicates that he or she is not considering smoking cessation. Ineffective health maintenance is defined as the inability to identify,manage,or seek out help to maintain health.

Question 18

The hospital nurse implements a teaching plan to assist an older patient who lives alone to independently accomplish daily activities. How would the nurse best evaluate the patient's long-term response to the teaching?

Accepted Answer

A home health referral would allow for the assessment of the patient's long-term response after discharge. The other actions allow evaluation of the patient's short-term response to teaching.

Question 19

A patient is diagnosed with heart failure after being admitted to the hospital for shortness of breath and fatigue. Which teaching strategy,if implemented by the nurse,is most likely to be effective?

Accepted Answer

Principles of adult education indicate that readiness and motivation to learn are high when facing new tasks (e.g.,learning about the sodium amounts in various food items)and when demonstration and practice of skills are available. Although a home health referral may be needed for this patient,teaching should not be postponed until discharge. Adult learners are independent. The nurse should act as a facilitator for learning,rather than as the expert. Adults learn best when the topic is of immediate usefulness. Long-term goals may not be very motivating.

Question 20

A family caregiver tells the home health nurse,"I feel like I can never get away to do anything for myself." Which action is best for the nurse to take?

Accepted Answer

Respite services allow family caregivers to have time away from their caregiving responsibilities. The other actions may also be helpful,but the caregiver's statement clearly indicates the need for some time away.

Quiz 4: Patient and Caregiver Teaching