Question 1

The nurse recognizes that, to be an effective teacher, communication must be clear. In an educational session for a patient newly diagnosed with congestive heart failure, which statements by the nurse would demonstrate barriers to teaching? (Select all that apply.)

Accepted Answer

"To help reduce the risk of pulmonary edema, your sodium intake must be monitored" and "Pulmonary edema can form if you have too much sodium" use medical jargon and little explanation. "Just remember, no sodium!" is a directive. Clear, precise communication skills are fundamental to teaching. The nurse must adjust his or her explanations such that patient education is delivered clearly, accurately, and in understandable terms. Examples of this include explaining the indication and administration of medication and the reason for diet changes.

Question 2

A home health nurse is teaching a patient about a new medication he will be starting in the morning. The patient lives with his son's family, including two spirited children less than 6 years old. The patient replies, "I just can't learn new information like I used to." The nurse will plan to:

Accepted Answer

The process of teaching new information requires the nurse to prepare the learning environment. Providing as much privacy as possible and minimizing distractions and noise can help ensure that the patient is comfortable discussing the treatment plan. Scheduling daily visits to administer medications defeats the purpose of teaching. Teaching the family to give the medication is unnecessary because the patient is able to care for himself. Telling the patient it is unsafe to take his medication is a false statement.

Question 3

Which fact would you select to describe the mandate by The Joint Commission (TJC) regarding educating patients? The training and education must be:

Accepted Answer

TJC standards state, "The patient receives education and training specific to the patient's assessed needs, abilities, learning preferences, and readiness to learn as appropriate to the care and services provided by the hospital." TJC requires patient education to be interdisciplinary, not delivered by only one person. Furthermore, health care facilities must audit patient education to ensure consistency of teaching and that the health care team members are evaluating the effectiveness of the patient education they give. Cost-effectiveness and timeliness are not requirements of TJC.

Question 4

Persons seeking health care have increased autonomy and insist on taking an active role in their medical treatment decisions. What aspect of a nurse's role does this fact affect?

Accepted Answer

More people are seeking information before seeing physicians and researching options that physicians suggest before accepting and implementing these suggestions. Extensive information is available about illnesses and treatments, and with the advent of the Internet, this information is even more readily available. Including the patient in developing a health-promotion plan of care provides the best opportunity for effective teaching and long-term learning.

Question 5

Adult patients are adult learners. Knowing this, the nurse understands the assumptions about adult learners that will help the nurse plan and provide the appropriate education. Which statement provides proof that more instruction about adult learners is needed?

Accepted Answer

Adults may represent different learning styles such as being a visual learner, auditory learner, or kinesthetic learner, so it is not a correct assumption that adults learn from taking notes. Adults will learn as the need arises and believe that the learning will fulfill the need. Adults use their lives as the point of reference for all learning and prefer to be self-directed in learning or at the very least have a say in it.

Question 6

The nurse is assessing a patient who needs teaching about how to care for her wound at home. The nurse knows to be sensitive about asking questions that cause embarrassment. Which question is stated in the best manner?

Accepted Answer

"Would you like me to write down how to change this dressing or is it better for you to see a demonstration?" is correct. In many cases, institutions provide written instructions to patients in the hope that they will use them as references. Studies have shown that a lower-than-expected level of literacy may exist in patient populations seeking health care in the United States, as reported in a study by Fisher (1999). The implication for nursing of this and other studies is that the RN should recognize that patients may not have the comprehension of material needed to manage their own care. All the other answer choices are insensitive and condescending.

Question 7

Which patient characteristic must a nurse consider when planning teaching?

Accepted Answer

The correct answer is their literacy level. In many cases, institutions provide written instructions to patients in the hope that they will use them as references. Studies have shown that a lower-than-expected level of literacy may exist in patient populations seeking health care with the United States, as reported in a study by Fisher (1999). The implication for nursing of this and other studies is that the RN should recognize that patients may not have the comprehension of material needed to manage their own care. Discharge instructions, good lighting, and pain medications are not characteristics.

Question 8

An 85-year-old patient with chronic health problems is being considered for placement in a long-term care facility after discharge from the hospital. What purpose does the cost-effective nursing strategy of patient teaching help to achieve?

Accepted Answer

As of late, the Centers for Medicare and Medicaid Services (CMS) has stated that reimbursement to hospitals will be limited for patients readmitted for the same conditions within a certain time period after admissions. Education is a critical part of transitional care, and nurses are key to providing adequate patient and family or caregiver education.

Question 9

A 78-year-old patient has shortness of breath on very slight exertion. The physician has written an order for her to be taught about a 2-gram sodium diet. Based on these data, which factor would be likely to interfere with diet teaching?

Accepted Answer

It is important to assess the patient's readiness to learn. In reality the patient experiences little benefit from patient teaching often because of the stress from the medical problem as well as the environment, and the addition of a learning experience would add to the stress. The patient may be motivated to learn but not yet ready to learn. In this scenario, the patient's shortness of breath is the medical problem interfering with the patient's readiness to learn. The patient's age and the chronic nature of the patient's illness have nothing to do with readiness to learn. The patient's reluctance to learn is an opinion.

Question 10

Which example demonstrates the principle that all adults learn best from and in relation to their experiences?

Accepted Answer

Showing the patient how the current hand washing procedure he is now learning is like the hand washing he has always done is correct. Adults need new information to be related to something they already know. This creates a link so that the information can be readily recalled. For example, compliance with fluid restriction may be easier if you, as a nurse, create an analogy to a familiar frame of reference. Teaching personal responsibility has nothing to do with teaching principles. Showing the patient the difference between syringes may be of no significance if the patient has no information about syringes. Teaching one topic at a time facilitates learning but has no relation to learning best from experience.

Question 11

An 18-year-old patient is scheduled for heart surgery tomorrow. To assess this patient's level of knowledge, the nurse would say:

Accepted Answer

"Tell me what you know about what is going to happen tomorrow" is correct. Some patients are experts in regard to their ailment. To avoid or correct errors, determine the accuracy of information the patient provides about the condition. Not only are many reliable resources of medical information available but many unreliable, untested sources are as well. All other answer options are closed-ended questions and call for limited responses.

Question 12

The nurse has just taught an adult patient with a new diagnosis of diabetes mellitus how to check blood glucose. The nurse should document:

Accepted Answer

When documenting, the nurse can record that the patient was able to answer questions and demonstrate procedures correctly at the time of observation. The nurse also must record how much time it took to complete the educational sessions. To state that the patient demonstrated understanding as a result of one observation would be incorrect because many factors are present at the time of the observation that may influence the patient's ability to understand. Documenting the steps of the procedure and noting that the nurse taught the procedure do nothing to communicate that learning took place.

Question 13

The nurse recognizes that, for learning to be effective, the patient must first have his or her basic and most immediate needs met. Which statement best indicates that the nurse clearly understands this principle?

Accepted Answer

Assessing the patient for comfort 30 minutes before the planned teaching and ensuring that the patient has eaten and had the opportunity to complete his bath routine validates that learning is best facilitated if the learner has had immediate needs met. Administering pain medication to the newly diabetic patient before teaching is incorrect because the nurse should delay (if advisable) medication that may cause distracting side effects. Deciding to teach while the patient eats is incorrect because eating a meal provides an unnecessary distraction. Making the spouse leave may be counterintuitive to the patient's learning because family may reinforce the patient's education, advocate for the patient, and seek clarification of the information taught.

Question 14

Which item would most likely be a barrier to learning for a patient who must begin to care for a large open wound at home?

Accepted Answer

Patients' values influence the willingness to accept the need to change and therefore the need to learn. Patients are often uneasy if they do not believe they can understand and perform the task of taking care of a wound. Patients may not live in the best environment and may feel embarrassed about their particular situation. When teaching patients about the care they require, it helps to reduce barriers to learning by considering their home situation, living arrangements, and usual activities. Curiosity about new experiences and new equipment, the ability to prioritize tasks, and understanding that the patient can promote his own healing are not barriers to learning.

Question 15

Assessment of patient learning is a required element of patient education. Shorter hospital stays make this step challenging, and we tend to evaluate learning immediately after teaching. What conclusion can be drawn from this?

Accepted Answer

For learning to have occurred, the patient must incorporate the learned behavior into his or her life. In reality, an assessment done a day or two later may be a better indicator of the retention and incorporation of new information or behavior changes. For this reason, the other answer items are incorrect.

Question 16

Which item would most likely be a barrier to learning for a patient who must begin to wear an insulin pump?

Accepted Answer

Patients are often embarrassed if they do not believe they can understand and perform the tasks of living with diabetes. When teaching patients about their illness and care required, it helps to consider their home situation, living arrangements, and usual activities. Myths and misconceptions about health, illness, and health care are often perpetuated by the experiences of the individual.

Question 17

A patient has been newly diagnosed with type 2 diabetes. The teaching begins in the hospital with an interdisciplinary approach and continues with outpatient classes. However, the patient continues to state, "I know I do not need to spend my time doing all this because I will be fine once I get out from under all this stress." The barrier to learning that the nurse recognizes and must deal with is the:

Accepted Answer

The patient is in denial of her new diagnosis. The RN must use rational thought and convey that logic in the presentation of the facts. The patient must decide that the change is necessary. The RN must understand the patient's decision and show acceptance of it. The patient's already knowing all she needs to know so more education is unnecessary is incorrect based on the patient's statement. The patient's not knowing what she does not know so the circle will continue is irrelevant. That the patient's blood sugar is keeping her from thinking clearly is a presumption.

Question 18

The nurse recognizes that new parents may be ready to learn about their newborn after the birth. What understanding leads the nurse to this conclusion?

Accepted Answer

The motivation to learn often results from a life-changing event, such as childbirth or illness. The RN who recognizes the significance of the event can seize the opportunity to explore the patient's motivation to learn. The baby's not being discharged until the parents have training is untrue. That the nurses on the mother-baby division do a better job of teaching baby care is irrelevant. That the parents have no choice at this point is an opinion.

Question 19

A nurse discusses home arrangements and safety factors related to emptying and changing the patient's new colostomy bag. The patient has strong concerns about visibility of any stored colostomy supplies. Which teaching-learning principle does this example demonstrate?

Accepted Answer

An informed patient is better able to manage health care, is more compliant with the plan of care, and as a result, experiences more positive outcomes. Active learning facilitates the learning process. A patient who is educated regarding his or her condition and plan of care is less likely to refuse the plan of care in lieu of his or her own plan, less likely to complain more when the plan is revised, and less likely to demand explanation for each intervention. The other answer choices are also teaching-learning principles, but they are not reflected in the scenario.

Question 20

A 63-year-old patient is uncertain whether she can self-inject her medication. Which would be most likely to be an effective strategy at this time?

Accepted Answer

The nurse should consider the learning style of the individual patient. For example, some people learn best by practice or hands-on experience. The nurse should also have appropriate teaching aids. In the first session, giving the patient a syringe to handle while the nurse administers the next injection helps the patient's readiness to learn. Starting a new teaching session with details, teaching the patient how and why to rotate injection sites, and sharing information about care of the injection site after the medication administration may overwhelm the patient and create a barrier to learning.

Quiz 15: Teaching Patients and Their Families