Deck 15: Teaching Patients and Their Families

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.)

A) "Furosemide will increase urination, so you take it every morning."
B) "To help reduce the risk of pulmonary edema, your sodium intake must be monitored."
C) "Just remember, no sodium!"
D) "Pulmonary edema can form if you have too much sodium."
E) "You will need to make sure you eat less salt to help prevent fluid from collecting in your lungs."

Answer 1

B, C, D
"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:

A) schedule the patient for daily visits for medication administration.
B) provide privacy and minimize distractions and noise and try again.
C) teach the patient's family members to give the medications.
D) tell the patient it is not safe to take the medication independently.

Answer 2

B
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:

A) specific to the assessed needs, interdisciplinary, and evaluated for effectiveness.
B) specific to the assessed needs, cost-effective, and focused.
C) based on the patient's ability to learn, cost-effective, and timely.
D) specific to assessed needs, timely, and delivered by only one person for continuity.

Answer 3

A
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?

A) Use of professional communication when doing patient teaching and admitting patients to the unit
B) Coordination of human and material resources that are directly used in the delivery of care at the bedside
C) Evaluation of performance and skills of nursing staff members involved in direct patient care
D) Patient collaboration with health care team members involved with the development of focused, quality care

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?

A) "Adults will learn as the need develops and the learning will fulfill that need."
B) "Adults use their lives as the point of reference for all learning."
C) "Adults are visual learners and learn best by taking notes."
D) "Adults prefer to have a say in their learning."

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?

A) "Would you like for me to write down how to change this dressing or is it better for you to see a demonstration?"
B) "What is the highest grade you completed when you were in school?"
C) "Do you read and write?"
D) "I am going to give you a handout on how to perform your dressing change. Now don't worry if you do not read, I'll read it to you."

Question 7

Which patient characteristic must a nurse consider when planning teaching?

A) Literacy level
B) Discharge instructions
C) Good lighting
D) Pain medication

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?

A) Providing reasonable expectations from health care
B) Giving the patient a sense of control over illness
C) Preventing complications of chronic illness
D) Increasing patient satisfaction with care

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?

A) The patient's age
B) The patient's shortness of breath
C) The patient's reluctance to change
D) The chronic nature of the patient's illness

Question 10

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

A) Teaching the attitude of personal responsibility for health care
B) Showing a patient newly diagnosed with diabetes the similarities between an insulin syringe and a 3-cc syringe
C) Refraining from teaching two skills at one time
D) Showing the patient how the current hand washing procedure he is now learning is like the hand washing he has always done

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:

A) "Tell me the name of the surgery you are going to have."
B) "Do you understand what the doctor is going to do to you?"
C) "Would you be willing to take a test for me?"
D) "Tell me what you know about what is going to happen tomorrow."

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:

A) "Demonstrated understanding of checking blood glucose."
B) that the patient demonstrated the procedure properly and the time it took to complete the educational session.
C) the steps of the procedure the patient was taught.
D) that the nurse taught the patient how to check blood glucose.

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?

A) The nurse administers pain medication to the new diabetic patient before she starts her teaching just in case the patient is in pain.
B) Thirty minutes before the planned teaching, the nurse assesses the patient for comfort and ensures that the patient has eaten and had the opportunity to complete his bath routine.
C) The nurse decides that conversation works best during a meal, so she plans to teach while the patient eats.
D) The nurse asks the patient's spouse to leave before beginning the teaching.

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?

A) Curiosity about the new experience and equipment
B) Tendency for uneasiness about making mistakes
C) Ability to prioritize tasks
D) Understanding that he can promote his own healing

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?

A) It takes time to truly incorporate what is learned, so immediate evaluation is not as accurate.
B) The nurse will not have time to evaluate immediately after teaching.
C) The patient will be too tired to participate in the evaluation.
D) That would be too much information at one time.

Question 16

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

A) Curiosity about new experiences and equipment
B) Tendency toward embarrassment about making mistakes and being seen with the pump
C) Ability to prioritize diabetes management
D) Understanding that the patient can promote his or her own well-being

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:

A) patient already knows all she needs to know, so more education is not necessary.
B) patient doesn't know what she doesn't know, so the circle will continue.
C) patient's blood sugar is keeping her from thinking clearly, so it is too soon to try to teach her.
D) patient is in denial and that will need to be dealt with before she will accept the diagnosis and thus the education related to it.

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?

A) The baby will not be discharged until the parents have the training.
B) The nurses on the mother-baby division do a better job of teaching baby care.
C) The parents now have the motivation to learn because the baby has been born.
D) The parents have no choice at this point.

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?

A) Using multiple teaching strategies to accommodate a variety of learning styles
B) Increased effectiveness of teaching by involving the patient in the setting of objectives
C) Paying attention to the timing during the hospitalization and planned discharge date when providing needed information
D) Developing a strong nurse-patient relationship from the beginning of the contract with the patient

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?

A) Start with the details about her condition, why she has it, and the importance of her medication.
B) In the first session, teach the patient how and why to rotate her abdominal injection sites.
C) Start with information about avoiding rubbing or putting pressure on the site after an injection.
D) In the first session let the patient handle a syringe while the nurse prepares and administers the next injection with another syringe.