Chapter 5: Patient Education to Promote Health
Test Bank
MULTIPLE CHOICE
1. The nurse is educating a 13-year-old boy newly diagnosed with diabetes and his parents about diet and glucose monitoring. Which domain of learning is represented when the patient expresses concern about feeling different from his peers?
a.
Cognitive
b.
Psychomotor
c.
Affective
d.
Learning style
ANS: C
The affective domain is characterized by conduct that expresses feelings, needs, beliefs, values, and opinions. The cognitive domain relates to basic factual knowledge. The psychomotor domain relates to kinesthetic knowledge, implemented in performance and skills requiring coordination. Learning style is not one of the three domains of learning.
DIF: Cognitive Level: Comprehension REF: p. 48 OBJ: 1
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
2. The nurse has taught a patients spouse to administer an injectable medication. After the spouse completed a return demonstration of the injection in the hospital, the nurse does not feel confident that this can be carried out independently at home and requests referral for a home health nurse. The nurse is using which phase of the nursing process?
a.
Assessment
b.
Implementation
c.
Planning
d.
Evaluation
ANS: D
The nurse has evaluated the injection technique of the patients spouse and determines additional instruction is needed. The nurse is not assessing the situation because she is not at the beginning of the process. The nurse is past implementation in the timeline of the process. The nurse has already planned and implemented interventions.
DIF: Cognitive Level: Application REF: p. 46 OBJ: 6
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
3. In preparing for health teaching with a patient who has an auditory learning style, which would be most appropriate?
a.
Pamphlets from a pharmaceutical company
b.
Models of equipment used in a procedure
c.
Verbal description of the steps of a procedure
d.
A workbook with space to record actions and results
ANS: C
Hearing the nurse present the information optimizes the patients perception of the data. Pamphlets from a pharmaceutical company or a workbook would be suitable for a patient who has a visual learning style. Models of equipment would be suitable for a patient with a psychomotor learning style.
DIF: Cognitive Level: Analysis REF: p. 49 | p. 53 OBJ: 3
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
4. Which is the most intangible portion of the learning process?
a.
Cognitive
b.
Affective
c.
Psychomotor
d.
Eminent
ANS: B
The affective domain concerns feelings, needs, beliefs, values, and opinions. The cognitive domain is the level at which basic knowledge is learned and stored; it is the thinking portion of the learning process. The psychomotor domain involves learning new procedures or skills; it is often referred to as the doing domain. Eminent domain in common law legal systems is the lawful power of the state to expropriate private property without the owners consent, either for its own use or on behalf of a third party.
DIF: Cognitive Level: Knowledge REF: p. 48 OBJ: 1
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
5. Which would positively affect readiness to learn?
a.
Fear and denial
b.
Willingness to attain an optimal level of health
c.
Poor cognitive and motor development
d.
Lack of trust and confidence in the staff
ANS: B
Readiness or the ability to engage in learning depends on motive, relevant preparatory learning, and physiologic maturation. In fear and denial, the patient is neither prepared nor willing to accept the limitations imposed by the disease process and learn to manage lifestyle changes. Poor cognitive and motor development handicap the patients willingness and ability to learn. Trust is essential in the process of patient education. The patient must have confidence in the staff in order to be receptive to teaching efforts.
DIF: Cognitive Level: Comprehension REF: p. 50 OBJ: 2
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
6. Which represents the psychomotor domain of learning?
a.
The patient draws up insulin in a syringe.
b.
The patient expresses a belief about medication use.
c.
The patient is able to verbalize foods that should be avoided.
d.
The patient relates past experience with smoking cessation.
ANS: A
The psychomotor domain involves the learning of a new procedure and is usually done by demonstration of the task. The patient expressing beliefs is an example of the affective domain. The patient verbalizing foods to be avoided is an example of the cognitive domain. The patient relating past experiences is an example of the affective domain.
DIF: Cognitive Level: Comprehension REF: pp. 48-49 OBJ: 1
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
7. Which is an example of ethnocentrism?
a.
A 5-year-old Native American child colors in a book about diabetes.
b.
A 14-year-old African American attends a support group to learn about disease management.
c.
A 36-year-old Asian prefers to take herbs instead of an oral medication.
d.
A 72-year-old Hispanic asks questions about potential adverse effects to a newly prescribed medication.
ANS: C
Ethnocentrism is the assumption that ones culture provides the right way, and taking herbs instead of the medication exemplifies this belief. A 5-year-old Native American child coloring in a book about diabetes is an example of age appropriate learning process. A 14-year-old African American attending a support group to learn about disease management is an example of developmental impact on learning. A 72-year-old Hispanic person asking questions about potential adverse effects to a newly prescribed medication is demonstrating learning readiness.
DIF: Cognitive Level: Comprehension REF: p. 53 OBJ: 4
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
8. What is the most important nursing consideration when teaching an older adult patient about a newly prescribed medication?
a.
Provide detailed information.
b.
Lengthen the time of each teaching session.
c.
Present information slowly.
d.
Limit discussion on the necessity of learning the information.
ANS: C
When teaching older adults, it is important to slow the pace of the presentation. Older adults process information more slowly because of limited short term memory. Detailed information may be too overwhelming. The length of sessions should be limited for the older adult patient. Adults need to understand why they must learn something before they undertake the effort to learn.
DIF: Cognitive Level: Comprehension REF: p. 52 OBJ: 6
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
9. The nurse caring for a Spanish speaking patient uses the assistance of an interpreter to help with preoperative teaching. While implementing the education, the nurse should:
a.
look directly at the patient.
b.
never use pantomime gestures.
c.
ask lengthy questions to provide clarity.
d.
ask a family member to assist with interpretation.
ANS: A
When using an interpreter, the nurse should look directly at the patient, not at the interpreter, while conversing. Sometimes supplementing questions with pictures and pantomime gestures may be helpful. The nurse should keep questions brief, asking them one at a time to give the interpreter an opportunity to rephrase the question and obtain a response. Whenever a third person enters into the communication cycle, lack of clarity and misinterpretation can occur.
DIF: Cognitive Level: Application REF: p. 53 OBJ: 2
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Psychological Integrity
10. A teaching plan has been developed by the nurse to educate the mother of a pre term infant on prescribed medications. Before initiating this teaching plan, the nurse should:
a.
recognize the individuals health beliefs.
b.
provide a formal learning setting.
c.
ensure that information is generalized.
d.
be sure that all care to the patient has been delivered.
ANS: A
Before initiating a teaching plan, the nurse must recognize the individuals health beliefs. Teaching does not require a formal setting. Because health teaching requires the integration of the patients beliefs, attitudes, values, opinions, and needs, an individualized teaching plan must be developed or a standardized teaching plan must be adapted to the individuals beliefs and needs. Some of the most effective teaching can be done while care is being delivered.
DIF: Cognitive Level: Application REF: p. 50 OBJ: 3
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Psychosocial Integrity
MULTIPLE RESPONSE
11. Which item(s) would be considered characteristic of the cognitive domain level of learning? (Select all that apply.)
a.
A patients opinion regarding wellness
b.
Basic mathematical formulas learned in grade school
c.
Incorporation of a persons previous experiences and perceptions
d.
Skill demonstration using a step by step approach
e.
Relationship between prior experiences and new concepts
ANS: B, C, E
Basic mathematical formulas learned previously, incorporating a persons previous experiences and perceptions, and a relationship between prior experiences and new concepts characterize the cognitive domain level of learning. A patients opinion regarding wellness is an example of the affective domain. Skill demonstration using a step by step approach is an example of the psychomotor domain.
DIF: Cognitive Level: Comprehension REF: p. 48 OBJ: 1
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
12. The nurse is preparing to instruct a patient and his wife on technique and importance of assessing pulse prior to taking heart medication. Which principle(s) of learning would be appropriate in this situation? (Select all that apply.)
a.
The learning environment
b.
The patients and wifes learning styles
c.
The objectives/goal statements listed on the patients care plan
d.
The patients financial ability to purchase the medication
e.
The patients understanding of the seriousness of his illness
ANS: A, B, C, E
Learning environment, learning style, listing clear objectives and goal statements, and understanding the seriousness of the situation are all principles of learning. Financial ability is not a principle of learning, but should be an important consideration and assessment when preparing for discharge of the patient and future compliance of the treatment regimen.
DIF: Cognitive Level: Application REF: p. 49 OBJ: 3
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
13. The nurse is writing a teaching plan for a 30-year-old patient who has AIDS. Which objective(s) is/are written in the correct format? (Select all that apply.)
a.
The patient will state adverse effects of the daily medications before discharge.
b.
The patient will correctly fill the daily medication pillbox with the correct medications in the appropriate time slots prior to discharge.
c.
The patient will adjust the medications accordingly.
d.
The patient will schedule an appointment with the infectious disease physician before discharge.
e.
The patient will have lab tests performed regularly.
ANS: A, B, D
Each of correct objectives noted are measurable and specific.
DIF: Cognitive Level: Analysis REF: p. 55 OBJ: 6
TOP: Nursing Process Step: Planning
MSC: NCLEX Client Needs Category: Physiological Integrity
14. Which action(s) by the nurse can foster patient responsibility for adhering to the therapeutic regimen? (Select all that apply.)
a.
Assessing the patients readiness to learn
b.
Determining the patients level of understanding of content
c.
Determining the patients education level and learning style
d.
Maintaining an aloof attitude toward presented content
e.
Documenting expected outcomes independently
ANS: A, B, C
The nurse should assess the patients readiness to learn when teaching the patient. The nurse should determine the patients level of understanding of the content and the patients education level and learning style when teaching the patient. The nurse should portray a positive attitude when teaching the patient. Goals should be mutually written with the patient.
DIF: Cognitive Level: Comprehension REF: p. 55 OBJ: 4
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
15. What should the nurse include during discharge in addition to verbal instructions? (Select all that apply.)
a.
Written instructions for the patients reference
b.
A phone number of the provider or hospital unit for follow up questions
c.
Written instructions for monitoring of parameters used to evaluate therapy
d.
Documentation in the nurses discharge notes of the nursing and collaborative problems that require continued monitoring and intervention
e.
Identification of the patients unreasonable expectations of therapy
ANS: A, B, C, D
Learning is an ongoing process. Verbal instructions should be followed up with instructions in writing. Patients should be given a contact number for future reference. Written instructions for monitoring of parameters used to evaluate therapy should be given to the patient. Documentation is an essential part of validating the patients understanding of the instructions provided. Although identifying the patients expectations will affect the outcome, they are not part of the discharge planning documentation.
DIF: Cognitive Level: Application REF: p. 49 OBJ: 5 | 6
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
16. Which action(s) would let the nurse know that the patient has mastered a psychomotor skill? (Select all that apply.)
a.
Describe the process verbally.
b.
Write a description of the process.
c.
Give a reciprocal demonstration of the process.
d.
Ask questions about the process.
e.
Demonstrate the process to another person while the nurse supervises.
f.
State whether the patient feels the process has been mastered.
ANS: C, D
Having the patient demonstrate the process to the nurse or to another person is the best way to ensure that he can perform the skill correctly. Having the patient describe the process or write a description of the process is not sufficient. Asking questions may reinforce learning but may also mask some deficiencies. Asking the patient whether he feels he has mastered the process is not sufficient.
DIF: Cognitive Level: Comprehension REF: p. 50 OBJ: 6
TOP: Nursing Process Step: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity
17. The nurse and patient are participating in cooperative goal setting regarding drug therapy. The nurse is aware that it is imperative to encourage the patient to perform which task(s)? (Select all that apply.)
a.
Contact the hospital for advice regarding discontinuation of medication.
b.
Keep records of essential data needed to evaluate prescribed therapy.
c.
See the health care provider regularly.
d.
Avoid community based agencies for assistance.
e.
Monitor parameters used to evaluate therapy.
ANS: B, C, E
An attitude of shared input into the goals and outcomes can encourage the patient into a therapeutic alliance. Therefore, the patient should be taught to help monitor the parameters used to evaluate therapy, keep records of essential data, and contact the health care provider for advice rather than alter or discontinue the medication entirely. The health care provider, not the hospital, should be contacted. In the event that the patient, family, or significant others do not understand all aspects of the continuing therapy prescribed, they may be referred to a community based agency for help in achieving long term health care requirements.
DIF: Cognitive Level: Application REF: p. 56 OBJ: 3
TOP: Nursing Process Step: Planning
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
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