ch 7 Flashcards
The nurse is developing a plan of care for a newly diagnosed hypertensive patient who is being discharged on medications and given the Dietary Approaches to Stop Hypertension (DASH) diet to follow. What statement by the patient signals to the nurse that the patient is motivated to learn?
a. “I am sure the medications will help to bring down my blood pressure.”
b. “I can’t wait to try the new recipes, and I’m hopeful I will lose weight.”
c. “Do I really need to follow the diet and take medications?”
d. “I have my parents to blame for this. They both have high blood pressure.”
ANS: B
A patient who is motivated will see what the benefits of following the teaching will do for them and will most likely be able to manage their own care. The patient who believes medications are the only solution may not be motivated to follow the prescribed diet. Blaming the parents for their condition does not show accountability or motivation for change.
The nurse is assessing a patient’s readiness to be discharged and ability to manage care at home. What is the most appropriate question for the nurse to ask to determine the patient’s learning needs before planning teaching activities?
a. “What are your hobbies and occupation?”
b. “What do you need to know before you go home from the hospital?”
c. “Do you have any cultural or religious beliefs that you would like incorporated into your plan of care?”
d. “What were your grades and learning style when you were in school?”
ANS: B
Motivation and readiness to learn depend on what the patient values. The other questions are also important but do not address what information interests the patient most at present and will assist the patient in managing his own care.
Which acute medical event should the nurse identify as requiring self-management when planning care for a patient?
a. Prenatal care
b. Depression
c. Diabetes
d. Femur fracture
ANS: D
A femur fracture is considered an acute medical event. Pregnancy is an expected and normal life event/condition. Depression and diabetes are considered disease states.
An 8-year-old child is newly diagnosed with asthma. Which nursing intervention best promotes self-efficacy for the parents to help the child follow the prescribed treatments?
a. Ask parents to list all possible triggers for asthma.
b. Request a spacer for the metered dose inhaler.
c. Suggest the parents enforce a strict exercise regimen.
d. Recommend replacing carpeting in the home with wood flooring.
ANS: B
The most realistic and helpful interventions will promote self-management. A spacer is helpful for children learning to use inhaled medication. Listing all the triggers for asthma may be overwhelming. The parents should focus on the individual triggers for the child. Enforcing a strict exercise regimen is restrictive and will not promote self-management. Environmental changes must be feasible and cost-effective. Replacing carpeting is optimal but may not be affordable.
When developing a plan of care to promote self-management, which patient is least likely to be affected by depression?
a. A 55-year-old employed female
b. A 35-year-old Hispanic male
c. A 40 year old with 5th grade education
d. A 42 year old with private insurance
ANS: D
Individuals most affected by depression are midlife adults ages 45–64, women, minorities, individuals without a high school education, and individuals without health insurance. Treatment for depression includes the use of medication and psychological therapy. Additionally, patients must learn to manage moods including suicidal thoughts, recognize triggers and relapse, and set goals for behavioral management of their disease.
The nurse is assisting an older adult patient, diagnosed with type 2 diabetes, with self-injection of insulin. What is the most appropriate intervention for this patient at discharge?
a. Arrange daily home visits for injections.
b. Request an insulin pen prescription.
c. Recommend upper arm injection sites.
d. Supply patient with 100 unit insulin syringes.
ANS: B
An insulin pen will be the most effective method for injection for an older adult secondary to reduced eyesight and dexterity compared to using syringes. A 100 unit syringe has very small calibration marks and numbers, making it more difficult for older adults to see the appropriate doses. Daily home visits are not usually paid for by insurance. Most patients must learn to administer medications themselves. The upper arm subcutaneous site is too difficult for self-administration and may not be feasible for an older adult.
The nurse is developing a teaching plan for a patient diagnosed with congestive heart failure. Which are the most appropriate teaching points to include that will assist in self-management of the disease? (Select all that apply.)
a. Side effects of medications
b. Activity restrictions
c. Daily weights
d. Increased sodium intake
e. Blood pressure monitoring
ANS: A, B, C, E
Congestive heart failure (CHF) is one of the most common complications of coronary artery disease in which the heart fails to pump efficiently enough to meet the metabolic demands of the body. Fluid overload is a common complication. As with most chronic conditions, patients with CHF benefit from education about their disease and self-managing diet, physical activity, weight, and medication adherence. Fluid retention occurs with increased sodium intake; therefore sodium is usually restricted in a congestive heart failure diet.
