chapter 25 : patient education

Question 1

A nurse is teaching a patient’s family member about permanent tube feedings at home. Which purpose of patient education is the nurse meeting?

a. Health promotion
b. Illness prevention
c. Restoration of health
d. Coping with impaired functions

Answer 1

d. Coping with impaired functions

Teach family members to help the patient with health care management (e.g., giving medications through gastric tubes and doing passive range-of-motion exercises) when coping with impaired functions. Not all patients fully recover from illness or injury. Many have to learn to cope with permanent health alterations. Health promotion involves healthy people staying healthy, while illness prevention is prevention of diseases. Restoration of health occurs if the teaching is about a temporary tube feeding, not a permanent tube feeding.

Question 2

A nurse is teaching a group of healthy adults about the benefits of flu immunizations. Which type of patient education is the nurse providing?

a. Health analogies
b. Restoration of health
c. Coping with impaired functions
d. Promotion of health and illness prevention

Answer 2

d. Promotion of health and illness prevention

As a nurse, you are a visible, competent resource for patients who want to improve their physical and psychological well-being. In the school, home, clinic, or workplace, you promote health and prevent illness by providing information and skills that enable patients to assume healthier behaviors. Injured and ill patients need information and skills to help them regain or maintain their level of health; this is referred to as restoration of health. Not all patients fully recover from illness or injury. Many have to learn to cope with permanent health alterations; this is known as coping with impaired functions. Analogies supplement verbal instruction with familiar images that make complex information more real and understandable. For example, when explaining arterial blood pressure, use an analogy of the flow of water through a hose.

Question 3

A nurse’s goal is to provide teaching for restoration of health. Which situation indicates the nurse is meeting this goal?

a. Teaching a family member to provide passive range of motion for a stroke patient
b. Teaching a woman who recently had a hysterectomy about possible adoption
c. Teaching expectant parents about changes in childbearing women
d. Teaching a teenager with a broken leg how to use crutches

Answer 3

d. Teaching a teenager with a broken leg how to use crutches

Injured or ill patients need information and skills to help them regain or maintain their levels of health. An example includes teaching a teenager with a broken leg how to use crutches. Not all patients fully recover from illness or injury. Many have to learn to cope with permanent health alterations. New knowledge and skills are often necessary for patients and/or family members to continue activities of daily living. Teaching family members to help the patient with health care management (e.g., giving medications through gastric tubes, doing passive range-of-motion exercises) is an example of coping with long-term impaired functions. For a woman with a hysterectomy, teaching about adoption is not restoration of health; restoration of health in this situation would involve activity restrictions and incision care if needed. In childbearing classes, you teach expectant parents about physical and psychological changes in the woman and about fetal development; this is part of health maintenance.

Question 4

A nurse attends a seminar on teaching/learning. Which statement indicates the nurse has a good understanding of teaching/learning?

a. Teaching and learning can be separated.
b. Learning is an interactive process that promotes teaching.
c. Teaching is most effective when it responds to the learner’s needs.
d. Learning consists of a conscious, deliberate set of actions designed to help the teacher.

Answer 4

c. Teaching is most effective when it responds to the learner’s needs.

Teaching is most effective when it responds to the learner’s needs. It is impossible to separate teaching from learning. Teaching is an interactive process that promotes learning. Teaching consists of a conscious, deliberate set of actions that help individuals gain new knowledge, change attitudes, adopt new behaviors, or perform new skills.

Question 5

A nurse is determining if teaching is effective. Which finding best indicates learning has occurred?

a. A nurse presents information about diabetes.
b. A patient demonstrates how to inject insulin.
c. A family member listens to a lecture on diabetes.
d. A primary care provider hands a diabetes pamphlet to the patient.

Answer 5

b. A patient demonstrates how to inject insulin.

Learning is the purposeful acquisition of new knowledge, attitudes, behaviors, and skills: patient demonstrates how to inject insulin. A new mother exhibits learning when she demonstrates how to bathe her newborn. A nurse presenting information and a primary care provider handing a pamphlet to a patient are examples of teaching. A family member listening to a lecture does not indicate that learning occurred; a change in knowledge, attitudes, behaviors, and/or skills must be evident.

Question 6

A nurse is teaching a patient about the Speak Up Initiatives. Which information should the nurse include in the teaching session?

a. If you still do not understand, ask again.
b. Ask a nurse to be your advocate or supporter.
c. The nurse is the center of the health care team.
d. Inappropriate medical tests are the most common mistakes.

Answer 6

a. If you still do not understand, ask again.

If you still do not understand, ask again is part of the S portion of the Speak Up Initiatives. Speak up if you have questions or concerns. You (the patient) are the center of the health care team, not the nurse. Ask a trusted family member or friend to be your advocate (advisor or supporter), not a nurse. Medication errors are the most common health care mistakes, not inappropriate medical tests.

Question 7

A nurse teaches a patient with heart failure healthy food choices. The patient states that eating yogurt is better than eating cake. Which element represents feedback?

a. The nurse
b. The patient
c. The nurse teaching about healthy food choices
d. The patient stating that eating yogurt is better than eating cake

Answer 7

d. The patient stating that eating yogurt is better than eating cake

Feedback needs to demonstrate the success of the learner in achieving objectives (i.e., the learner verbalizes information or provides a return demonstration of skills learned). The nurse is the sender. The patient (learner) is the receiver. The teaching is the message.

Question 8

While preparing a teaching plan, the nurse describes what the learner will be able to accomplish after the teaching session about healthy eating. Which action is the nurse completing?

a. Developing learning objectives
b. Providing positive reinforcement
c. Presenting facts and knowledge
d. Implementing interpersonal communication

Answer 8

a. Developing learning objectives

Learning objectives describe what the learner will exhibit as a result of successful instruction. Positive reinforcement follows feedback and reinforces good behavior and promotes continued compliance. Interpersonal communication is necessary for the teaching/learning process but describing what the learner will be able to do after successful instruction constitutes learning objectives. Facts and knowledge will be presented in the teaching session.

Question 9

After a teaching session with a nurse, a patient learns that a normal adult heartbeat is 60 to 100 beats/min. In which domain did learning take place?

a. Kinesthetic
b. Cognitive
c. Affective
d. Psychomotor

Answer 9

b. Cognitive

The patient acquired knowledge, which is cognitive. Cognitive learning includes all intellectual skills and requires thinking. In the hierarchy of cognitive behaviors, the simplest behavior is acquiring knowledge. Kinesthetic is a type of learner who learns best with a hands-on approach. Affective learning deals with expression of feelings and development of attitudes, beliefs, or values. Psychomotor learning involves acquiring skills that require integration of mental and physical activities, such as the ability to walk or use an eating utensil.

Question 10

A nurse is trying to help a patient begin to accept the chronic nature of diabetes. Which teaching technique should the nurse use to enhance learning?

a. Lecture
b. Role play
c. Demonstration
d. Question and answer sessions

Answer 10

b. Role play

Affective learning deals with expression of feelings and acceptance of attitudes, beliefs, or values. Roleplay and discussion (one-on-one and group) are effective teaching methods for the affective domain. Lecture and question and answer sessions are effective teaching methods for the cognitive domain. Demonstration is an effective teaching method for the psychomotor domain.

Question 11

A nurse is describing a patient’s perceived ability to successfully complete a task. Which term should the nurse use to describe this attribute?

a. Self-efficacy
b. Motivation
c. Attentional set
d. Active participation

Answer 11

a. Self-efficacy

Self-efficacy, a concept included in social learning theory, refers to a person’s perceived ability to successfully complete a task. Motivation is a force that acts on or within a person (e.g., an idea, an emotion, a physical need) to cause the person to behave in a particular way. An attentional set is the mental state that allows the learner to focus on and comprehend a learning activity. Learning occurs when the patient is actively involved in the educational session.

Question 12

A toddler is going to have surgery on the right ear. Which teaching method is most appropriate for this developmental stage?

a. Encourage independent learning.
b. Develop a problem-solving scenario.
c. Wrap a bandage around a stuffed animal’s ear.
d. Use discussion throughout the teaching session.

Answer 12

c. Wrap a bandage around a stuffed animal’s ear.

Use play to teach a procedure or activity (e.g., handling examination equipment, applying a bandage to a doll) to toddlers. Encouraging independent learning is for the young or middle adult. Use of discussion is for older children, adolescents, and adults, not for toddlers. Use problem solving to help adolescents make choices. Problem solving is too advanced for a toddler.

Question 13

A nurse is preparing to teach a patient about smoking cessation. Which factors should the nurse assess to determine a patient’s ability to learn?

a. Sociocultural background and motivation
b. Stage of grieving and overall physical health
c. Developmental capabilities and physical capabilities
d. Psychosocial adaptation to illness and active participation

Answer 13

c. Developmental capabilities and physical capabilities

Developmental and physical capabilities reflect one’s ability to learn. Sociocultural background and motivation are factors determining readiness to learn. Psychosocial adaptation to illness and active participation are factors in readiness to learn. Readiness to learn is related to the stage of grieving. Overall physical health does reflect ability to learn; however, because it is paired here with stage of grieving (which is a readiness to learn factor), this is incorrect.

Question 14

A nurse is teaching a patient about heart failure. Which environment will the nurse use?

a. A darkened, quiet room
b. A well-lit, ventilated room
c. A private room at 85F temperature
d. A group room for 10 to 12 patients with heart failure

Answer 14

b. A well-lit, ventilated room

The ideal environment for learning is a room that is well lit and has good ventilation, appropriate furniture, and a comfortable temperature. Although a quiet room is appropriate, a darkened room interferes with the patient’s ability to watch your actions, especially when demonstrating a skill or using visual aids such as posters or pamphlets. A room that is cold, hot, or stuffy makes the patient too uncomfortable to focus on the information being presented. Learning in a group of six or less is more effective and avoids distracting behaviors.

Question 15

Which assessment finding will best indicate that the patient is ready to learn?

a. The ability to grasp and apply the elastic bandage.
b. Expresses the motivation to walk with an assistive device.
c. Demonstrates sufficient coordination to handle a syringe safely.
d. Has sufficient upper body strength to move from a bed to a wheelchair.

Answer 15

b. Expresses the motivation to walk with an assistive device.

Motivation underlies a person’s desire or willingness to learn. Motivation is a force that acts on or within a person (e.g., an idea, emotion, or a physical need) to cause the person to behave in a particular way. For example, a patient with a below-the-knee amputation is motivated to learn how to walk with assistive devices, indicating a readiness to learn. Do not confuse readiness to learn with ability to learn. All the other answers are examples of ability to learn because this often depends on the patient’s level of physical development and overall physical health. To learn psychomotor skills, a patient needs to possess a certain level of strength, coordination, and sensory acuity. For example, it is useless to teach a patient to transfer from a bed to a wheelchair if he or she has insufficient upper body strength. An older patient with poor eyesight or an inability to grasp objects tightly cannot learn to apply an elastic bandage or handle a syringe.

Question 16

A nurse is teaching a patient with a risk for hypertension how to take a blood pressure. Which action by the nurse is the priority to assist learning?

a. Assess laboratory results for high cholesterol and other data.
b. Identify that teaching is the same as the nursing process.
c. Perform nursing care therapies to address hypertension.
d. Focus on a patient’s learning needs and objectives.

Answer 16

d. Focus on a patient’s learning needs and objectives

The teaching process focuses on the patient’s learning needs, motivation, and ability to learn; writing learning objectives and goals is also included. Nursing and teaching processes are not the same. Assessing laboratory results for high cholesterol and performing nursing care therapies are all components of the nursing process, not the teaching process.

Question 17

A patient diagnosed with both heart failure and kidney failure requires teaching about dialysis. Which nursing assessment is most appropriate for determining this patient’s learning needs?

a. Total health care needs
b. Health literacy
c. Sources of patient data
d. Goals of patient care

Answer 17

b. Health literacy

Because health literacy influences how you deliver teaching strategies, it is critical for you to assess a patient’s health literacy before providing instruction. The nursing process requires assessment of all sources of data to determine a patient’s total health care needs. Evaluation of the teaching process involves determining outcomes of the teaching/learning process and the achievement of learning objectives; assessing the goals of patient care is the evaluation component of the nursing process.

Question 18

A nurse is teaching a patient about hypertension. In which order from first to last will the nurse implement the steps of the teaching process? 1.Set mutual goals for knowledge of hypertension. 2.Teach what the patient wants to know about hypertension. 3.Assess what the patient already knows about hypertension. 4.Evaluate the outcomes of patient education for hypertension.

a. 1, 3, 2, 4
b. 2, 3, 1, 4
c. 3, 1, 2, 4
d. 3, 2, 1, 4

Answer 18

c. 3, 1, 2, 4

Assessment is the first step of any teaching session, then diagnosing, planning (goals), implementation, and evaluation.

Question 19

A nurse is preparing to teach the patient about cane use after a stroke. Which learning objective/outcome is most appropriate for the nurse to include in the teaching plan?

a. The patient will walk to the bathroom and back to bed using a cane.
b. The patient will understand the importance of using a cane.
c. The patient will know the correct use of a cane.
d. The patient will learn how to use a cane.

Answer 19

a. The patient will walk to the bathroom and back to bed using a cane.

Outcomes often describe a behavior that identifies the patient’s ability to do something on completion of teaching such as will empty a colostomy bag or will administer an injection. Understand, learn, and know are not behaviors that can be observed or evaluated.

Question 20

Which learning objective/outcome has the highest priority for a patient with life-threatening, severe food allergies that requires epinephrine therapy?

a. The patient will identify the main ingredients in several foods.
b. The patient will list the side effects of epinephrine.
c. The patient will learn about food labels.
d. The patient will administer epinephrine.

Answer 20

d. The patient will administer epinephrine.

Once you assist in meeting patient needs related to basic survival (how to give epinephrine), you can discuss other topics, such as nutritional needs and side effects of medications. For example, a patient recently diagnosed with coronary artery disease has deficient knowledge related to the illness and its implications. The patient benefits most by first learning about the correct way to take nitroglycerin and how long to wait before calling for help when chest pain occurs. Thus, in this situation, the patient benefits most by first learning about the correct way to take epinephrine. ―The patient will learn about food labels‖ is not objective and measurable and is not correctly written.

Question 21

After a teaching session on taking blood pressures, the nurse tells the patient, ―You took that blood pressure like an experienced nurse.‖ Which type of reinforcement did the nurse use?

a. Social acknowledgment
b. Pleasurable activity
c. Tangible reward
d. Entrusting

Answer 21

a. Social acknowledgment

Reinforcers come in the form of social acknowledgments (e.g., nods, smiles, words of encouragement), pleasurable activities (e.g., walks or play time), and tangible rewards (e.g., toys or food). The entrusting approach is a teaching approach that provides a patient the opportunity to manage self-care. It is not a type of reinforcement.

Question 22

A patient diagnosed with heart failure is learning to reduce salt in the diet. When will be the best time for the nurse to address this topic?

a. At bedtime, while the patient is relaxed.
b. At bath time when the nurse is cleaning the patient.
c. At lunchtime, while the nurse is preparing the food tray.
d. At medication time when the nurse is administering patient medication.

Answer 22

c. At lunchtime, while the nurse is preparing the food tray.

In this situation, because the teaching is about food, coordinating it with routine nursing care that involves food can be effective. Many nurses find that they are able to teach more effectively while delivering nursing care. For example, while hanging blood, you explain to the patient why the blood is necessary and the symptoms of a transfusion reaction that need to be reported immediately. At bedtime would be a good time to discuss routines that enhance sleep. At bath time would be a good time to describe skin care and how to prevent pressure ulcers. At medication time would be a good time to explain the purposes and side effects of the medication.

Question 23

A nurse is teaching a patient identified as having low health literacy about chronic obstructive pulmonary disease (COPD). Which technique is most appropriate for the nurse to use?

a. Use complex analogies to describe COPD.
b. Ask for feedback to assess understanding of COPD at the end of the session.
c. Offer pamphlets about COPD written at the eighth-grade level with large type.
d. Include the most important information on COPD at the beginning of the session.

Answer 23

d. Include the most important information on COPD at the beginning of the session.

Include the most important information at the beginning of the session for patients with literacy or learning disabilities. Also, use visual cues and simple, not complex, analogies when appropriate. Another technique is to frequently ask patients for feedback to determine whether they comprehend the information. Additionally, provide teaching materials that reflect the reading level of the patient, with attention given to short words and sentences, large type, and simple format (generally, information written on a fifth grade reading level is recommended for adult learners).

Question 24

A nurse is teaching a culturally diverse patient with a learning disability about nutritional needs. What must the nurse do first before starting the teaching session?

a. Obtain pictures of food.
b. Get an interpreter.
c. Establish a rapport.
d. Refer to a dietitian.

Answer 24

c. Establish a rapport.

Establishing trust is important for all patients, especially culturally diverse and learning-disabled patients, before starting teaching sessions. Obtaining pictures of food, getting an interpreter, and referring to a dietitian all occur after rapport/trust is established.

Question 25

A nurse is teaching an older-adult patient about strokes. Which teaching technique is most appropriate for the nurse to use?

a. Speak in a high tone of voice to describe strokes.
b. Use a pamphlet about strokes with large font in blues and greens.
c. Provide specific information about strokes in short, small amounts.
d. Begin the teaching session facing the teaching white board with stroke information.

Answer 25

c. Provide specific information about strokes in short, small amounts.

With older adults, keep the teaching session short with small amounts of information. Also, if using written material, assess the patient’s ability to read and use information that is printed in large type and in a color that contrasts highly with the background (e.g., black 14-point print on matte white paper). Avoid blues and greens because they are more difficult to see. Speak in a low tone of voice (lower tones are easier to hear than higher tones). Directly face the older-adult learner when speaking.

Question 26

A patient who is going to surgery has been taught how to cough and deep breathe. Which evaluation method will the nurse use?

a. Return demonstration
b. Computer instruction
c. Verbalization of steps
d. Cloze test

Answer 26

a. Return demonstration

To demonstrate mastery of the skill, have the patient perform a return demonstration under the same conditions that will be experienced at home or in the place where the skill is to be performed. Computer instruction is use of a programmed instruction format in which computers store response patterns for learners and select further lessons on the basis of these patterns (programs can be individualized). Computer instruction is a teaching tool, rather than an evaluation tool. Verbalization of steps can be an evaluation tool, but it is not as effective as a return demonstration when evaluating a psychomotor skill. The Cloze test, a test of reading comprehension, asks patients to fill in the blanks that are in a written paragraph.

Question 27

A patient has been taught how to change a colostomy bag but is having difficulty manipulating the equipment and has many questions. To which resource should the nurse institute a referral to?

a. A mental health specialist
b. A wound care specialist
c. An ostomy specialist
d. A dietitian

Answer 27

c. An ostomy specialist

Resources that specialize in a particular health need (e.g., wound care or ostomy specialists) are integral to successful patient education. A mental health specialist is helpful for emotional issues rather than for physical problems. A dietitian is a resource for nutritional needs. A wound care specialist provides complex wound care.

Question 28

A nurse is teaching a patient about healthy eating habits. Which learning objective/outcome for the affective domain will the nurse add to the teaching plan?

a. The patient will state three facts about healthy eating.
b. The patient will identify two foods for a healthy snack.
c. The patient will verbalize the value of eating healthy.
d. The patient will cook a meal with low-fat oil.

Answer 28

c. The patient will verbalize the value of eating healthy.

Affective learning deals with expression of feelings and acceptance of attitudes, beliefs, or values. Having the patient value healthy eating habits falls within the affective domain. Stating three facts or identifying two foods for a healthy snack falls within the cognitive domain. Cooking falls within the psychomotor domain.

Question 29

A nurse is assessing the ability to learn of a patient who has recently experienced a stroke. Which question/statement will best assess the patient’s ability to learn?

a. What do you want to know about strokes?
b. Please read this handout and tell me what it means.
c. Do you feel strong enough to perform the tasks I will teach you?
d. On a scale from 1 to 10, tell me where you rank your desire to learn.

Answer 29

b. Please read this handout and tell me what it means

A patient’s reading level affects ability to learn. One way to assess a patient’s reading level and level of understanding is to ask the patient to read instructions from an educational handout and then explain their meaning. Reading level is often difficult to assess because patients who are functionally illiterate are often able to conceal it by using excuses such as not having the time or not being able to see. Asking patients what they want to know identifies previous learning and learning needs and preferences; it does not assess ability to learn. Motivation (desire to learn) is related to readiness to learn, not ability to learn. Just asking a patient if he or she feels strong is not as effective as actually assessing the patient’s strength.

Question 30

A nurse is preparing to teach a kinesthetic learner about exercise. Which technique will the nurse use?

a. Let the patient touch and use the exercise equipment.
b. Provide the patient with pictures of the exercise equipment.
c. Let the patient listen to a video about the exercise equipment.
d. Provide the patient with a case study about the exercise equipment.

Answer 30

a. Let the patient touch and use the exercise equipment.

Kinesthetic learners process knowledge by moving and participating in hands-on activities. Return demonstrations and role-playing work well with these learners. Patients who are visual-spatial learners enjoy learning through pictures and visual charts to explain concepts. The verbal/linguistic learner demonstrates strength in the language arts and therefore prefers learning by listening or reading information. Patients who learn through logical-mathematical reasoning think in terms of cause and effect and respond best when required to predict logical outcomes. Specific teaching strategies could include open-ended questioning or problem-solving exercises, like a case study.

Question 31

A nurse is asked by a co-worker why patient education/teaching is important. Which statements will the nurse share with the co-worker? (Select all that apply.)

a. Patient education is an essential component of safe, patient-centered care.
b. Patient education is a standard for professional nursing practice.
c. Patient teaching falls within the scope of nursing practice.
d. Patient teaching is documented and part of the chart.
e. Patient education is not effective with children.
f. Patient teaching can increase health care costs.

Answer 31

a. Patient education is an essential component of safe, patient-centered care.
b. Patient education is a standard for professional nursing practice.
c. Patient teaching falls within the scope of nursing practice.
d. Patient teaching is documented and part of the chart.

Patient education has long been a standard for professional nursing practice. All state Nurse Practice Acts acknowledge that patient teaching falls within the scope of nursing practice. Patient education is an essential component of providing safe, patient-centered care. It is important to document evidence of successful patient education in patients’ medical records. Patient education is effective for children. Different techniques must be used with children. Creating a well-designed, comprehensive teaching plan that fits a patient’s unique learning needs reduces health care costs, improves quality of care, and ultimately changes behaviors to improve patient outcomes.

Question 32

A nurse is preparing to teach patients. Which patient finding will cause the nurse to postpone a teaching session? (Select all that apply.)

a. The patient’s pain is not controlled.
b. The patient is reporting being fatigued.
c. The patient is mildly anxious about their condition.
d. The patient is asking numerous questions about their health status.
e. The patient is currently febrile with an oral temperature of 101.2F.
f. The patient is in the acceptance phase of dealing with their medical diagnosis.

Answer 32

a. The patient’s pain is not controlled.
b. The patient is reporting being fatigued.
e. The patient is currently febrile with an oral temperature of 101.2F.

Any condition (e.g., pain, fatigue) that depletes a person’s energy also impairs the ability to learn, so the session should be postponed until the pain is relieved and the patient is rested. Postpone teaching when an illness becomes aggravated by complications such as a high fever or respiratory difficulty. A mild level of anxiety motivates learning. When patients are ready to learn, they frequently ask questions. When the patient enters the stage of acceptance, the stage compatible with learning, introduce a teaching plan