Lewis Test Bank - Medical-Surgical Nursing 10th Edition Chapter 4

Chapter 04: Patient and Caregiver Teaching Lewis: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. A patient with newly diagnosed colon cancer has a nursing diagnosis of deficient knowledge about colon cancer. The nurse should initially focus on which learning goal for this patient? a. The patient will state ways of preventing the recurrence of the cancer. b. The patient will explore and select an appropriate colon cancer therapy. c. The patient will demonstrate coping skills needed to manage the disease. d. The patient will choose methods to minimize adverse effects of treatment. ANS: B Adults learn best when given information that can be used immediately. The first action the patient will need to take after a cancer diagnosis is to explore and choose a treatment option. The other goals may be appropriate as treatment progresses. DIF: Cognitive Level: Apply (application) REF: 47 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 2. After the nurse provides diet instructions for a patient with diabetes, the patient can restate the information but fails to make the recommended diet changes. How would the nurse best evaluate the patient‘s situation? a. Learning did not occur because the patient‘s behavior did not change. b. Choosing not to follow the diet is the behavior that resulted from learning. c. The nurse‘s responsibility for helping the patient make diet changes has been fulfilled. d. The teaching methods were ineffective in helping the patient learn about the necessary diet changes. ANS: B Although the patient behavior has not changed, the patient‘s ability to restate the information indicates that learning has occurred, and the patient is choosing at this time not to change the diet. The patient may be in the contemplation or preparation stage in the transtheoretical model. The nurse should reinforce the need for change and continue to provide information and assistance with planning for change. DIF: Cognitive Level: Apply (application) REF: 47 TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 3. A patient is diagnosed with heart failure after being admitted to the hospital for shortness of breath and fatigue. Which teaching strategy, if implemented by the nurse, is most likely to be effective? a. Assure the patient that the nurse is an expert on management of heart failure. b. Teach the patient at each meal about the amounts of sodium in various foods. c. Discuss the importance of medication control in maintenance of long-term health. d. Refer the patient to a home health nurse for instructions on diet and fluid restrictions. ANS: B Downloaded by: aaalishba | Distribution of this document is illegal Lewis Test Bank - Medical-Surgical Nursing 10th Edition Chapter 4 S - The Marketplace to Buy and Sell your Study Material Principles of adult education indicate that readiness and motivation to learn are high when facing new tasks (e.g., learning about the sodium amounts in various food items) and when demonstration and practice of skills are available. Although a home health referral may be needed for this patient, teaching should not be postponed until discharge. Adult learners are independent. The nurse should act as a facilitator for learning, rather than as the expert. Adults learn best when the topic is of immediate usefulness. Long-term goals may not be very motivating. DIF: Cognitive Level: Apply (application) REF: 47 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 4. A patient who was admitted to the hospital with hyperglycemia and newly diagnosed diabetes mellitus is scheduled for discharge the second day after admission. When implementing patient teaching, what is the priority action for the nurse? a. Instruct about the increased risk for cardiovascular disease. b. Provide detailed information about dietary control of glucose. c. Teach glucose self-monitoring and medication administration. d. Give information about the effects of exercise on glucose control. ANS: C When time is limited, the nurse should focus on the priorities of teaching. In this situation, the patient should know how to test blood glucose and administer medications to control glucose levels. The patient will need further teaching about the role of diet, exercise, various medications, and the many potential complications of diabetes, but these topics can be addressed through planning for appropriate referrals. DIF: Cognitive Level: Apply (application) REF: 49 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 5. A patient states, ―I told my husband I wouldn‘t buy as much prepared food snacks, so I will go the grocery store to buy fresh fruit, vegetables, and whole grains.‖ When using the Transtheoretical Model of Health Behavior Change, the nurse identifies that this patient is in which stage of change? a. Preparation c. Maintenance b. Termination d. Contemplation ANS: A The patient‘s statement indicating that the plan for change is being shared with someone else indicates that the preparation stage has been achieved. Contemplation of a change would be indicated by a statement like ―I know I should exercise.‖ Maintenance of a change occurs when the patient practices the behavior regularly. Termination would be indicated when the change is a permanent part of the lifestyle. DIF: Cognitive Level: Understand (comprehension) REF: 48 TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 6. While admitting a patient to the medical unit, the nurse determines that the patient has a hearing impairment. How should the nurse use this information to plan teaching and learning strategies? a. Motivation and readiness to learn will be affected. b. The family must be included in the teaching process. Downloaded by: aaalishba | Distribution of this document is illegal S - The Marketplace to Buy and Sell your Study Material c. The patient will have problems understanding information. d. Written materials should be provided with verbal instructions. ANS: D The information that the patient has a hearing impairment indicates that the nurse should use written and verbal materials in teaching along with other strategies. The patient does not indicate a lack of motivation or an inability to understand new information. The patient‘s decreased hearing does not necessarily imply that the family must be included in the teaching process. DIF: Cognitive Level: Understand (comprehension) REF: 51 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 7. A patient who is morbidly obese states, ―I‘ve recently made some changes in my life. I‘ve decreased my fat intake, and I‘ve stopped smoking.‖ Which statement, if made by the nurse, is the best initial response? a. ―Although those are important, it is essential that you make other changes, too.‖ b. ―Are you having any difficulty in maintaining the changes you have already made?‖ c. ―Which additional changes in your lifestyle would you like to implement at this time?‖ d. ―You have already accomplished changes that are important for the health of your heart.‖ ANS: D Positive reinforcement of the learner‘s achievements is critical in making lifestyle changes. This patient is in the action stage of the Transtheoretical Model when reinforcement of the changes being made is an important nursing intervention. The other responses are also appropriate but are not the best initial response. DIF: Cognitive Level: Apply (application) REF: 53 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 8. The nurse is planning a teaching session with a patient newly diagnosed with migraine headaches. To assess a patient‘s readiness to learn, which question should the nurse ask first? a. ―What kind of work and leisure activities do you do?‖ b. ―What information do you think you need right now?‖ c. ―Can you describe the types of activities that help you learn new information?‖ d. ―Do you have any religious beliefs that are inconsistent with the planned treatment?‖ ANS: B Motivation and readiness to learn depend on what the patient values and perceives as important. The other questions are also important in developing the teaching plan, but do not address what information most interests the patient at present. DIF: Cognitive Level: Apply (application) REF: 53 TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 9. The nurse considers a nursing diagnosis of ineffective health maintenance related to low motivation for a patient with diabetes. Which finding would the nurse most likely use to support this nursing diagnosis? Downloaded by: aaalishba | Distribution of this document is illegal S - The Marketplace to Buy and Sell your Study Material a. The patient does not perform capillary blood glucose tests as directed. b. The patient occasionally forgets to take the daily prescribed medication. c. The patient states that dietary changes have not made any difference at all. d. The patient cannot identify signs or symptoms of high and low blood glucose. ANS: C The patient‘s motivation to follow a diabetic diet will be decreased if the patient believes that dietary changes do not affect symptoms. The other responses do not indicate that the ineffective health maintenance is caused by lack of motivation. DIF: Cognitive Level: Apply (application) REF: 48 TOP: Nursing Process: Diagnosis MSC: NCLEX: Health Promotion and Maintenance 10. A patient with diabetic neuropathy requires teaching about foot care. Which learning goal should the nurse include in the teaching plan? a. The nurse will demonstrate the proper technique for trimming toenails. b. The patient will list three ways to protect the feet from injury by discharge. c. The nurse will instruct the patient on appropriate foot care before discharge. d. The patient will understand the rationale for proper foot care after instruction. ANS: B Learning goals should state clear, measurable outcomes of the learning process. Demonstrating technique for trimming toenails and providing instructions on foot care are actions that the nurse will take rather than behaviors that indicate that patient learning has occurred. A learning goal that states that the patient will understand the rationale for proper foot care is too vague and nonspecific to measure whether learning has occurred. DIF: Cognitive Level: Apply (application) REF: 54 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 11. A patient needs to learn how to instill eye drops. Which teaching strategy, if implemented by the nurse, would be most effective? a. Peer teaching b. Lecture-discussion c. Printed instructions d. Demonstration and return demonstration ANS: D Demonstration with return demonstration (show back) is best used to teach a patient how to learn to perform a skill. Lecture-discussion, peer teaching, and printed materials are more useful for other learning needs. DIF: Cognitive Level: Understand (comprehension) REF: 56 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 12. The nurse and the patient who is diagnosed with hypertension develop this goal: ―The patient will select a 2-gram sodium diet from the hospital menu for the next 3 days.‖ Which evaluation method will be best for the nurse to use when determining whether teaching was effective? a. Have the patient list substitutes for favorite foods that are high in sodium. b. Check the sodium content of the patient‘s menu choices over the next 3 days. Downloaded by: aaalishba | Distribution of this document is illegal S - The Marketplace to Buy and Sell your Study Material c. Ask the patient to identify which foods on the hospital menus are high in sodium. d. Compare the patient‘s sodium intake before and after the teaching was implemented. ANS: B All of the answers address the patient‘s sodium intake, but the desired patient behaviors in the learning objective are most clearly addressed by evaluating the sodium content of the patient‘s menu choices. DIF: Cognitive Level: Apply (application) REF: 57 TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 13. The nurse prepares written handouts to be used as part of the standardized teaching plan for patients who have been recently diagnosed with diabetes. What statement would be most appropriate to include in the handouts? a. Eating the right foods can help in keeping blood glucose at a near-normal level. b. Polyphagia, polydipsia, and polyuria are common symptoms of diabetes mellitus. c. Some patients with diabetes control blood glucose with oral medications, injections, or dietary interventions. d. Diabetes mellitus is characterized by chronic hyperglycemia and the associated symptoms than can lead to long-term complications. ANS: A The reading level for patient teaching materials should be at the fifth grade level. The other responses have words with three or more syllables, use many medical terms, or are too long. DIF: Cognitive Level: Apply (application) REF: 52 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 14. The hospital nurse implements a teaching plan to assist an older patient who lives alone to independently accomplish daily activities. How would the nurse best evaluate the patient‘s long-term response to the teaching? a. Make a referral to the home health nursing agency for home visits. b. Have the patient demonstrate the learned skills at the end of the teaching session. c. Arrange a physical therapy visit before the patient is discharged from the hospital. d. Check the patient‘s ability to bathe and get dressed without any assistance the next day. ANS: A A home health referral would allow for the assessment of the patient‘s long-term response after discharge. The other actions allow evaluation of the patient‘s short-term response to teaching. DIF: Cognitive Level: Apply (application) REF: 57 TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 15. A patient who smokes a pack of cigarettes per day tells the nurse, ―I enjoy smoking and have no plans to quit.‖ Which nursing diagnosis is most appropriate? a. Health-seeking behaviors related to cigarette use b. Ineffective health maintenance related to tobacco use c. Readiness for enhanced self-health management related to smoking d. Deficient knowledge related to long-term effects of cigarette smoking Downloaded by: aaalishba | Distribution of