Chapter 4: Patient and Caregiver Teaching(FREE) My Nursing Test Banks

Lewis: Medical-Surgical Nursing, 8th Edition

Chapter 4: Patient and Caregiver Teaching

Test Bank

MULTIPLE CHOICE

1. A patient with newly diagnosed breast cancer has a nursing diagnosis of deficient knowledge about breast cancer. When the nurse is planning teaching for the patient, which is the most important initial learning goal?

a.

The patient will select the most appropriate breast cancer therapy.

b.

The patient will state ways of preventing the recurrence of the tumor.

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: A

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 choose a treatment option. The other goals may be appropriate as treatment progresses.

DIF: Cognitive Level: Application REF: 50 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

2. After the nurse implements diet instruction for a patient with heart disease, the patient can explain the information but fails to make the recommended dietary changes. The nurses evaluation is that

a.

learning did not occur because the patients behavior did not change.

b.

choosing not to follow the diet is the behavior that resulted from learning.

c.

the nursing responsibility for helping the patient make dietary changes has been fulfilled.

d.

the teaching methods were ineffective in helping the patient learn the dietary information.

ANS: B

Although the patient behavior has not changed, the patients ability to explain the information indicates that learning has occurred and the patient is choosing at this time to continue with the previous diet. The patient may be in the contemplation or preparation state 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: Application REF: 50-51 TOP: Nursing Process: Evaluation

MSC: NCLEX: Health Promotion and Maintenance

3. A 43-year-old is diagnosed with type 2 diabetes mellitus after being admitted to the hospital with an infected foot wound. When applying principles of adult learning, which teaching strategy by the nurse is most likely to be effective?

a.

Discuss the importance of blood glucose control in maintenance of long-term health.

b.

Demonstrate the correct method for cleaning and redressing the wound to the patient.

c.

Assure the patient that the nurse is an expert on management of diabetes complications.

d.

Wait until after discharge and have a home health nurse teach about foot care and diabetes management.

ANS: B

Principles of adult education indicate that readiness and motivation to learn are high when facing new tasks (such wound care) 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: Application REF: 50 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

4. A patient admitted to the hospital with hyperglycemia and newly diagnosed diabetes mellitus is scheduled for discharge the second day after admission. When implementing patient teaching, which is the best action for the nurse to take?

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: Application REF: 52

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

5. When using the Transtheoretical Model of Health Behavior Change during patient teaching, the nurse identifies that the patient who states, I told my wife that I was going to start exercising, and I think I will join a fitness club, is in the stage of

a.

preparation.

b.

termination.

c.

maintenance.

d.

contemplation.

ANS: A

The patients 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: Comprehension REF: 50-51

TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

6. While admitting a patient to the medical unit, the nurse learns that the patient does not read well. This information will guide the nurse in determining

a.

the degree of patient motivation and readiness to learn.

b.

what information the patient will be able to understand.

c.

that the family must be included in the teaching process.

d.

which instructional strategies should be used in teaching.

ANS: D

The information that the patient is illiterate indicates that the nurse should avoid the use of written materials in teaching and choose other strategies. The patient does not indicate a lack of motivation or an inability to understand new information. The patients lack of reading ability does not necessarily imply that the family must be included in the teaching process.

DIF: Cognitive Level: Comprehension REF: 54 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

7. When assessing the learning needs for a patient who has coronary heart disease, the nurse finds that the patient has recently made dietary changes to decrease fat intake and has stopped smoking. The best initial statement by the nurse at this time is

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.

You have already accomplished some changes that are important in heart health.

d.

Which additional changes in your lifestyle would you like to implement at this time?

ANS: C

Positive reinforcement of the learners 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: Application REF: 51 | 55

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

8. To assess a patients readiness to learn before planning teaching activities, which question should the nurse ask?

a.

What kind of work and leisure activities do you do?

b.

What information do you think you need right now?

c.

Do you have any religious beliefs that are inconsistent with the treatment?

d.

Can you describe the types of activities that help you learn new information?

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: Application REF: 55

TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

9. The nurse develops a nursing diagnosis of ineffective health maintenance related to low motivation based on the finding that the diabetic patient

a.

does not perform capillary blood glucose tests as directed.

b.

occasionally forgets to take the daily prescribed medication.

c.

says that dietary intake does not seem to impact fatigue level.

d.

cannot identify signs or symptoms of high and low blood glucose.

ANS: C

The patients motivation to follow a diabetic diet will be decreased if the patient feels that dietary changes do not impact symptoms. The other responses do not indicate that the ineffective health maintenance is caused by lack of motivation.

DIF: Cognitive Level: Application REF: 55 TOP: Nursing Process: Diagnosis

MSC: NCLEX: Health Promotion and Maintenance

10. A patient with poor circulation to the feet 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. Options a and c describe actions that the nurse will take, rather than behaviors that indicate that patient learning has occurred. Option d is too vague and nonspecific to measure whether learning has occurred.

DIF: Cognitive Level: Application REF: 55-56 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

11. When the nurse is planning teaching for a patient who needs to improve skills in being more assertive, the most effective teaching strategy will be

a.

role playing.

b.

peer teaching.

c.

printed materials.

d.

lecture-discussion.

ANS: A

Role-playing allows the patient to practice assertive behavior and receive feedback about how the behavior is perceived. Lecture-discussion, peer-teaching, and printed materials are more useful for other learning needs.

DIF: Cognitive Level: Comprehension REF: 57 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

12. The patients teaching plan includes 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.

Check the sodium content of the patients menu choices over the next 3 days

b.

Ask the patient to identify which foods on the hospital menus are high in sodium.

c.

Have the patient list favorite foods that are high in sodium and foods that could be substituted for these favorites.

d.

Compare the patients sodium intake over the next 3 days with the sodium intake before the teaching was implemented.

ANS: A

All of the answers address the patients sodium intake, but the desired patient behaviors in the learning objective are most clearly addressed by evaluation of the patients menu choices.

DIF: Cognitive Level: Application REF: 58-59 TOP: Nursing Process: Evaluation

MSC: NCLEX: Health Promotion and Maintenance

13. The nurse is preparing written handouts to be used as part of the standardized teaching plan for patients who have been recently diagnosed with diabetes. Which of the following statements would be appropriate to include in the handouts?

a.

Polyphagia, polydipsia, and polyuria are common symptoms of diabetes mellitus.

b.

The use of the right foods can help in keeping blood glucose at a near-normal level.

c.

Some diabetics control blood glucose with oral medications or nutritional interventions.

d.

Diabetes mellitus is characterized by chronic hyperglycemia and the associated symptoms.

ANS: B

Reading level for patient teaching materials should be at the 5th grade level. The other responses have words with three or more syllables, use many medical terms, and/or are too long.

DIF: Cognitive Level: Application REF: 56 | 58 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

14. The nurse in the hospital has implemented a teaching plan to assist a patient with rheumatoid arthritis in accomplishing daily activities independently. To evaluate the patients long-term response to the teaching, the best action by the nurse will be to

a.

make a referral to the home health nursing department for home visits.

b.

check the patients ability to bathe without any assistance the next day.

c.

have the patient demonstrate the learned skills at the end of the teaching session.

d.

arrange a physical therapy visit before the patient is discharged from the hospital.

ANS: A

The patients long-term response may need to be assessed after discharge; a home health referral would allow this to occur. The other actions allow evaluation of the patients short-term response to teaching.

DIF: Cognitive Level: Application REF: 58-59 TOP: Nursing Process: Evaluation

MSC: NCLEX: Health Promotion and Maintenance

15. When assessing a 22-year-old male patient, the nurse learns that he smokes a pack of cigarettes daily. The patient 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

ANS: B

The patients statement indicates that he is not considering smoking cessation. Ineffective health maintenance is defined as the inability to identify, manage, and/or seek out help to maintain health.

DIF: Cognitive Level: Application REF: 55 TOP: Nursing Process: Diagnosis

MSC: NCLEX: Health Promotion and Maintenance

16. A 73-year-old Hispanic/Latino patient is seen at the health clinic and diagnosed with protein malnutrition. The priority action in the nurses teaching plan will be to

a.

suggest the use of liquid supplements as a way to increase protein intake.

b.

encourage the patient to increase the dietary intake of meat, cheese, and milk.

c.

ask the patient to record the intake of all foods and beverages for a 3-day period.

d.

focus on the use of combinations of beans and rice to improve daily protein intake.

ANS: C

Assessment is the first step in assisting a patient with health changes. The other answers may be appropriate for the patient, but the nurse will not be able to determine this until the assessment of the patient is complete.

DIF: Cognitive Level: Application REF: 53

OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

17. A newly diagnosed diabetic patient tells the nurse, I want to know how to give my own insulin. Which action will the nurse take first when implementing the standardized diabetic teaching plan?

a.

Demonstrate how to draw up and administer insulin.

b.

Discuss the use of exercise to decrease insulin needs.

c.

Teach about differences between the various types of insulin.

d.

Provide handouts about therapeutic and adverse effects of insulin.

ANS: A

Adult education is most effective when focused on information that the patient thinks is needed right now. All of the indicated information will need to be included when planning teaching for this patient, but the teaching will be most effective if the nurse starts with the patients stated priority topic.

DIF: Cognitive Level: Application REF: 50 | 55

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

MSC: NCLEX: Health Promotion and Maintenance

18. Which action should the nurse take first when teaching a patients spouse how to manage the blood pressure (BP) for a patient with newly diagnosed high BP?

a.

Teach the caregiver how to take the patients BP using a manual blood pressure cuff.

b.

Have the dietician meet with the patient and caregiver to discuss low sodium dietary choices.

c.

Ask the patient and caregiver to select important information from a list of hypertension teaching topics.

d.

Provide written information about treatment and complications of hypertension for the patient and caregiver.

ANS: C

Since adults learn best when given information that they view as being needed immediately, asking the caregiver and patient to prioritize learning needs is likely to be the most successful approach to home management of health problems. The other actions also may be appropriate, depending on what learning needs the caregiver and patient have, but the initial action should be to assess what the learners feel is important.

DIF: Cognitive Level: Application REF: 50 | 53

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Health Promotion and Maintenance

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

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