Concept 6: Adherence My Nursing Test Banks

Concept 6: Adherence

Test Bank

MULTIPLE CHOICE

1. A patient has been newly diagnosed with hypertension. The nurse assesses the need to develop a collaborative plan of care that includes a goal of adhering to the prescribed regimen. When the nurse is planning teaching for the patient, which is the most important initial learning goal?

a.

The patient will select the type of learning materials they prefer.

b.

The patient will verbalize an understanding of the importance of following the regimen.

c.

The patient will demonstrate coping skills needed to manage hypertension.

d.

The patient will verbalize the side effects of treatment.

ANS: A

Adults learn best when given information they can understand that is tailored to their learning styles and needs. Verbalizing an understanding is important; however, the nurse will first need to teach the patient.

REF: 50 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

2. After the nurse implements a teaching plan for a newly diagnosed patient with hypertension, the patient can explain the information but fails to take the medications as prescribed. The nurses next action would be to

a.

reeducate the patient, because learning did not occur because the patients behavior did not change.

b.

assess the patients perception and attitude towards the risks associated with not taking their anti-hypertensives.

c.

take full responsibility for helping the patient make dietary changes.

d.

ask the provider to prescribe a different medication, because the patient does not want to take this medication.

ANS: B

Although the patient behavior has not changed, the patients ability to explain the information indicates that learning has occurred. The nurse would need to ask what the patients perceptions are of taking the medications to determine if the patient understands the ramifications of not taking the medication. The patient may be in the contemplation or preparation state (see Health Belief Model). The nurse should reinforce the need for change and continue to provide information and assistance with planning for change.

REF: 52 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

3. A diabetic patient presents to the diabetes clinic with A1c levels of 7.5%. The nurse has met this patient for the first time. When applying principles of Theory of Planned Behavior (TPB), which teaching strategy by the nurse is most likely to be effective?

a.

Provide information on the importance of blood glucose control in maintenance of long-term health and evaluate how the patient has been following the prescribed regime.

b.

Establish a rapport with the patient by complimenting them on what they did correctly, and ask what strategies they have tried thus far.

c.

Refer the patient to a certified diabetic educator, because the educator is an expert on management of diabetes complications.

d.

Have the patient explain what medications they are on and what diet they should be following.

ANS: B

Principles of a TPB indicate that the patient will need to establish a good rapport with the nurse in order to talk about nonadherence. If the patient finds it difficult to discuss their diabetes self-management and adherence with the nurse, the patient may not open up to the nurse. Although a referral to an educator is a good idea, it would be better to use this resource as a follow-up for this visit. Having the patient verbalize medications and diet is not part of the TPB method.

REF: 52 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

4. The nurse is assessing a newly diagnosed diabetic, and the patients readiness to learn about glucose monitoring. Before planning teaching activities, which approach would be most effective?

a.

Assist the patient with long-term goals and plan teaching according to these goals.

b.

Provide the patient with all the latest research from the Internet on glucose monitoring.

c.

Refer the patient to the diabetic specialist who can assist the patient with the glucometer.

d.

Assist the patient in developing realistic short-term goals.

ANS: D

Concordance reflects development of an alliance with patients based on realistic expectations. Providing the patient with the research will not help with the practical skill of using the glucometer. Long-term goals are useful; however, the goals need to be immediate with a newly diagnosed patient learning a new skill. Referring the patient would be useful if the patient has not been able to grasp the concept after several attempts.

REF: 55 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

5. The nurse is developing a care plan for a patient who has low motivation and nonadherence with blood glucose monitoring. Which statement by the patient would indicate to the nurse that the patient is not motivated and will most likely not comply?

a.

I do not like to test my sugar, but I do it because my wife nags me.

b.

I forget to check my sugar once in a while.

c.

I dont see or feel any different when I do keep my blood sugars under control.

d.

I have no idea what the signs of low blood sugar are.

ANS: C

If patients do not perceive any benefit from changing their behavior, sustaining the change becomes very difficult. Having someone remind the patient is more likely to reinforce compliance. Forgetting to check glucose occasionally may indicate the patient needs memory cues or joggers. The patient who doesnt know the signs of low glucose will need further teaching.

REF: 52 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

6. The nurse is doing discharge teaching on a patient who has peripheral vascular disease and has poor circulation to the feet. 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 understand the rationale for proper foot care after instruction.

c.

The nurse will instruct the patient on appropriate foot care before discharge.

d.

The patient will post reminder stickers on their calendar to check feet every day and record scheduled appointments with podiatrist.

ANS: D

To improve the patient adherence to treatment, it will be important to help them develop reminder strategies that fit into their lifestyle. Options A and C describe actions that the nurse will take, rather than behaviors that indicate that patient learning has occurred. Option B is too vague and nonspecific to measure whether learning has occurred.

REF: 55 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

7. A patient with hypertension is prescribed a low-sodium diet. 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 intervention would be most effective at increasing the patients compliance with the diet?

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: C

Including a patients favorite foods will most likely increase compliance because the patient is not being deprived. Checking the sodium will be useful for teaching strategies but will not be the most effective means of increasing adherence.

REF: 55 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

8. The nurse is evaluating the need to refer a patient with osteoarthritis for a home care visit to be sure the patient can function in accomplishing daily activities independently. What is the nurses first priority?

a.

Determine if the patient has had home visits before and if the experience was positive.

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

To begin the assessment of adherence, it is first important to clarify with the patient (a) their beliefs and perceptions about their health risk status, (b) their existing knowledge about cardiovascular disease risk reduction, (c) any prior experience with health care professionals, and (d) their degree of confidence with controlling the disease. The other actions allow evaluation of the patients short-term response to teaching.

REF: 55 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

9. 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.

REF: 51 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

10. A 73-year-old male patient is seen in the home setting for a routine physical. The nurse notes which behavior as the most reassuring sign that the patient has been following the treatment plan for the diagnoses of hypertension, diabetes, and hyperlipidemia?

a.

The patient has a list of glucose readings for the past 10 days.

b.

The patient has a list of medications along with newly refilled meds.

c.

The patient has a list of all foods and beverages for a 3-day period.

d.

The patient verbalizes the side effects of all his medications.

ANS: B

Confirming how often a patient renews or refills his/her prescriptions is a measurement of the patients persistence with continuation of the treatment. Having a list of glucose readings or verbalizing side effects does not necessarily mean that the patient is compliant unless the readings were all normal, which is not indicated. Listing foods may not indicate the patient is following the treatment plan.

REF: 55 OBJ: NCLEX Client Needs Category: Health Promotion and Maintenance

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