Chapter 25: Patient Education

Question 1

1. A nurse is asked about the goal of patient education. What is the nurse’s best response? The goal of educating others is to help people
   a.
   Meet standards of the Nurse Practice Act.
   b.
   Achieve optimal levels of health.
   c.
   Become dependent on the health care team.
   d.
   Provide self-care only in the hospital.

Answer 1

ANS: B
The goal of educating others about their health is to help individuals, families, or communities achieve optimal levels of health. Although all state Nurse Practice Acts acknowledge that patient teaching falls within the scope of nursing practice, this is the nurse’s standard, not the goal of education. Patient education helps patients make informed decisions about their care and become healthier and more independent, not dependent. Nurses provide patients with information needed for self-care to ensure continuity of care from the hospital to the home.

Question 2

2.	A nurse is teaching a group of healthy adults about the benefits of flu immunizations. Which purpose of patient education is the nurse fulfilling?
a.
Restoration of health
b.
Coping with impaired functions
c.
Promotion of health and illness prevention
d.
Health analogies

Answer 2

ANS: C
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

3. A nurse provides teaching about coping with long-term impaired functions. Which situation serves as the best example?
   a.
   Teaching a family member to give medications through the patient’s permanent gastric tube
   b.
   Teaching a woman who recently had a hysterectomy about her pathology reports
   c.
   Teaching expectant parents about physical and psychological changes in childbearing women
   d.
   Teaching a teenager with a broken leg how to use crutches

Answer 3

ANS: A
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. Injured and ill patients need information and skills to help them regain or maintain their levels of health. Some examples of this include teaching a woman who recently had a hysterectomy about her pathology reports and expected length of recovery and teaching a teenager with a broken leg how to use crutches. 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

4. Which statement indicates that 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.
   “Learning consists of a conscious, deliberate set of actions designed to help the teacher.”
   d.
   “Teaching is most effective when it responds to the learner’s needs.”

Answer 4

ANS: D
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

5. Which action best indicates that 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

ANS: B
Learning is the purposeful acquisition of new knowledge, attitudes, behaviors, and skills. Complex patterns are required if the patient is to learn new skills, change existing attitudes, transfer learning to new situations, or solve problems. 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

6. A nurse is teaching a patient about the Speak Up Initiatives. Which information should the nurse include?
   a.
   The nurse is the center of the health care team.
   b.
   If you still do not understand, ask again.
   c.
   Ask a nurse to be your advocate or supporter.
   d.
   Inappropriate medical tests are the most common mistakes.

Answer 6

ANS: B
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

7. A nurse teaches a patient with heart failure healthy food choices. The patient states that eating yogurt is better than eating cake. In this situation, 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

ANS: D
Feedback should show 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 is the receiver. The teaching is the message

Question 8

8.	While preparing a teaching plan, the nurse described what the learner will be able to accomplish after the teaching session. Which action did the nurse complete?
a.
Developed learning objectives
b.
Provided positive reinforcement
c.
Implemented interpersonal communication
d.
Presented facts and knowledge

Answer 8

ANS: A
Learning objectives describe what the learner will be able to do after successful instruction. Positive reinforcement follows feedback and involves the use of praise and acknowledgment of new attitudes, behaviors, or knowledge. 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

9.	A student nurse learns that a normal adult heartbeat is 60 to 100 beats/minute. In which domain did learning take place?
a.
Kinesthetic
b.
Cognitive
c.
Affective
d.
Psychomotor

Answer 9

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

Question 10

10.	A nurse wants the patient to begin to accept the chronic nature of diabetes. Which teaching technique should the nurse use to enhance learning?
a.
Lecture
b.
Demonstration
c.
Role play
d.
Question and answer session

Answer 10

ANS: C
Affective learning deals with expression of feelings and acceptance of attitudes, opinions, or values. Role play 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

11.	When the nurse describes a patient’s perceived ability to successfully complete a task, which term should the nurse use?
a.
Self-efficacy
b.
Motivation
c.
Attentional set
d.
Active participation

Answer 11

ANS: A
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

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.
Use discussion throughout the teaching session.
c.
Apply a bandage to a doll’s ear.
d.
Develop a problem-solving scenario.

Answer 12

ANS: C
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 middle-aged 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

13. Which factors should the nurse assess to determine a patient’s ability to learn?
    a.
    Developmental capabilities and physical capabilities
    b.
    Sociocultural background and motivation
    c.
    Psychosocial adaptation to illness and active participation
    d.
    Stage of grieving and overall physical health

Answer 13

ANS: A
Developmental and physical capabilities reflect one’s ability to learn. Sociocultural background and motivation are factors in 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 a wrong answer.

Question 14

14.	A nurse is preparing to teach a patient about heart failure. Which environment is best for patient learning?
a.
A darkened, quiet room
b.
A well-lit, ventilated room
c.
A private room at 85° F temperature
d.
A group room for 10 to 12 patients with heart failure

Answer 14

ANS: B
The ideal environment for learning is a room that is well lit and has good ventilation, appropriate furniture, and a comfortable temperature. Although quiet is appropriate, a darkened room interferes with the patient’s ability to watch your actions, especially when you are 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 fewer is more effective than in larger groups and avoids outburst behaviors.

Question 15

15. Which situation indicates to the nurse that the patient is ready to learn?
    a.
    A patient has sufficient upper body strength to move from a bed to a wheelchair.
    b.
    A patient has the ability to grasp and apply the elastic bandage.
    c.
    A patient with a below-the-knee amputation is motivated about how to walk with assistive devices.
    d.
    A patient has normal eyesight to identify the markings on a syringe and coordination to handle a syringe.

Answer 15

ANS: C
Motivation or readiness to learn sometimes results from social task mastery, or physical motives may be involved. Often patient motives are physical. Some patients are motivated to return to a level of physical normalcy. For example, a patient with a below-the-knee amputation is motivated to learn how to walk with assistive devices. 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

16.	A nurse is teaching the staff about nursing and teaching processes. Which information should the nurse include regarding the teaching process? During the teaching process, what should the nurse do?
a.
Assess all sources of data.
b.
Identify that it is the same as the nursing process.
c.
Perform nursing care therapies.
d.
Focus on a patient’s learning needs

Answer 16

ANS: D
The teaching process focuses on the patient’s learning needs and willingness and capability to learn. Nursing and teaching processes are not the same. All the rest are components of the nursing process: Assess all sources of data and perform nursing care therapies

Question 17

17.	Which nursing action is most appropriate for assessing a patient’s learning needs?
a.
Assess the patient’s total health care needs.
b.
Assess the patient’s health literacy.
c.
Assess all sources of patient data.
d.
Assess the goals of patient care.

Answer 17

ANS: B
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, not patient care. Assessing the goal of meeting patient care is the evaluation component of the nursing process.

Question 18

18. A nurse is going to teach a patient about hypertension. Which action should the nurse implement first?
    a.
    Set mutual goals for knowledge of hypertension.
    b.
    Teach what the patient wants to know about hypertension.
    c.
    Assess what the patient already knows about hypertension.
    d.
    Evaluate the outcomes of patient education for hypertension.

Answer 18

ANS: C
Assessment is the first step of any teaching session, then diagnosing, planning, implementation, and evaluation. An effective assessment provides the basis for individualized patient teaching. Assessing what the adult patient currently knows improves the outcomes of patient education

Question 19

19. A patient had a stroke and must use a cane for support. A nurse is preparing to teach the patient about the cane. Which learning objective/outcome is most appropriate?
    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 learn how to use a cane.
    d.
    The patient will know the correct use of a cane.

Answer 19

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

Question 20

20. Which learning objective/outcome has the highest priority for a patient with life-threatening, severe food allergies that require an EpiPen (epinephrine)?
    a.
    The patient will administer epinephrine.
    b.
    The patient will identify the main ingredients in several foods.
    c.
    The patient will list the side effects of epinephrine.
    d.
    The patient will learn about food labels

Answer 20

ANS: A
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

21.	After a teaching session on taking blood pressures, the nurse tells the patient, “You took that blood pressure like an experienced nurse.” What type of reinforcement did the nurse use?
a.
Material
b.
Activity
c.
Social
d.
Entrusting

Answer 21

ANS: C
Three types of reinforcers are social, material, and activity. When a nurse works with a patient, most reinforcers are social and are used to acknowledge a learned behavior (e.g., smiles, compliments, words of encouragement). Examples of material reinforcers include food, toys, and music. Activity reinforcers rely on the principle that a person is motivated to engage in an activity if he or she has the opportunity to engage in a more desirable activity after completion of the task. The entrusting approach is a teaching approach that provides the patient the opportunity to manage self-care. It is not a type of reinforcement.

Question 22

22. A patient with heart failure is learning to reduce salt in the diet. When would be the best time for the nurse to address this topic?
    a.
    At bedtime, when the patient is relaxed
    b.
    At lunchtime while the nurse is preparing the food tray
    c.
    At bath time, when the nurse is cleaning the patient
    d.
    At medication time, when the nurse is administering patient medication

Answer 22

ANS: B
Appropriate times to talk about food/diet changes during routine nursing care are at breakfast, lunch, and dinner times or when the patient is completing the menu. 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. In this situation, because the teaching is about food, coordinating it with routine nursing care that involves food can be effective. 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

23. A nurse is teaching a patient who has low health literacy about chronic obstructive pulmonary disease (COPD) while giving COPD medications. Which technique is most appropriate for the nurse to use?
    a.
    Use complex analogies to describe COPD.
    b.
    Include the most important information on COPD at the beginning of the session.
    c.
    Ask for feedback to assess understanding of COPD at the end of the session.
    d.
    Offer pamphlets about COPD written at the eighth grade level with large type

Answer 23

ANS: B
Include the most important information at the beginning of the session for illiterate patients or patients with a learning disability. 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

24.	A nurse is teaching a culturally diverse patient 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

ANS: C
Establishing a rapport is important for all patients, especially culturally diverse patients, before starting teaching sessions. Obtaining pictures of food, getting an interpreter, and referring to a dietitian all occur after rapport is established.

Question 25

25. A nurse is teaching an older adult patient about strokes. Which teaching technique is most appropriate for the nurse to use?
    a.
    Use a pamphlet about strokes with large font in blues and greens.
    b.
    Speak in a high tone of voice to describe strokes.
    c.
    Begin and end each teaching session with the most important information about strokes.
    d.
    Provide specific information about strokes in frequent, large amounts.

Answer 25

ANS: C
Begin and end each teaching session with the most important information when teaching older adult patients. 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 buff-colored 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). Provide specific information in frequent, small (not large) amounts for older adult patients

Question 26

26.	A patient has been taught how to cough and deep breathe. Which evaluation method is most appropriate?
a.
Return demonstration
b.
Computer instruction
c.
Verbalization of steps
d.
Cloze test

Answer 26

ANS: A
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 in a written paragraph.

Question 27

27.	A patient has been taught how to change a colostomy bag but is having trouble measuring and manipulating the equipment and has many questions. What is the nurse’s next action?
a.
Refer to a mental health specialist.
b.
Refer to an ostomy specialist.
c.
Refer to a dietitian.
d.
Refer to a wound care specialist.

Answer 27

ANS: B
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

28. A nurse has taught a patient about healthy eating habits. Which learning objective/outcome is most appropriate for the affective domain?
    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

ANS: C
Affective learning deals with expression of feelings and acceptance of attitudes, opinions, 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

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

Answer 29

ANS: D
A patient’s reading level affects ability to learn. 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. 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. Asking patients what they want to know identifies previous learning and learning needs and preferences; it does not assess ability to learn. Motivation is related to readiness to learn, not ability to learn. Just asking a patient if they feel strong is not as effective as actually assessing the patient’s strength.

Question 30

30. A nurse is preparing to teach a kinesthetic learner about exercise. Which technique should 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 podcast about the exercise equipment.
    d.
    Provide the patient with a case study about the exercise equipment.

Answer 30

ANS: A
Kinesthetic learners learn best while they are moving and participating in hands-on activities. Demonstrations and role playing work well with these learners. Patients who are visual learners learn best when you use pictures and diagrams to explain information. Patients who prefer auditory learning are distracted by pictures and prefer listening to information (e.g., podcasts). Patients who learn best by reasoning logically and intuitively learn better if presented with a case study that requires careful analysis and discussion with others to arrive at conclusions.

Question 31

1. Which statements by the nurse indicate a good understanding of patient education/teaching? (Select all that apply.)
   a.
   “Patient education is a standard for professional nursing practice.”
   b.
   “Patient teaching falls within the scope of nursing practice.”
   c.
   “Patient education is an essential component of safe, patient-centered care.”
   d.
   “Patient education is not effective with children.”
   e.
   “Patient teaching can increase health care costs.”
   f.
   “Patient teaching should be documented in the chart.”

Answer 31

ANS: A, B, C, F
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 the quality of care, and ultimately changes behaviors to improve patient outcomes.

Question 32

2.	Which situation will cause the nurse to postpone a teaching session? (Select all that apply.)
a.
The patient is mildly anxious.
b.
The patient is fatigued.
c.
The patient is asking questions.
d.
The patient is hurting.
e.
The patient is febrile (high fever).
f.
The patient is in the acceptance phase.

Answer 32

ANS:	B, D, E
Any condition (e.g., pain, fatigue) that depletes a person’s energy also impairs his or her 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.