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A patient admitted to a hospital has difficulty with information recall, decision making, and conclusion-drawing skills. The patient also lacks proper psychomotor knowledge. Which of the following nursing diagnoses would the nurse most likely identify for this patient?
- A. Knowledge Deficit
- B. Ineffective Self Health Management
- C. Effective Self Health Management
- D. Anxiety
Correct Answer: A
Rationale: The nursing diagnosis used for patients with deficient cognitive knowledge and psychomotor skills is Deficient Knowledge. Ineffective Self Health Management is useful in discharge teaching. Effective Self Health Management describes a patient who is successfully managing the medication regimen. Anxiety would reflect a patient who is fearful or expresses concern regarding the drug regimen or shows a total lack of adherence to the drug regimen.
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To develop an effective teaching plan, the nurse must first determine a client's needs, which can include which of the following? Select all that apply.
- A. Information the client needs to know about a particular medication
- B. Client's ability to read
- C. Client's ability to learn the information presented
- D. Client's ability to use the information presented
- E. Client's ability to accept the information presented
Correct Answer: A,B,C,D,E
Rationale: To develop an effective teaching plan, the nurse must first determine a client's needs, which can include information the client needs to know about a particular medication; the client's ability to learn, accept, and use information; and any barriers or obstacles to learning (which might include the client's ability to read).
The nurse is assessing a patient and suspects that the patient may have limited health literacy. Which of the following would support this suspicion? Select all that apply.
- A. Clear description of how to take the medication
- B. Difficulty naming the medication
- C. Problems filling out forms accurately
- D. English as the primary language
- E. Inability to explain the purpose of the medication
Correct Answer: B,C,E
Rationale: Behaviors indicating limited health literacy include filling out forms incompletely or inaccurately, an inability to name or give the purpose of medications, and an inability to describe how to take the medications. Higher rates of low health literacy are found in individuals with English as a second language.
A nurse is preparing a teaching plan and is determining the best time for teaching. Which of the following would be an inappropriate time for client teaching? Select all that apply.
- A. When there are visitors
- B. Immediately prior to discharge
- C. The day of admission
- D. While the client is sedated
- E. While the client is in pain
Correct Answer: A,B,D,E
Rationale: Client teaching should not be performed when there are visitors, immediately prior to discharge, or if the client is sedated or in pain.
A client is to be discharged from a nursing home. The nurse caring for the client has to educate the client regarding the appropriate use of prescribed drugs. Which factor would be most important in promoting learning?
- A. Attitude
- B. Motivation
- C. Interest
- D. Grasping power
Correct Answer: B
Rationale: Motivation is probably the key factor in providing an impetus to the process of patient learning and teaching. Attitude, interest, and grasping power may also help the learning process, but without motivation the patient could be noncompliant to the treatment.
The nurse makes use of the psychomotor domain when information is given to the client or caregiver about which of the following? Select all that apply.
- A. Instruction on the correct administration of insulin
- B. Review of complications associated with diabetes
- C. Review of adverse reactions associated with insulin
- D. Review of how frequently to administer insulin
- E. Instruction on how to use a glucometer
Correct Answer: A,E
Rationale: The nurse makes use of the psychomotor domain when information is given to the client or caregiver about a physical skill or task. A review of complications, adverse reactions, and frequency of administration involve the cognitive domain.