Nokea
A wound care nurse approaches a client to instruct in home care needs. In which clinical scenario would the nurse delay teaching due to learning readiness?
- A. The client says that a grandchild will be in soon.
- B. The client is eating breakfast.
- C. The client is anxious about physical therapy.
- D. The client is meeting with the priest.
Correct Answer: C
Rationale: Learning readiness pertains to the optimal time for learning. This occurs when a client is in a state of physical and psychological well-being. Being anxious about an upcoming activity distracts the client from learning. Waiting until after the activity allows the client to be more focused on the teaching. Nurses may decide to delay teaching due to visiting family, eating breakfast, and meeting with a priest, but it is not from learning readiness.
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The nurse is caring for a geriatric client who has decided to move to a skilled nursing facility. The nurse assisted with the arrangements and, when leaving the room, touched the client on the shoulder. Which therapeutic technique was the nurse demonstrating?
- A. Therapeutic communication
- B. Affective touch
- C. Silence
- D. Task-oriented contact
Correct Answer: B
Rationale: Affective touch is used to demonstrate concern or affection. Its intention is to communicate caring and support. Therapeutic communication and silence can be helpful in this situation but does not fit into the scenario. Task-oriented 'touch' involves the personal contact that is required when performing nursing procedures.
Which of the following is a reason why silence is considered therapeutic?
- A. It demonstrates concern or affection.
- B. It communicates caring and support.
- C. It encourages a client's verbal communication.
- D. It is therapeutic when a client is uncomfortable.
Correct Answer: C
Rationale: Silence is the art of remaining quiet. One of its therapeutic uses is to encourage a client's verbal communication. Affective touch is typically used to demonstrate concern or affection. Its intention is to communicate caring and support. The nurse uses affective touch therapeutically in many situations, including when a client is uncomfortable.
The nurse is caring for a client who has been diagnosed with a cerebral vascular accident and displays expressive aphasia. In which manner does the nurse best promote communication?
- A. Ask the client open-ended questions and allow time for a response.
- B. Give the client a tablet and pencil to use.
- C. Provide the client with a speaking valve.
- D. Use a picture board with common responses.
Correct Answer: D
Rationale: For clients with aphasia, it is most helpful to have a picture board with responses to convey meaning. This decreases some frustration and allows the client to have some control over care. Asking a client with expressive aphasia open-ended questions is not the best option because the client is unable to give lengthy responses. Depending on the client's degree of aphasia, closed-ended questions may be appropriate. A speaking valve is useful for a client who has a tracheostomy or one who has had laryngectomy.
Advocacy and support are activities associated with which learning style?
- A. Cognitive
- B. Cultural
- C. Psychomotor
- D. Affective
Correct Answer: D
Rationale: The affective learner learns best when presented with information that appeals to feelings, beliefs, and values. Cognitive learners process information best by listening to or reading facts and descriptions. The psychomotor learner prefers to learn by doing. There is no learning style classified as cultural.
The nurse enters the client's room and assesses that the client's affect appears sad. The client is sitting near the window, staring into the distance with a tear in the eye. The nurse approaches and places a hand on the client's shoulder asking for the client's thoughts. What type of emotion is the nurse projecting?
- A. Sympathy
- B. Empathy
- C. Ambivalence
- D. Pity
Correct Answer: B
Rationale: The nurse is projecting empathy. Empathy is an intuitive awareness of what the client is experiencing. Nurses perceive the client's emotional state and provide support. Sympathy is the projection of understanding the way one may feel, many times by having gone through the experience as well. Ambivalence projects conflicting feelings and uncertainty. Pity projects a feeling of sorrow.