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The nurse in the hospital has implemented a teaching plan to assist a client with rheumatoid arthritis in accomplishing daily activities independently. Which of the following actions is the best approach for the nurse to take in order to evaluate the client's long-term response to the teaching?
- A. Make a referral to the home health nursing department for home visits.
- B. Assess the client's ability to bathe without any assistance the next day.
- C. Have the client demonstrate the learned skills at the end of the teaching session.
- D. Arrange a physical therapy visit before the client is discharged from the hospital.
Correct Answer: A
Rationale: The client's long-term response may need to be assessed after discharge, long-term evaluation necessitates follow-up by the nurse, outpatient clinic, or outside agency. In this case, a home health referral would allow this to occur. The other actions allow evaluation of the client's short-term response to teaching.
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The client's teaching plan includes this goal: 'The client will select foods lower in sodium 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 client's menu choices over the next 3 days.
- B. Ask the client to identify which foods on the hospital menus are high in sodium.
- C. Have the client list favourite foods that are high in sodium and foods that could be substituted for these favourites.
- D. Compare the client's sodium intake over the next 3 days with the sodium intake before the teaching was implemented.
Correct Answer: A
Rationale: All of the answers address the client's sodium intake, but the desired client behaviours in the learning objective are most clearly addressed by evaluation of the client's menu choices.
When using the Transtheoretical Model of Health Behaviour Change during client teaching, the nurse identifies that the client who states, 'I told my wife that I was going to start exercising, and I think I will join a fitness club,' is in which of the following stages?
- A. Preparation
- B. Termination
- C. Maintenance
- D. Contemplation
Correct Answer: A
Rationale: The client's 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 client practises the behaviour regularly. Termination would be indicated when the change is a permanent part of the lifestyle.
A client 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 client will list three ways to protect the feet from injury by discharge.
- C. The nurse will instruct the client on appropriate foot care before discharge.
- D. The client will understand the rationale for proper foot care after instruction.
Correct Answer: B
Rationale: Learning goals should state clear, measurable outcomes of what is to be accomplished from the learning process. Demonstrating a proper technique or providing instruction are actions that the nurse will take, rather than behaviours that would indicate if client learning has occurred. Having the client understand the rationale for proper foot care after instruction is an example of a learning outcome.
Which action should the nurse take first when teaching a client's spouse how to manage the blood pressure (BP) for a client with newly diagnosed hypertension?
- A. Teach the caregiver how to take the client's BP using a manual blood pressure cuff.
- B. Have the dietitian meet with the client and caregiver to discuss low sodium dietary choices.
- C. Ask the client 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 client and caregiver.
Correct Answer: C
Rationale: Since adults learn best when given information that they view as being needed immediately, asking the caregiver and client 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 client have, but the initial action should be to assess what the learners feel is important.
The nurse is caring for an adult client who has been 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 client.
- C. Assume the client 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.
Correct Answer: B
Rationale: Principles of adult education indicate that readiness and motivation to learn are high when facing new tasks (such as wound care) and when demonstration and practice of skills are available. Although a home health referral may be needed for this client, 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.