Nokea
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.
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The nurse is caring for a client with diabetes and develops a nursing diagnosis of ineffective health management related to insufficient knowledge of therapeutic regimen (resulting in low motivation). Which of the following client actions is the basis for this nursing diagnosis?
- A. Does not perform capillary blood glucose tests as directed
- B. Occasionally forgets to take the daily prescribed medication.
- C. Says that dietary intake does not seem to impact fatigue level.
- D. Cannot identify signs or symptoms of high and low blood glucose.
Correct Answer: C
Rationale: The client's motivation to follow a diabetic diet will be decreased if the client feels that dietary changes do not impact symptoms. The other responses do not indicate that the ineffective health maintenance is caused by lack of motivation.
Which of the following are determinants of learning that require learning assessments?
- A. Learner needs
- B. Demonstrated learner behaviour
- C. Learner self-concept
- D. State of learner readiness
- E. Preferred learning style
Correct Answer: A,D,E
Rationale: The three determinants of learning that require learning assessments are learner needs, state of learner readiness, and the client's preferred learning style. Demonstrated learner behaviour is an evaluation of learning. Self-concept is not a determinant of learning.
A young adult client tells the nurse, 'I enjoy smoking and have no plans to quit.' Which stage of the Transtheoretical Model of Health Behaviour Change does this example portray?
- A. Contemplation
- B. Precontemplation
- C. Preparation
- D. Maintenance
Correct Answer: B
Rationale: The precontemplation phase indicates that the client is not considering a change and is not ready to learn. In the contemplation phase, a change is being considered. The client starts gathering information for the change in the preparation stage. In the maintenance stage, the change has already occurred.
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.
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.