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The nurse is working with a male patient who has diagnoses of coronary artery disease and angina pectoris. During a clinic visit, the nurse learns that he has only been taking his prescribed antiplatelet medication when he experiences chest pain and fatigue. What nursing diagnosis is most relevant to this assessment finding?
- A. Acute pain related to myocardial ischemia
- B. Confusion related to mismanagement of drug regimen
- C. Ineffective health maintenance related to inappropriate medication use
- D. Ineffective role performance related to inability to manage medications
Correct Answer: C
Rationale: This patients actions suggest that by taking his medications incorrectly he is not adequately maintaining his health. Role performance is not directly applicable to the patients actions and confusion suggests a cognitive deficit. Pain is not central to the essence of the problem.
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A gerontologic nurse has observed that patients often fail to adhere to a therapeutic regimen. What strategy should the nurse adopt to best assist an older adult in adhering to a therapeutic regimen involving wound care?
- A. Demonstrate a dressing change and allow the patient to practice.
- B. Provide a detailed pamphlet on a dressing change.
- C. Verbally instruct the patient how to change a dressing and check for comprehension.
- D. Delegate the dressing change to a trusted family member.
Correct Answer: A
Rationale: The nurse must consider that older adults may have deficits in the ability to draw inferences, apply information, or understand major teaching points. Demonstration and practice are essential in meeting their learning needs. The other options are incorrect because the elderly may have problems reading and/or understanding a written pamphlet or verbal instructions. Having a family member change the dressing when the patient is capable of doing it impedes self-care and independence.
As the nurse working in a gerontology clinic, you know that some elderly people do not adhere to therapeutic regimens because of chronic illnesses that require long-term treatment by several health care providers. What is the most important consideration when dealing with this segment of the population?
- A. Health care professionals must know all the dietary supplements the patient is taking.
- B. Health care professionals must work together to provide coordinated care.
- C. Health care professionals may negate the efforts of another health care provider.
- D. Health care professionals must have a peer witness their interactions with the patient.
Correct Answer: B
Rationale: Above all, health care professionals must work together to provide continuous, coordinated care; otherwise, the efforts of one health care professional may be negated by those of another. Interactions do not necessarily need to be witnessed. The care team should be aware of the patients use of supplements, but this is not a priority principle that guides overall care.
A 20-year-old man newly diagnosed with type 1 diabetes needs to learn how to self-administer insulin. When planning the appropriate educational interventions and considering variables that will affect his learning, the nurse should prioritize which of the following factors?
- A. Patients expected lifespan
- B. Patients gender
- C. Patients occupation
- D. Patients culture
Correct Answer: D
Rationale: One of the major variables that influences a patients readiness to learn is the patients culture, because it affects how a person learns and what information is learned. Other variables include illness states, values, emotional readiness, and physical readiness. Lifespan, occupation, and gender are variables that are usually less salient.
You are the nurse planning to teach tracheostomy care to a patient who will be discharged home following a spinal cord injury. When preparing your teaching, which of the following is the most important component of your teaching plan?
- A. Citing the evidence that underlies each of your teaching points
- B. Alleviating the patients guilt associated with not knowing appropriate self-care
- C. Determining the patients readiness to learn new information
- D. Including your nursing colleagues in the planning process
Correct Answer: C
Rationale: Assessment in the teaching-learning process is directed toward the systematic collection of data about the person and family's learning needs and readiness to learn. Patient readiness is critical to accepting and integrating new information. Unless the patient is ready to accept new information, patient teaching will be ineffective. Citing the evidence base will not likely enhance learning. Patient guilt cannot be alleviated until the patient understands the intricacies of the condition and his physiologic response to the disease. Inclusion of colleagues can be beneficial, but this does not determine the success or failure of teaching.
You are the oncoming nurse and you have just taken end-of-shift report on your patients. One of your patients newly diagnosed with diabetes was admitted with diabetic ketoacidosis. Which behavior best demonstrates this patients willingness to learn?
- A. The patient requests a visit from the hospitals diabetic educator.
- B. The patient sets aside a dessert brought in by a family member.
- C. The patient wants a family member to meet with the dietician to discuss meals.
- D. The patient readily allows the nurse to measure his blood glucose level.
Correct Answer: A
Rationale: Emotional readiness also affects the motivation to learn. A person who has not accepted an existing illness or the threat of illness is not motivated to learn. The patients willingness to learn is expressed through the action of seeking information on his or her own accord. Seeking information shows an emotional readiness to learn. The other options do not as clearly demonstrate a willingness to learn.