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When assessing the learning needs for a client who has coronary heart disease, the nurse finds that the client has recently made dietary changes to decrease fat intake and has stopped smoking. Which of the following is the most appropriate initial statement by the nurse at this time?
- A. Although those are important, it is essential that you make other changes, too.
- B. Are you having any difficulty in maintaining the changes you have already made?
- C. You have already accomplished some changes that are important in heart health.
- D. Which additional changes in your lifestyle would you like to implement at this time?
Correct Answer: C
Rationale: Positive reinforcement of the learner's achievements is critical in making lifestyle changes. This client is in the action stage of the Transtheoretical Model, when reinforcement of the changes being made is an important nursing intervention. The other responses are also appropriate, but are not the best initial response.
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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.
The nurse is preparing written handouts to be used as part of the standardized teaching plan for clients who have been recently diagnosed with diabetes and requires an awareness of literacy levels. Which of the following literacy levels is generally reflective of students who graduate from high school?
- A. 1
- B. 2
- C. 3
- D. 4
Correct Answer: C
Rationale: People with Level 3 literacy have the minimum skills necessary for everyday life in a complex society, such as graduation from high school. People with Level 1 literacy have very poor skills; for example, they were unable to determine the correct dose of medication from information on the package. People with Level 2 literacy require material to be simple and clearly laid out, and only tasks that are not too complex are to be included in learning material. People with Levels 4 and 5 literacy had higher order skills in information processing.
After the nurse implements diet instruction for a client with heart disease, the client can explain the information but fails to make the recommended dietary changes. Which of the following statements reflects the correct evaluation of the intervention?
- A. Learning did not occur because the client's behaviour did not change.
- B. Choosing not to follow the diet is the behaviour that resulted from learning.
- C. The nursing responsibility for helping the client make dietary changes has been fulfilled.
- D. The teaching methods were ineffective in helping the client learn the dietary information.
Correct Answer: B
Rationale: Although the client's behaviour has not changed, the client's ability to explain the information indicates that learning has occurred and the client is choosing at this time to continue with the previous diet. The client may be in the contemplation or preparation state in the Transtheoretical Model. The nurse should reinforce the need for change and continue to provide information and assistance with planning for change.
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.
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.