Medical Surgical Nursing Single Volume Assessment and Management of Clinical Problems 7th Edition by Sharon L. Lewis -Test Bank

Medical Surgical Nursing Single Volume Assessment and Management of Clinical Problems 7th Edition by Sharon L. Lewis -Test Bank

 

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Lewis: Medical-Surgical Nursing, 7^th Edition

 

Test Bank

 

Chapter 5: Patient and Family Teaching

 

MULTIPLE CHOICE

 

1. A patient has just been diagnosed with breast cancer following a needle biopsy of a breast lump. The nurse plans teaching for the patient to meet the goal of

a.	preventing the recurrence of the tumor.
b.	learning skills to live with the disease.
c.	selecting and using treatment options.
d.	minimizing adverse effects of treatment.

 

Correct Answer: C

Rationale: Adults learn best when given information that can be used immediately. The first action the patient will need to take after a cancer diagnosis is to choose a treatment option. The other goals may be appropriate as treatment progresses.

 

Cognitive Level: Application                       Text Reference: pp. 54, 59

Nursing Process: Planning

NCLEX: Health Promotion and Maintenance

 

 

2. After the nurse implements diet instruction with a patient with heart disease, the patient can explain the information but fails to make the recommended dietary changes. The nurse’s evaluation is that

a.	learning did not occur because the patient’s behavior did not change.
b.	choosing not to follow the diet is the behavior that resulted from learning.
c.	the nursing responsibility for helping the patient make dietary changes has been fulfilled.
d.	the teaching methods were ineffective in helping the patient learn the dietary information.

 

Correct Answer: B

Rationale: Although the patient behavior has not changed, the patient’s ability to explain the information indicates that learning has occurred and the patient is choosing at this time to continue with the previous diet. The patient 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.

 

Cognitive Level: Application                       Text Reference: p. 55

Nursing Process: Evaluation

NCLEX: Health Promotion and Maintenance

 

 

 

3. The nurse applies principles of adult education when teaching a new diabetic about the disease by

a.	explaining that making lifestyle changes and taking medications correctly will help the patient start to feel better right away.
b.	informing the patient that a home health nurse will be scheduled to visit and evaluate how well the patient is managing the disease.
c.	telling the patient that learning about diabetes will be an opportunity for a completely new life experience.
d.	advising the patient that this information is needed to manage the disease and maintain long-term health.

 

Correct Answer: A

Rationale: Principles of adult education indicate that adults learn best when the information can be used immediately. The answer option beginning, “informing the patient that a home health nurse will be scheduled to visit” indicates a lack of respect for the patient’s independence. The answer option beginning, “telling the patient that learning about diabetes will be an opportunity” is less appropriate because adults prefer to base new learning on past experience. And the final answer option (advising the patient that this is information is needed to manage the disease and maintain long-term health) focuses on long-term benefits, which are less appealing to the adult learner.

 

Cognitive Level: Application                       Text Reference: pp. 54, 59

Nursing Process: Implementation

NCLEX: Health Promotion and Maintenance

 

 

4. A patient admitted to the hospital with hyperglycemia and diagnosed with diabetes mellitus is scheduled for discharge the second day after admission. In view of the patient’s limited hospitalization, the nurse should plan to

a.	include detailed information about diet and medication use in patient teaching.
b.	use every interaction to teach the patient about the details of glucose control.
c.	focus on teaching the family instead of the patient about diabetic management.
d.	teach the patient about how to monitor glucose and self-administer insulin.

 

Correct Answer: D

Rationale: When time is limited, the nurse should set realistic goals with the patient that will meet immediate needs. The patient and family will need further teaching about the role of diet, exercise, medications, etc., in controlling glucose, but these topics can be addressed through planning for appropriate referrals.

 

Cognitive Level: Application                       Text Reference: p. 56

Nursing Process: Planning

NCLEX: Health Promotion and Maintenance

 

 

5. When using the Transtheoretical Model of Health Behavior Change during patient teaching, the nurse identifies that the patient who states, “I told my wife that I was going to start exercising, and I think I will join a fitness club,” is in the stage of

a.	contemplation.
b.	preparation.
c.	maintenance.
d.	termination.

 

Correct Answer: B

Rationale: The patient’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 patient practices the behavior regularly. Termination would be indicated when the change is a permanent part of the lifestyle.

 

Cognitive Level: Comprehension                 Text Reference: p. 55

Nursing Process: Assessment

NCLEX: Health Promotion and Maintenance

 

 

6. A 73-year-old Latino patient is seen at the health clinic and diagnosed with protein malnutrition. When developing a plan to teach the patient about meeting dietary needs, the first action by the nurse should be to

a.	encourage the patient to use milk and meat as primary protein intake sources.
b.	focus on the use of combinations of beans and rice to improve daily protein intake.
c.	ask the patient to record the intake of all foods and beverages for a 3-day period.
d.	stress the need to increase protein intake through the use of liquid supplements.

 

Correct Answer: C

Rationale: Assessment is the first step in assisting a patient with health changes. The other answers may be appropriate for the patient, but the nurse will not be able to determine this until the assessment of the patient is complete.

 

Cognitive Level: Application                       Text Reference: p. 57

Nursing Process: Assessment

NCLEX: Health Promotion and Maintenance

 

 

7. While admitting a patient to the medical unit, the nurse learns that the patient does not read well. This information will guide the nurse in determining

a.	which instructional strategies should be used in teaching.
b.	the degree of the patient’s motivation to learn.
c.	what information the patient will be able to understand.
d.	that the family must be included in the teaching process.

 

Correct Answer: A

Rationale: The information that the patient is illiterate indicates that the nurse should avoid the use of written materials in teaching and choose other strategies. The patient does not indicate a lack of motivation or an inability to understand new information. The patient’s lack of reading ability does not necessarily imply that the family must be included in the teaching process.

 

Cognitive Level: Comprehension                 Text Reference: p. 58

Nursing Process: Planning

NCLEX: Health Promotion and Maintenance

 

 

8. A postoperative patient says it hurts too much to deep breathe and cough every 2 hours and refuses to carry out the activity. The best initial action by the nurse is to

a.	explain how coughing and deep breathing will decrease the risk of complications.
b.	respect the patient’s wishes and assist the patient to turn side-to-side more frequently.
c.	enlist the help of the health care provider in reinforcing the need to cough and deep breathe.
d.	document the patient’s refusal to cough and deep breathe in the patient’s chart.

 

Correct Answer: A

Rationale: Teaching the patient about the reason for the deep breathing and coughing will be likely to improve compliance and decrease the risk for complications. Turning side-to-side will not be as effective in preventing postoperative complications. The health care provider may need to help reinforce the need for coughing and deep breathing, but this should not be the initial action by the nurse. Documentation is important but is not an adequate response to the situation.

 

Cognitive Level: Application                       Text Reference: p. 55

Nursing Process: Implementation

NCLEX: Health Promotion and Maintenance

 

 

9. When assessing the learning needs for a patient who has coronary heart disease, the nurse finds that the patient has recently made dietary changes to decrease fat intake and has stopped smoking. The best initial response by the nurse at this time is,

a.	“You have already accomplished some changes that are important in heart health.”
b.	“Although those are important, it is essential that you make other changes, too.”
c.	“Which additional changes in your lifestyle would you like to implement at this time?”
d.	“Are you having any difficulty in maintaining the changes you have already made?”

 

Correct Answer: A

Rationale: Adult learners are more motivated when their accomplishments are recognized. The other responses are also appropriate but are not the best initial response.

 

Cognitive Level: Application                       Text Reference: pp. 55, 63

Nursing Process: Implementation

NCLEX: Health Promotion and Maintenance

 

 

10. To assess a patient’s readiness to learn before planning teaching activities, the most appropriate question for the nurse to ask is,

a.	“What kind of work and leisure activities do you do?”
b.	“What information do you think you need right now?”
c.	“Do you have any religious beliefs that are inconsistent with the treatment?”
d.	“Can you describe the types of activities that help you learn new information?”

 

Correct Answer: B

Rationale: Motivation and readiness to learn depend on what the patient values. The other questions are also important but do not address what information interests the patient most at present.

 

Cognitive Level: Application                       Text Reference: pp. 54, 59

Nursing Process: Assessment

NCLEX: Health Promotion and Maintenance

 

 

11. The nurse identifies a nursing diagnosis of ineffective health maintenance related to low motivation based on the finding that the diabetic patient

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 patient’s motivation to follow a diabetic diet will be decreased if the patient 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.

 

Cognitive Level: Application                       Text Reference: pp. 54, 60

Nursing Process: Diagnosis

NCLEX: Health Promotion and Maintenance

 

 

12. The nurse is teaching a patient with peripheral vascular disease about foot care. A correctly written learning objective is,

a.	“The nurse will instruct the patient on appropriate foot care before discharge.”
b.	“The patient will list three ways to protect the feet from injury by discharge.”
c.	“The nurse will demonstrate for the patient the proper technique for trimming toenails.”
d.	“The patient will understand the rationale for proper foot care after instruction.”

 

Correct Answer: B

Rationale: This objective contains all four elements of a specific learning objective. The objective stating, “The patient will understand the rationale for proper foot care after instruction” will be impossible to measure. The remaining two answer options describe actions that the nurse will take, not behaviors that indicate patient learning has occurred.

 

Cognitive Level: Application                       Text Reference: p. 60

Nursing Process: Planning

NCLEX: Health Promotion and Maintenance

 

 

13. When the nurse is planning teaching for a patient who needs to improve skills in being more assertive, the most effective teaching strategy will be

a.	lecture-discussion.
b.	role playing.
c.	peer teaching.
d.	printed materials.

 

Correct Answer: B

Rationale: Role-playing allows the patient to practice assertive behavior and receive feedback about how the behavior is perceived. Lecture-discussion, peer-teaching, and printed materials are more useful for other forms of teaching.

 

Cognitive Level: Comprehension                 Text Reference: pp. 58, 62

Nursing Process: Planning

NCLEX: Health Promotion and Maintenance

 

 

14. A newly diagnosed diabetic patient who will need instruction about diet, exercise, and insulin use tells the nurse, “I think that the most important thing I need to control my blood sugar is how to give my own insulin.” During implementation of the teaching plan, the nurse will initially focus on

a.	demonstrating how to draw up and administer the prescribed insulin.
b.	teaching the patient that changes in diet can help decrease insulin use.
c.	describing how exercise can be used to decrease the need for insulin.
d.	giving the patient written material with information about how insulin works.

 

Correct Answer: A

Rationale: Adult education is most effective when focused on information that the patient thinks is needed right now. All the indicated information will need to be included when planning teaching for this patient, but the teaching will be most effective if the nurse starts with the patient’s priority.

 

Cognitive Level: Application                       Text Reference: pp. 54, 59

Nursing Process: Implementation

NCLEX: Health Promotion and Maintenance

 

 

15. To evaluate how effective teaching has been for the following teaching objective, “The patient will select a 2000-mg sodium diet from the hospital menu daily for 3 days with 90% accuracy,” the nurse will

a.	ask the patient to identify which foods on the daily menu are highest in sodium.
b.	total the sodium content of the foods the patient has eaten for the last 3 days.
c.	note the food selected on three daily menus and determine whether the daily sodium content is within 1800 to 2200 mg.
d.	compare the patient’s sodium intake over the next 3 days with the sodium intake before the teaching was implemented.

 

Correct Answer: C

Rationale: The statement of the teaching objective is most clearly addressed with this answer. The other answers also address the patient’s sodium intake but do not directly address the objective as written.

 

Cognitive Level: Application                       Text Reference: pp. 60, 63-64

Nursing Process: Evaluation

NCLEX: Health Promotion and Maintenance

 

 

16. The nurse is preparing written handouts to be used as part of the standardized teaching plan for patients who have been recently diagnosed with diabetes. Which statement best reflects the appropriate reading level?

a.	Polyphagia, polydipsia, and polyuria are common symptoms of diabetes mellitus.
b.	Some diabetics control blood glucose with oral medications or nutritional interventions.
c.	The use of the right foods can help in keeping blood sugar at a near-normal level.
d.	Diabetes mellitus is characterized by chronic hyperglycemia and the associated symptoms.

 

Correct Answer: C

Rationale: The readability of this statement will be most appropriate for the widest variety of patients. The other responses have words with three or more syllables, use many medical terms, and/or are too long.

 

Cognitive Level: Application                       Text Reference: p. 62

Nursing Process: Planning

NCLEX: Health Promotion and Maintenance

 

 

17. The nurse in the hospital has implemented a teaching plan to assist a patient with rheumatoid arthritis in accomplishing daily activities independently. To evaluate the patient’s long-term response to the teaching, the best action by the nurse will be to

a.	check the patient’s ability to bathe without any assistance the next day.
b.	make a referral to the home health nursing department for home visits.
c.	arrange a physical therapy visit before the patient is discharged from the hospital.
d.	have the patient demonstrate the taught skills again at the end of the teaching session.

 

Correct Answer: B

Rationale: The patient’s long-term response may need to be assessed after discharge; a home health referral will allow this to occur. The other actions will allow evaluation of the patient’s short-term response to teaching.

 

Cognitive Level: Application                       Text Reference: p. 64

Nursing Process: Planning

NCLEX: Health Promotion and Maintenance