Medical Surgical Nursing Assessment and Management of Clinical Problems 10th Edition by Sharon L. Lewis Shannon Ruff Dirksen Margaret McLean Heitkemper Test Bank

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Medical Surgical Nursing Assessment and Management of Clinical Problems 10th Edition by Sharon L. Lewis Shannon Ruff Dirksen Margaret McLean Heitkemper Test Bank

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Chapter 04: Patient and Caregiver Teaching
Lewis: Medical-Surgical Nursing, 10th Edition

MULTIPLE CHOICE

1. A patient with newly diagnosed colon cancer has a nursing diagnosis of deficient knowledge about colon cancer. The nurse should initially focus on which learning goal for this patient?
a. The patient will state ways of preventing the recurrence of the cancer.
b. The patient will explore and select an appropriate colon cancer therapy.
c. The patient will demonstrate coping skills needed to manage the disease.
d. The patient will choose methods to minimize adverse effects of treatment.

ANS: B
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 explore and choose a treatment option. The other goals may be appropriate as treatment progresses.

DIF: Cognitive Level: Apply (application) REF: 47
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance

2. After the nurse provides diet instructions for a patient with diabetes, the patient can restate the information but fails to make the recommended diet changes. How would the nurse best evaluate the patients situation?
a. Learning did not occur because the patients behavior did not change.
b. Choosing not to follow the diet is the behavior that resulted from learning.
c. The nurses responsibility for helping the patient make diet changes has been fulfilled.
d. The teaching methods were ineffective in helping the patient learn about the necessary diet changes.

ANS: B
Although the patient behavior has not changed, the patients ability to restate the information indicates that learning has occurred, and the patient is choosing at this time not to change the diet. The patient may be in the contemplation or preparation stage in the transtheoretical model. The nurse should reinforce the need for change and continue to provide information and assistance with planning for change.

DIF: Cognitive Level: Apply (application) REF: 47
TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance

3. A patient is diagnosed with heart failure after being admitted to the hospital for shortness of breath and fatigue. Which teaching strategy, if implemented by the nurse, is most likely to be effective?
a. Assure the patient that the nurse is an expert on management of heart failure.
b. Teach the patient at each meal about the amounts of sodium in various foods.
c. Discuss the importance of medication control in maintenance of long-term health.
d. Refer the patient to a home health nurse for instructions on diet and fluid restrictions.

ANS: B
Principles of adult education indicate that readiness and motivation to learn are high when facing new tasks (e.g., learning about the sodium amounts in various food items) and when demonstration and practice of skills are available. Although a home health referral may be needed for this patient, 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.

DIF: Cognitive Level: Apply (application) REF: 47
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance

4. A patient who was admitted to the hospital with hyperglycemia and newly diagnosed diabetes mellitus is scheduled for discharge the second day after admission. When implementing patient teaching, what is the priority action for the nurse?
a. Instruct about the increased risk for cardiovascular disease.
b. Provide detailed information about dietary control of glucose.
c. Teach glucose self-monitoring and medication administration.
d. Give information about the effects of exercise on glucose control.

ANS: C
When time is limited, the nurse should focus on the priorities of teaching. In this situation, the patient should know how to test blood glucose and administer medications to control glucose levels. The patient will need further teaching about the role of diet, exercise, various medications, and the many potential complications of diabetes, but these topics can be addressed through planning for appropriate referrals.

DIF: Cognitive Level: Apply (application) REF: 49
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

5. A patient states, I told my husband I wouldnt buy as much prepared food snacks, so I will go the grocery store to buy fresh fruit, vegetables, and whole grains. When using the Transtheoretical Model of Health Behavior Change, the nurse identifies that this patient is in which stage of change?
a. Preparation c. Maintenance
b. Termination d. Contemplation

ANS: A
The patients 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.

DIF: Cognitive Level: Understand (comprehension) REF: 48
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

6. While admitting a patient to the medical unit, the nurse determines that the patient has a hearing impairment. How should the nurse use this information to plan teaching and learning strategies?
a. Motivation and readiness to learn will be affected.
b. The family must be included in the teaching process.
c. The patient will have problems understanding information.
d. Written materials should be provided with verbal instructions.

ANS: D
The information that the patient has a hearing impairment indicates that the nurse should use written and verbal materials in teaching along with other strategies. The patient does not indicate a lack of motivation or an inability to understand new information. The patients decreased hearing does not necessarily imply that the family must be included in the teaching process.

DIF: Cognitive Level: Understand (comprehension) REF: 51
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance

7. A patient who is morbidly obese states, Ive recently made some changes in my life. Ive decreased my fat intake, and Ive stopped smoking. Which statement, if made by the nurse, is the best initial response?
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. Which additional changes in your lifestyle would you like to implement at this time?
d. You have already accomplished changes that are important for the health of your heart.

ANS: D
Positive reinforcement of the learners achievements is critical in making lifestyle changes. This patient 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.

DIF: Cognitive Level: Apply (application) REF: 53
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

8. The nurse is planning a teaching session with a patient newly diagnosed with migraine headaches. To assess a patients readiness to learn, which question should the nurse ask first?
a. What kind of work and leisure activities do you do?
b. What information do you think you need right now?
c. Can you describe the types of activities that help you learn new information?
d. Do you have any religious beliefs that are inconsistent with the planned treatment?

ANS: B
Motivation and readiness to learn depend on what the patient values and perceives as important. The other questions are also important in developing the teaching plan, but do not address what information most interests the patient at present.

DIF: Cognitive Level: Apply (application) REF: 53
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

9. The nurse considers a nursing diagnosis of ineffective health maintenance related to low motivation for a patient with diabetes. Which finding would the nurse most likely use to support this nursing diagnosis?
a. The patient does not perform capillary blood glucose tests as directed.
b. The patient occasionally forgets to take the daily prescribed medication.
c. The patient states that dietary changes have not made any difference at all.
d. The patient cannot identify signs or symptoms of high and low blood glucose.

ANS: C
The patients motivation to follow a diabetic diet will be decreased if the patient believes that dietary changes do not affect symptoms. The other responses do not indicate that the ineffective health maintenance is caused by lack of motivation.

DIF: Cognitive Level: Apply (application) REF: 48
TOP: Nursing Process: Diagnosis MSC: NCLEX: Health Promotion and Maintenance

10. A patient with diabetic neuropathy 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 patient will list three ways to protect the feet from injury by discharge.
c. The nurse will instruct the patient on appropriate foot care before discharge.
d. The patient will understand the rationale for proper foot care after instruction.

ANS: B
Learning goals should state clear, measurable outcomes of the learning process. Demonstrating technique for trimming toenails and providing instructions on foot care are actions that the nurse will take rather than behaviors that indicate that patient learning has occurred. A learning goal that states that the patient will understand the rationale for proper foot care is too vague and nonspecific to measure whether learning has occurred.

DIF: Cognitive Level: Apply (application) REF: 54
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance

11. A patient needs to learn how to instill eye drops. Which teaching strategy, if implemented by the nurse, would be most effective?
a. Peer teaching
b. Lecture-discussion
c. Printed instructions
d. Demonstration and return demonstration

ANS: D
Demonstration with return demonstration (show back) is best used to teach a patient how to learn to perform a skill. Lecture-discussion, peer teaching, and printed materials are more useful for other learning needs.

DIF: Cognitive Level: Understand (comprehension) REF: 56
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance

12. The nurse and the patient who is diagnosed with hypertension develop this goal: The patient will select a 2-gram sodium diet 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. Have the patient list substitutes for favorite foods that are high in sodium.
b. Check the sodium content of the patients menu choices over the next 3 days.
c. Ask the patient to identify which foods on the hospital menus are high in sodium.
d. Compare the patients sodium intake before and after the teaching was implemented.

ANS: B
All of the answers address the patients sodium intake, but the desired patient behaviors in the learning objective are most clearly addressed by evaluating the sodium content of the patients menu choices.

DIF: Cognitive Level: Apply (application) REF: 57
TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance

13. The nurse prepares written handouts to be used as part of the standardized teaching plan for patients who have been recently diagnosed with diabetes. What statement would be most appropriate to include in the handouts?
a. Eating the right foods can help in keeping blood glucose at a near-normal level.
b. Polyphagia, polydipsia, and polyuria are common symptoms of diabetes mellitus.
c. Some patients with diabetes control blood glucose with oral medications, injections, or dietary interventions.
d. Diabetes mellitus is characterized by chronic hyperglycemia and the associated symptoms than can lead to long-term complications.

ANS: A
The reading level for patient teaching materials should be at the fifth grade level. The other responses have words with three or more syllables, use many medical terms, or are too long.

DIF: Cognitive Level: Apply (application) REF: 52
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance

14. The hospital nurse implements a teaching plan to assist an older patient who lives alone to independently accomplish daily activities. How would the nurse best evaluate the patients long-term response to the teaching?
a. Make a referral to the home health nursing agency for home visits.
b. Have the patient demonstrate the learned skills at the end of the teaching session.
c. Arrange a physical therapy visit before the patient is discharged from the hospital.
d. Check the patients ability to bathe and get dressed without any assistance the next day.

ANS: A
A home health referral would allow for the assessment of the patients long-term response after discharge. The other actions allow evaluation of the patients short-term response to teaching.

DIF: Cognitive Level: Apply (application) REF: 57
TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance

15. A patient who smokes a pack of cigarettes per day tells the nurse, I enjoy smoking and have no plans to quit. Which nursing diagnosis is most appropriate?
a. Health-seeking behaviors related to cigarette use
b. Ineffective health maintenance related to tobacco use
c. Readiness for enhanced self-health management related to smoking
d. Deficient knowledge related to long-term effects of cigarette smoking

ANS: B
The patients statement indicates that he or she is not considering smoking cessation. Ineffective health maintenance is defined as the inability to identify, manage, or seek out help to maintain health.

DIF: Cognitive Level: Apply (application) REF: 47
TOP: Nursing Process: Diagnosis MSC: NCLEX: Health Promotion and Maintenance

16. An older Asian patient, who is seen at the health clinic, is diagnosed with protein malnutrition. What priority action should the nurse include in the teaching plan?
a. Suggest the use of liquid supplements as a way to increase protein intake.
b. Encourage the patient to increase the dietary intake of meat, cheese, and milk.
c. Ask the patient to record the intake of all foods and beverages for a 3-day period.
d. Focus on the use of combinations of beans and rice to improve daily protein intake.

ANS: C
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.

DIF: Cognitive Level: Apply (application) REF: 49
OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance

17. A middle-aged patient who has diabetes tells the nurse, I want to know how to give my own insulin so I dont have to bother my wife all the time. What is the priority action of the nurse?
a. Demonstrate how to draw up and administer insulin.
b. Discuss the use of exercise to decrease insulin needs.
c. Teach about differences between the various types of insulin.
d. Provide handouts about therapeutic and adverse effects of insulin.

ANS: A
Adult education is most effective when focused on information that the patient thinks is needed right now. All of 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 patients stated priority topic.

DIF: Cognitive Level: Apply (application) REF: 47
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance

18. The nurse plans to teach a patient and the caregiver how to manage high blood pressure (BP). Which action should the nurse take first?
a. Give written information about hypertension to the patient and caregiver.
b. Have the dietitian meet with the patient and caregiver to discuss a low-sodium diet.
c. Teach the caregiver how to take the patients BP using a manual blood pressure cuff.
d. Ask the patient and caregiver to select information from a list of high BP teaching topics.

ANS: D
Because adults learn best when given information that they view as being needed immediately, asking the caregiver and patient to prioritize learning needs is likely to be the most successful approach to home management of health problems. The other actions may also be appropriate, depending on what learning needs the caregiver and patient have, but the initial action should be to assess what the learners feel is important.

DIF: Cognitive Level: Apply (application) REF: 47
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Health Promotion and Maintenance

19. A postoperative patient and caregiver need discharge teaching. Which actions included in the teaching plan can the nurse delegate to unlicensed assistive personnel (UAP)?
a. Evaluate whether the patient and caregiver understand the teaching.
b. Show the caregiver how to accurately check the patients temperature.
c. Schedule the discharge teaching session with the patient and caregiver.
d. Give the patient a pamphlet reinforcing teaching already done by the nurse.

ANS: D
Providing a pamphlet to a patient to reinforce previously taught material does not require nursing judgment and can safely be delegated to UAP. Demonstration of how to take a temperature accurately, determining the best time for teaching, and evaluation of the success of patient teaching all require judgment and critical thinking and should be done by the registered nurse.

DIF: Cognitive Level: Apply (application) REF: 46
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment

20. A family caregiver tells the home health nurse, I feel like I can never get away to do anything for myself. Which action is best for the nurse to take?
a. Assist the caregiver in finding respite services.
b. Assure the caregiver that the work is appreciated.
c. Encourage the caregiver to discuss feelings openly with the nurse.
d. Tell the caregiver that family members provide excellent patient care.

ANS: A
Respite services allow family caregivers to have time away from their caregiving responsibilities. The other actions may also be helpful, but the caregivers statement clearly indicates the need for some time away.

DIF: Cognitive Level: Apply (application) REF: 49
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

1. The nurse plans to provide instructions about diabetes to a patient who has a low literacy level. Which teaching strategies should the nurse use (select all that apply)?
a. Discourage use of the Internet as a source of health information.
b. Avoid asking the patient about reading abilities and level of education.
c. Provide illustrations and photographs showing various types of insulin.
d. Schedule one-to-one teaching sessions to practice insulin administration.
e. Obtain CDs and DVDs that illustrate how to perform blood glucose testing.

ANS: C, D, E
For patients with low literacy, visual and hands-on learning techniques are most appropriate. The nurse will need to obtain as much information as possible about the patients reading level in order to provide appropriate learning materials. The nurse should guide the patient to Internet sites established by reputable heath care organizations such as the American Diabetes Association.

DIF: Cognitive Level: Apply (application) REF: 52
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

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