Test Bank Problems Clinical Edition Surgical Bucher of Heitkemper Camera Dirksen Assessment 8th Management Lewis Medical Nursing and


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Chapter 4: Patient and Caregiver Teaching
Test Bank
1. A patient with newly diagnosed breast cancer has a nursing diagnosis of deficient
knowledge about breast cancer. When the nurse is planning teaching for the patient,
which is the most important initial learning goal?
a. The patient will select the most appropriate breast cancer therapy.
b. The patient will state ways of preventing the recurrence of the tumor.
c. The patient will demonstrate coping skills needed to manage the disease.
d. The patient will choose methods to minimize adverse effects of treatment.
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.
DIF: Cognitive Level: Application REF: 50 TOP: Nursing Process:
MSC: NCLEX: Health Promotion and Maintenance
2. After the nurse implements diet instruction for 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
d. the teaching methods were ineffective in helping the patient learn the dietary
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.
DIF: Cognitive Level: Application REF: 50-51 TOP: Nursing Process:
MSC: NCLEX: Health Promotion and Maintenance
Test Bank
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
3. A 43-year-old is 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
b. Demonstrate the correct method for cleaning and redressing the wound to the
c. Assure the patient that the nurse is an expert on management of diabetes
d. Wait until after discharge and have a home health nurse teach about foot care and
diabetes management.
Principles of adult education indicate that readiness and motivation to le arn are high
when facing new tasks (such wound care) 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 independe nt; 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: Application REF: 50 TOP: Nursing Process:
MSC: NCLEX: Health Promotion and Maintenance
4. A patient admitted to the hospital with hyperglycemia and newly diagnosed diabetes
mellitus is scheduled for discharge the second day after admission. When implementing
patient teaching, which is the best action for the nurse to take?
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.
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: Application REF: 52
TOP: Nursing Process: Implementation MSC: 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. preparation.
b. termination.
c. maintenance.
Test Bank
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
d. contemplation.
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.
DIF: Cognitive Level: Comprehension REF: 50-51
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
6. 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. the degree of patient motivation and readiness to learn.
b. what information the patient will be able to understand.
c. that the family must be included in the teaching process.
d. which instructional strategies should be used in teaching.
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 b e included in the teaching
DIF: Cognitive Level: Comprehension REF: 54 TOP: Nursing Process:
MSC: NCLEX: Health Promotion and Maintenance
7. 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 statement by the nurse at this time is
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
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
Positive reinforcement of the learner’s 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: Application REF: 51 | 55
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
Test Bank
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
8. To assess a patient’s readiness to learn before planning teaching activities, which
question should the nurse ask?
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?”
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: Application REF: 55
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
9. The nurse develops 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.
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.
DIF: Cognitive Level: Application REF: 55 TOP: Nursing Process:
MSC: NCLEX: Health Promotion and Maintenance
10. A patient with poor circulation to the feet requires teaching about foot care. Which
learning goal should the nurse include in the teaching pl an?
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.
Learning goals should state clear, measurable outcomes of the learning process. Options a
and c describe actions that the nurse will take, rather than behaviors that indicate that
patient learning has occurred. Option d is too vague and nonspecific to meas ure whether
learning has occurred.
DIF: Cognitive Level: Application REF: 55-56 TOP: Nursing Process:
MSC: NCLEX: Health Promotion and Maintenance

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