Chapter 04: Patient and Caregiver Teaching
Harding: Lewis’s Medical-Surgical Nursing, 11th Edition
MULTIPLE CHOICE
1. The nurse has assessed that a patient with newly diagnosed colon cancer does not have basic
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) 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 does not make the recommended diet changes. How would the nurse evaluate
this outcome?
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 nurse’s 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 patient’s 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) 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. Delay teaching until the patient is seen by a home health nurse after discharge.
c. Discuss the importance of medication control to avoid long-term complications.
d. Explain to the patient at each meal about the amounts of sodium in various foods.
ANS: D
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) 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
is scheduled for discharge the second day after admission. When implementing patient
teaching, what is the priority action for the nurse?
a. Provide detailed information about dietary control of glucose.
b. Teach glucose self-monitoring and medication administration.
c. Give information about the effects of exercise on glucose control.
d. Instruct about the risk for cardiovascular disease with hyperglycemia.
ANS: B
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: Analyze (analysis)
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
5. A patient states, “I told my husband I will go the grocery store to buy fresh fruit, vegetables,
and whole grains instead of prepared food snacks.” When using the Transtheoretical Model of
Health Behavior Change, the nurse identifies that this patient is in which stage of change?
a. Preparation
b. Termination
c. Maintenance
d. Contemplation
ANS: A
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: Understand (comprehension)
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 patient’s
decreased hearing does not necessarily imply that the family must be included in the teaching
process.
DIF: Cognitive Level: Understand (comprehension) TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
7. A patient who is morbidly obese states, “I’ve recently decreased my fat intake, and I’ve
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.”
b. “You have accomplished changes that are important for the health of your heart.”
c. “Are you having any difficulty in maintaining the changes you have already
made?”
d. “Which additional changes in your lifestyle would you like to implement at this
time?”
ANS: B
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: Apply (application)
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 the patient’s 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)
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
9. 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) TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
10. A patient needs to learn how to instill eyedrops. Which teaching strategy, if implemented by
the nurse, would be most effective?
a. Peer teaching
b. Lecture-discussion
c. Printed instructions
d. 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) TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
11. The nurse and the patient who is diagnosed with hypertension develop this goal: “The patient
will select a 2-g sodium diet from the hospital menu for 3 days.” Which evaluation method
will the nurse use to determine 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 patient’s menu choices over the next 3 days.
c. Compare the patient’s sodium intake before and after the teaching was
implemented.
d. Ask the patient to identify which foods on the hospital menus are high in sodium
for 3 days in a row.
ANS: B
The desired patient behaviors in the learning objective are most clearly addressed by
evaluating the sodium content of the patient’s menu choices. Other answers address the
patient’s sodium intake but not the specific goal.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Evaluation
MSC: NCLEX: Health Promotion and Maintenance
12. 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 is written at a level
appropriate to include in the handouts?
a. Polyphagia, polydipsia, and polyuria are common symptoms of diabetes.
b. Eating the right foods can help in keeping blood glucose at a near-normal level.
c. Some patients with diabetes control blood glucose with oral medications,
injections, or dietary interventions.
d. Diabetes is characterized by chronic hyperglycemia and the associated symptoms
than can lead to long-term complications.
ANS: B
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) TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
13. 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 patient’s
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 patient’s ability to bathe and get dressed without assistance the next day.
ANS: A
A home health referral would allow for the assessment of the patient’s long-term response
after discharge. The other actions allow evaluation of the patient’s short-term response to
teaching.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Evaluation
MSC: NCLEX: Health Promotion and Maintenance
14. A patient who smokes a pack of cigarettes per day tells the nurse, “I enjoy smoking and have
no plans to quit.” When using the Transtheoretical Model of Health Behavior Change, the
nurse identifies that this patient is in which stage of change?
a. Precontemplation
b. Contemplation
c. Maintenance
d. Termination
ANS: A
The patient’s statement shows that he or she is not considering smoking cessation. In the
precontemplation stage, patients are not concerned about their cigarette smoking and are not
considering changing their behavior.
DIF: Cognitive Level: Understand (comprehension) TOP: Nursing Process: Diagnosis
MSC: NCLEX: Health Promotion and Maintenance
15. An older Asian patient seen at the health clinic is diagnosed with protein malnutrition. What
action should the nurse plan to implement first?
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)
OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
16. A middle-aged patient who has diabetes tells the nurse, “I want to know how to give my own
insulin so I don’t have to bother my wife all the time.” What action should the nurse complete
first?
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 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 stated priority topic.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
17. The nurse plans to teach a patient and the caregiver how to manage high blood pressure.
Which action should the nurse take first?
a. Teach the caregiver how to use a manual blood pressure cuff.
b. Give written information about hypertension to the patient and caregiver.
c. Ask the patient to select information from a list of hypertension teaching topics.
d. Have the dietitian meet with the patient and caregiver to discuss a low-sodium diet
ANS: C
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)
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
18. 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. Give the patient a pamphlet to reinforce teaching done by the nurse.
c. Plan for the discharge teaching session with the patient and caregiver.
d. Show the caregiver how to accurately check the patient’s temperature.
ANS: B
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)
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
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 patient’s 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)
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance