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== SAMPLE ==

Chapter 2: Patient Teaching and Health Literacy
Edmunds: Introduction to Clinical Pharmacology, 8th Edition

MULTIPLE CHOICE

1. A patient comes into the clinic and is started on a new antihypertensive medication. In the past, this patient has not been taking the medication on a daily basis as per the drug treatment plan. Which strategy should the nurse use to get the patient to take the prescribed medication?
a. Tell the patient to follow the plan of care.
b. Tell the patient he will have a stroke if he does not take his medication.
c. Discuss with the patient the reasons that he is not taking his medication.
d. Tell the patient he will have to see a doctor to get more medication.

ANS: C
When the nurse teaches the patient, the nurse should discuss the patient’s reasons for not taking the medication and help the patient set goals so the patient can make informed decisions about taking the medication.

DIF: Cognitive Level: Apply REF: p. 11 OBJ: 2
TOP: Compliance, Noncompliance, and Concordance
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. A patient is a newly diagnosed diabetic who has been incorrectly taking the medication prescribed. Which is the most likely reason?
a. The patient feels the dose of medication is not enough.
b. The patient feels the dose of medication is too much.
c. The patient does not understand the medication dosage.
d. The patient cannot swallow the medication.

ANS: C
There are two basic reasons a patient has difficulty meeting treatment goals: (1) the patient does not understand what to do, or (2) the patient understands what to do but fails to do it. When teaching the patient, discuss both of these reasons with the goal of helping the patient make informed decisions about properly taking medications.

DIF: Cognitive Level: Apply REF: p. 11 OBJ: 2
TOP: Compliance KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

3. Poor literacy is a problem that interferes with a patient’s ability to deal with the health care setting. What can contribute to a patient’s literacy problems?
a. The patient is hearing-impaired.
b. The patient cannot read health content.
c. The patient’s family is not involved.
d. The patient lives alone.

ANS: B
Inability to read health content often means that patients cannot read the information nurses or doctors send home with them about their disease, the medications they are taking, and important things they need to know. Recent research suggests that written information given to most patients should be written at a fifth- to seventh-grade level to make it more likely that they will understand.

DIF: Cognitive Level: Understand REF: p. 12 OBJ: 2
TOP: Communicating with Patient KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

4. The nurse needs to teach a patient about the side effects of a medication she is taking. By what means will the nurse know whether the patient has learned the information she needs to know about her medication?
a. The patient can repeat the information.
b. The patient learns the information in her mind.
c. The patient remembers most of the information given.
d. The patient is selective with the information given.

ANS: A
Have the patient repeat information back, show a procedure, or follow up on a behavior to determine how well the material has been learned. Return demonstration or discussion is the only way to measure a patient’s understanding.

DIF: Cognitive Level: Understand REF: p. 13 OBJ: 3
TOP: Assess Learning Needs KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

5. The nurse is planning the teaching/learning objectives for a patient who comes into the clinic to learn about hormonal therapy and is experiencing stress. What will help the patient’s learning process?
a. Covering as many topics as possible at one time
b. Timing the teaching to coincide with visiting hours
c. Teaching the patient while a favorite television program is playing in the background
d. Systematic teaching in a quiet, unhurried setting

ANS: D
Teaching needs to be given in a systematic manner to decrease stress. It needs to be provided in a timely way and in a quiet, unhurried setting that gives the patient a chance to ask questions. If the patient appears to be anxious or in pain, stop and reschedule the session.

DIF: Cognitive Level: Apply REF: p. 14 OBJ: 3
TOP: Teaching Plan KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

6. Television ads that are created by drug companies cannot always answer patients’ questions. What is the term for television ads created for patients?
a. Direct-to-consumer advertising
b. Direct visual teaching advertising
c. Limited-content advertising
d. Limited-focus advertising

ANS: A
Television ads created by drug companies for patients are called direct-to-consumer advertising. Patients may have many questions or inaccurate information because they have seen these ads.

DIF: Cognitive Level: Understand REF: p. 16 OBJ: 3
TOP: Audiovisual Resources KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

7. The nurse used a combination of spoken and written information to teach a patient about the medications he will be taking when he leaves the hospital. What is another teaching resource available to the patient that can provide him with the latest information once he is home?
a. A direct phone number to an on-call nurse
b. A website’s navigational address
c. All written informational material in a neat folder
d. A list of journal articles with direct information

ANS: B
The Internet is becoming a source of up-to-date health information, not only for nurses but for patients as well. Many Internet sites meet the needs of both. Patients should be aware that not all information presented on the Internet is accurate or appropriate.

DIF: Cognitive Level: Apply REF: p. 16 OBJ: 3
TOP: Internet Use KEY: Nursing Process Step: Implementation
MSC: NCLEX: N/A

8. The nurse is teaching a patient about blood pressure control along with diet and weight reduction. How will the nurse be reassured that the patient understands this learning session?
a. The patient takes a few notes.
b. The patient repeats back some of the information given.
c. The patient is on time for every teaching session.
d. The patient takes his blood pressure and weighs himself.

ANS: D
Teaching that is active and which provides sensory involvement like handling things, hearing things, eating something, and so forth allows more effective learning to take place. The more senses involved, the better the chance that the patient will remember.

DIF: Cognitive Level: Apply REF: p. 17 OBJ: 3
TOP: Evaluation of Learning KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity

9. The nurse is teaching a patient from a general teaching plan that has been set up for all patients with type 2 diabetes. What should be the nurse’s first consideration if this patient is unable to perform her blood glucose test without assistance?
a. The patient has not accepted her diagnosis.
b. The patient feels the test strip is wrong for testing her blood.
c. The patient is having problems understanding the process.
d. The learning objectives should be less specific for this patient.

ANS: C
Sometimes the process breaks down when a patient does not understand what to do, cannot afford the treatment plan, or loses confidence in her ability to change. Whatever the problem, the nurse must attempt to discover where the process went wrong.

DIF: Cognitive Level: Apply REF: pp. 16-17 OBJ: 3
TOP: Evaluation of Learning KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity

10. An elderly patient tells the nurse he is unable to read some of the instructions about his medication. The nurse’s first response is to do which of the following?
a. Give the patient verbal instructions for the medication.
b. Read the instructions with the patient and then have the patient repeat them back to the nurse.
c. Stop the medication until the patient can get an appointment in the clinic.
d. Do nothing and tell the patient to take the medication as prescribed.

ANS: B
Have the patient repeat information back, show a procedure, or follow through on behavior to determine how well he has learned the material. Giving feedback to the patient helps the patient realize what he has learned or identify areas in which he still needs help. Try to assess why he can’t read the instructions. It may be that the print is too small. A magnifying glass may help.

DIF: Cognitive Level: Apply REF: p. 13 OBJ: 1
TOP: Assessment of Patient Education Needs
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

11. It is important for the nurse and the patient to communicate effectively. The inability of a patient to read and write can interfere with effective communication and place her in “health disparity.” Which factor can help the patient’s treatment plan?
a. Teaching the patient to read and write
b. Teaching the patient about his drugs and disease process
c. Teaching the patient to call the drug company for information about prescription drugs
d. Giving instructions only in written form

ANS: B
It is clear that there is no more important teaching than that which the nurse gives to the patient about his disease and its drug treatment.

DIF: Cognitive Level: Apply REF: p. 12 OBJ: 2
TOP: Communicating with Patient KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

12. The nurse is teaching an elderly man who has hearing challenges. What is the best way to help this patient meet those challenges?
a. Speak loudly into the patient’s ear.
b. Give the information to the patient’s family.
c. Stand to the patient’s side and speak normally.
d. Give the patient written information.

ANS: D
A growing number of patients are elderly and may present certain challenges to the nurse in ensuring that they can hear, understand, and accept suggestions. Although speaking clearly to patients is important, much of the teaching patients need will be given in writing. How and what is written are very important if we wish to send the right message.

DIF: Cognitive Level: Apply REF: p. 11 OBJ: 2
TOP: Communicating with Patient KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

13. The nurse is teaching a patient about her oral diabetic medication that is taken daily. The patient has specific goals that have been set with regard to glucose control. What specific learning objectives would be a teaching guide for this patient?
a. Take blood sugar with fingerstick at 12 noon and repeat at supper daily.
b. Fingerstick glucose will be 85 mg/dL to 125 mg/dL 2 hours after meals daily.
c. Fingerstick blood sugar will be normal after breakfast and lunch daily.
d. Blood sugar will be normal before breakfast and lunch and after supper daily.

ANS: B
The best objectives are clearly stated by describing the desired performance and what makes it adequate.

DIF: Cognitive Level: Apply REF: p. 14 OBJ: 3
TOP: Preparing a Teaching Plan KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

14. The nurse is teaching a patient with a new diagnosis of hypothyroidism. The patient is anxious and fears gaining weight with this condition. Which of the following would help this patient’s learning process?
a. Allow the patient to go home and read the information.
b. Let the patient watch television for 2 hours before teaching.
c. Give the teaching sessions in a systematic manner.
d. Only tell the patient what he wants to hear.

ANS: C
To avoid creating more stress for the patient, teaching needs to be given in a systematic manner. It needs to be provided in a timely, unhurried, and quiet setting, allowing the patient to ask questions.

DIF: Cognitive Level: Apply REF: p. 14 OBJ: 3
TOP: Preparing a Teaching Plan KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

15. A patient begins medication therapy for hypertension. Which reason is most likely to make the scheduled teaching plan change for this patient?
a. The patient’s outlook for her condition changes.
b. The patient writes down some of the information.
c. The patient has no questions after being taught.
d. The patient’s systolic blood pressure falls below 60 mm Hg with therapy.

ANS: D
Additional teaching will be required when changes in the patient’s condition warrant further adjustment in therapy.

DIF: Cognitive Level: Apply REF: p. 13 OBJ: 3
TOP: Preparing a Teaching Plan KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity

16. When giving the patient key written information about his discharge, the nurse will include which of the following?
a. Prescriptions written by the physician
b. The questionnaire found at the bedside
c. The unit-dose package given at discharge
d. Drug inserts and booklets prepared for medications

ANS: D
Written information can include special labels for prescription bottles, inserts from drug packages, and booklets prepared about medications.

DIF: Cognitive Level: Remember REF: pp. 14-15 OBJ: 3
TOP: Teaching Plan KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

17. A teaching plan is scheduled to deliver specific content during a session. Which is the appropriate response to unrelated but important questions interrupting the planned content of the session?
a. A quick response is acceptable during the session.
b. The plan must be closely followed with no interruptions.
c. Interruptions are only allowed at break time.
d. Unrelated content questions can only be answered at the end of the session.

ANS: A
In the clinic or hospital, teaching often happens in response to a patient’s questions, and the nurse may need to respond quickly without time to prepare, plan, or consider overall what the patient needs to know.

DIF: Cognitive Level: Apply REF: p. 14 OBJ: 2
TOP: Teaching Plan KEY: Nursing Process Step: Implementation
MSC: NCLEX: N/A

18. The nurse and other health care providers are legally obligated to provide which kind of information to the patient for the purpose of informed consent?
a. A lot of technical and scientific information
b. Legal information for the patient and family
c. Reasonable specifics
d. Information in the patient’s own language and jargon

ANS: C
The law requires that the amount and type of information provided to the patient be “reasonable.”

DIF: Cognitive Level: Remember REF: p. 14 OBJ: 2
TOP: Patient Understanding KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity

19. Which efforts suggested by researchers in patient education are useful for nurses to follow to increase a patient’s medication compliance?
a. Short verbal responses are easy to learn.
b. Limited visual material with more verbal responses may be helpful.
c. Flash cards are very useful for visualization.
d. A variety of teaching methods, including written information and audiotapes, are useful.

ANS: D
Research suggests that to increase medication compliance in patients, the nurse should use a variety of means to give necessary instructions. These methods include telling patients the necessary information and using written information, audiotapes, videotapes, and the computer.

DIF: Cognitive Level: Apply REF: p. 14 OBJ: 2
TOP: Teaching Plan KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

20. The term concordance is sometimes preferred over compliance or noncompliance when speaking of a patient following a prescribed plan of care for which reason?
a. It is judgmental.
b. It is nonjudgmental.
c. It is caring.
d. It is uncaring.

ANS: B
A term that does not judge the patient is concordance. Instead, this term emphasizes the collaboration among the patient, family, health care provider, and pharmacist.

DIF: Cognitive Level: Remember REF: p. 11 OBJ: 2
TOP: Compliance, Noncompliance, and Concordance KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

21. When a patient is first diagnosed with a disease, education should start with which of the following?
a. Describing what has gone wrong and what is likely to happen
b. Determining why the problem took so long to develop
c. Deciding who caused this problem
d. Discussing what the patient should have done differently

ANS: A
When a patient is first diagnosed with a problem, education must start with what has gone wrong and what is likely to happen.

DIF: Cognitive Level: Remember REF: p. 13 OBJ: 3
TOP: Patient Education KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity

22. The nurse is teaching the patient an activity the patient needs to learn by the time this teaching session is over. Which objectives for this patient clarify that learning has taken place?
a. The patient’s face shows understanding while the nurse is explaining.
b. The patient smiles after each instruction is given during the teaching session.
c. The patient describes the information at the end of the session.
d. The patient looks the nurse directly in the face during the session.

ANS: C
The best objectives are clearly stated by describing the desired patient performance and what makes it acceptable. Feedback is essential to determine whether learning has taken place.

DIF: Cognitive Level: Apply REF: p. 14 OBJ: 3
TOP: Teaching Plan KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity

23. When teaching a patient about her plan of care, which action will confirm for the nurse that learning has taken place?
a. Ask the patient if she understands the information.
b. Have the patient repeat the information learned.
c. Allow the patient to take the lead.
d. Let the patient evaluate her own level of learning.

ANS: B
Have the patient repeat information back, show a procedure, or follow through on a behavior to determine how well she has learned the material.

DIF: Cognitive Level: Remember REF: p. 13 OBJ: 3
TOP: Patient Education KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

24. The LPN is teaching a patient about the side effects of his hypertension medication. Research has shown that the nurse should tell the patient about all the side effects of this medication for which reason?
a. Medications are hard to recognize by color and shape only.
b. Patients want to be able to discuss their medications.
c. Patients must be able to recognize side effects correctly.
d. Medication names are easier to pronounce.

ANS: C
Research has shown that those patients who are given more information are better able to correctly recognize side effects should they occur.

DIF: Cognitive Level: Apply REF: p. 12 OBJ: 3
TOP: Patient Education KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

25. The nurse talks with a clinic patient by phone and discovers the patient is not taking her medication as instructed. The patient was given only verbal instructions in her teaching session. The nurse should now have the patient do which of the following?
a. Listen to the nurse as the nurse repeats the instructions by phone.
b. Call every day, and the nurse will repeat the instructions until learned.
c. Return to the clinic to receive other teaching methods.
d. Have a family member take the instructions by phone.

ANS: C
Using a variety of teaching methods is more effective for learning than use of a single teaching method. In this case, the verbal teaching has not been effective so other methods should be employed.

DIF: Cognitive Level: Apply REF: p. 13 OBJ: 3
TOP: Patient Education KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity

26. There are three patients in the class the nurse is teaching about insulin injections. Two of the patients have demonstrated the ability to draw up and inject the insulin correctly. One patient has problems drawing up the insulin and injecting the medication after it is in the syringe. Which represents the next step the nurse could take to meet this patient’s learning needs?
a. Teach a family member to do the injections.
b. Teach each activity separately on different days.
c. Show the patient a film on giving injections.
d. Let the patient read about each activity, then do the procedures together.

ANS: B
Different teaching skills may be needed at different times for the same patient. Teaching should be carried out in small amounts over several meetings.

DIF: Cognitive Level: Apply REF: p. 13 OBJ: 3
TOP: Patient Education KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

27. Before educating a patient about his discharge medications, the nurse should do what?
a. Discuss where the patient will be staying after discharge.
b. Determine which pharmacy will fill the patient’s prescription.
c. Assess the patient’s specific learning needs.
d. Select a teaching method.

ANS: C
Before the nurse begins to educate the patient, the nurse should first assess the patient’s specific learning needs. This allows the nurse to take into account not only the patient’s specific learning needs but also the patient’s knowledge, reading ability, beliefs, and experiences.

DIF: Cognitive Level: Remember REF: p. 13 OBJ: 3
TOP: Patient Education KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

28. Patients may have difficulty in meeting treatment goals for which reasons? (Select all that apply.)
a. Lack of understanding of the goals
b. Incongruity between patient and nursing goals
c. Compliance with all aspects of the treatment plan
d. Limited financial resources
e. Limited time available

ANS: A, B, D, E
Some reasons patients have difficulty in meeting treatment goals are lack of understanding, different beliefs about treatment, different goals for treatment, and financial and time limitations. The nurse must determine the cause of the patient’s difficulty and develop a plan to address it.

DIF: Cognitive Level: Understand REF: p. 11 OBJ: 2
TOP: Compliance KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

29. What are essential steps in the patient-teaching process? (Select all that apply.)
a. Develop a single teaching strategy.
b. Assess the specific needs of the patient.
c. Select the teaching method.
d. Determine how well the material has been learned.
e. Assess the patient’s willingness to learn.

ANS: B, C, D, E
The patient-teaching process begins with an assessment of the needs of the patient and validation of the patient’s willingness to learn. Then the method of teaching is selected, and a variety of teaching strategies are developed. The nurse also determines how well the material has been learned by the patient.

DIF: Cognitive Level: Understand REF: p. 13 OBJ: 3
TOP: Patient Education KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

30. Health literacy is a problem for which reasons? (Select all that apply.)
a. Age
b. Inability to read a map
c. Inability to read a prescription
d. Lack of financial resources
e. Little knowledge of diseases

ANS: B, C, D
Health literacy is the ability to understand and use information that is important in keeping healthy. If a person cannot read a prescription to learn how many pills he should take, cannot read a map to find out how to get to the next appointment, or cannot understand his disease process, he has problems with health literacy.

DIF: Cognitive Level: Understand REF: p. 12 OBJ: 2
TOP: Patient Education KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

31. Which are basic reasons a treatment plan may be ineffective? (Select all that apply.)
a. Goal content focuses on medical facts.
b. Goal content is not in a handout.
c. Goal content has four objectives.
d. Goal content is measurable.
e. Goal content focuses on behavior.

ANS: A, B, C
Focus on behavior rather than medical facts. Be sure the goals of the handout are stated. There should be one or two objectives.

DIF: Cognitive Level: Understand REF: p. 15 OBJ: 2
TOP: Patient Communication KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

32. What factors may contribute to patient medication errors? (Select all that apply.)
a. Only two objectives, instead of four, are included in the treatment plan discussed with the patient.
b. The nurse fails to provide patients with information about both the desirable effects and the possible side effects of prescribed medication so that they can make an informed decision about the treatment plan.
c. Medication-related teaching materials sent home with patients are written at a higher than eighth-grade reading level.
d. Medication-related teaching materials sent home contain long sentences and medical terms rather than common or familiar words.
e. The nurse gives patients with new prescriptions verbal instructions only, rather than talking to patients and giving them written information or talking to patients along with showing audiovisual aids.

ANS: B, C, D, E
Patients tend to be more compliant and comfortable with taking their medication the more information they have about it, including both desirable (therapeutic) effects and possible side effects. Medication teaching materials should be written at the fifth- to seventh-grade reading level to ensure that most patients will be able to read and comprehend the information. Also, short sentences composed of common or familiar words, rather than a lot of medical jargon, make these educational tools easier to understand for the vast majority of people. It is particularly important to use both verbal and visual information when discussing new prescription medication with patients.

DIF: Cognitive Level: Understand REF: pp. 12-13 | pp. 15-16
OBJ: 1 TOP: Assessment of Patient Education Needs
KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe, Effective Care Environment

33. Which key points should the nurse include when providing patient education for a patient receiving medications? (Select all that apply.)
a. Common side effects
b. Intended use
c. Drug brand name only
d. Expected actions
e. Any special directions

ANS: A, B, D, E
When providing patient education for medication administration the nurse should include information such as common side effects, intended use and expected actions, generic and brand names of the drug, and any special directions such as take with meals.

DIF: Cognitive Level: Remember REF: pp. 12-14| Box 2-1
OBJ: 3 TOP: Preparing a Teaching Plan
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance