Chapter 09: Patient Education and Health Promotion Williams: Dewit'S Fundamental Concepts and Skills For Nursing, 5Th Edition

Chapter 09: Patient Education and Health Promotion
Williams: deWit's Fundamental Concepts and Skills for Nursing, 5th Edition
MULTIPLE CHOICE
1. Before beginning to teach a patient to give himself insulin, the nurse asks, “Have you ever
known anyone who gave himself insulin injections?” This question is primarily designed to:
a. assess the patient’s learning needs.
b. stimulate the patient to focus on the patient education goal.
c. reduce the patient’s anxiety relative to insulin injection.
d. reduce the amount of information the nurse has to provide.
ANS: A
Assessing a patient’s previous experience (as well as education, learning mode, and
motivation) gives the nurse valuable information in developing a patient education plan
tailored to the individual. It may reduce the amount of information needed, or it may
increase it if some of what the patient “knows” is erroneous.
DIF: Cognitive Level: Analysis REF: p. 121 OBJ: Theory #3

TOP: Assessing Learning Needs KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
2. The nurse uses a syringe and vial of insulin to show how to draw up the correct dose while
she explains the procedure to the patient. To best promote learning, her next step should be
to:
a. give the patient written materials to study and learn the procedure.
b. have the patient explain the procedure to the nurse to assess understanding.
c. give the patient a day to allow him to process and absorb the information.
d. have the patient practice the procedure with the nurse helping.
ANS: D
Kinesthetic, or hands-on, learning reinforces the visual demonstration. Immediate handling
of the materials reduces anxiety. Giving the patient reading materials or asking the patient to
explain verbally will not be as effective as the kinesthetic application.
DIF: Cognitive Level: Application REF: p. 121 OBJ: Theory #3

TOP: Modes of Learning KEY: Nursing Process Step: Implementation
3. Patient education for an 82-year-old patient to perform a dressing change to be done at home
after discharge, the nurse would adjust the teaching session to:
a. include another person in the instruction because an 82-year-old person will be
unable to master the technique.
b. slow the pace and frequently ask questions to assess comprehension.
c. speed through the details because age and experience will shorten learning time.
d. provide written material and diagrams alone.
ANS: B
The older patient needs to have the pace slowed and have time to ask questions to confirm
comprehension. The inclusion of written materials to reinforce patient education is also
good, but should not be the only method of instruction.

TOP: Factors Affecting Learning KEY: Nursing Process Step: Planning
4. An 80-year-old patient is to be taught the process of colostomy irrigation and reattachment

of the colostomy bag. The nurse’s initial assessment prior to instruction should address the
patient’s:
a. understanding of the process of irrigation.
b. familiarity with the irrigation materials.
c. manual dexterity.
d. motivation to learn.
ANS: D
The patient’s motivation to learn a new skill is essential to the success of the instruction.
Some patients need to see the advantage of independence to motivate them to learn. Manual
dexterity and basic understanding of materials and process are important, but initially the
motivation needs to be assessed.
DIF: Cognitive Level: Analysis REF: p. 122

OBJ: Clinical Practice #1 TOP: Motivation
KEY: Nursing Process Step: Assessment
5. The nurse can assess her patient’s ability to read and comprehend written instructions by
doing which of the following?
a. Asking the patient, “Did you graduate from high school?”
b. Giving the patient a printed instruction sheet and saying, “Some people have
difficulty with written instructions. Others find them helpful. Would these be
helpful to you?”
c. Asking the patient, “Are you able to read?”
d. Giving the patient some printed materials and saying, “After you have read this, I’ll
ask you some questions about what’s in them, to see if you’ve learned it.”
ANS: B
Graduation from high school does not guarantee reading comprehension. Actually reading
allows the nurse to know if the patient can read as well as comprehend.

TOP: Assessing Literacy KEY: Nursing Process Step: Assessment
6. A patient being assessed for preoperative learning needs says his mother had the same
surgery by the same surgeon 3 years ago. The nurse should design the patient education plan
to:
a. do a brief review of the preoperative patient education, because the patient is
already familiar with the procedure.
b. teach thoroughly as the procedure may have changed.
c. simply give the patient a written list of preoperative instructions.
d. explore with the patient what he knows about the proposed surgery and add or
correct where necessary.
ANS: D
Assessing a patient’s experience and knowledge allows the nurse to tailor patient education
to the individual. The nurse should never assume that a patient “knows” what he is supposed
to know and that teaching again what the patient already knows is a waste of time or insults
the patient’s intelligence and experience. Giving a list of preoperative instructions is simply
impossible.
DIF: Cognitive Level: Analysis REF: p. 121 OBJ: Theory #4

TOP: Assessing Learning Needs KEY: Nursing Process Step: Assessment
7. The nurse is aware that the knowledge deficit of a postpartum patient with her first child that
can be safely addressed by the community nurse after discharge is:
a. weaning the child from breastfeeding.
b. care of the patient’s surgical incision.
c. feeding the baby by breast or bottle.
d. recognizing signs or symptoms of infection.
ANS: A
Priority patient education needs prior to discharge are those that have to do with
physiological or safety needs. Thus feeding the baby, care of the incision (prevent infection),
and recognition of signs that affect safety must be addressed before discharge. Weaning will
not occur until much later and can be addressed safely by the home health nurse.
DIF: Cognitive Level: Comprehension REF: p. 120 OBJ: Theory #8

TOP: Prioritizing Learning Needs KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of
Disease
8. The nurse evaluates the effectiveness of patient education relative to how to use an eye
shield after eye surgery is to:
a. have the patient tell the nurse what he is going to do.
b. have the patient demonstrate that he can secure the eye shield.
c. ask the patient if he has any questions related to the use of the shield.
d. call the patient at home in 3 days and ask if he has been wearing the shield.
ANS: B
A return demonstration and explanation by the patient will evaluate whether the patient’s
learning needs are met. Having the patient describe the process and ask questions might be
helpful but does not show that the patient can place the shield correctly (a psychomotor
skill). Evaluation of patient education should be done to allow time to revise the education
plan if the patient is unable to meet the behavioral objectives. Calling after discharge is too
late to correct problems.

TOP: Evaluation of Learning KEY: Nursing Process Step: Evaluation
9. The nurse will choose the best time to continue postoperative education regarding wound
care and dressings, which would be:
a. immediately after the patient has been medicated for pain.
b. just before the patient is discharged, so the information is current.
c. when the patient is comfortable and receptive to the patient education.
d. the last thing in the evening, after visitors have left, before bedtime.
ANS: C
A patient who is in pain, sedated from pain medication, or fatigued at the end of the day
after visitors leave will not be receptive to patient education. Patient education should begin
before discharge to improve learning.

TOP: Readiness to Learn KEY: Nursing Process Step: Planning
10. A nurse plans to teach a 4-year-old about what to expect after his broken arm has been
casted by:
a. bringing a doll and casting materials to the room, showing the casting materials and
actually casting the doll’s arm, and explaining the purpose of the cast.
b. telling the child that while he is asleep, the doctor will take off his arm and wrap it
up.
c. breaking up the patient education sessions into two separate 5-minute sessions.
d. being treated as an adult because this approach helps the child to feel “grown up.”
ANS: C
Children benefit from patient education that is geared toward their age and level of
understanding. Patient education in short sessions, allowing for the child’s brief attention
span, will enhance patient education. Children are very literal and improbable stories will be
believed.

TOP: Patient Education of a Child KEY: Nursing Process Step: Planning
11. The best way for a nurse to reinforce learning during a return demonstration by the patient is
for the nurse to:
a. give recognition and praise for the parts the patient does well and to assist or teach
when the patient becomes confused or forgetful.
b. watch quietly until the return demonstration is finished and then list the errors.
c. instruct the patient to read the written material again when an error is made.
d. stop the patient each time he makes a mistake and have him start again after the
nurse reviews the procedure with him.
ANS: A
Praise and “walking through” the procedure reinforces learning.
TOP: Teaching Methods KEY: Nursing Process Step: Implementation
12. A patient states, “I don’t think I’ll ever be able to give myself an injection.” The best reply
by the nurse is:
a. “Everyone feels like that at first. You’ll get over it.”
b. “Don’t be afraid. It’s an easy skill for anyone to learn.”
c. “What bothers you most about the idea of giving yourself an injection?”
d. “I know just how you feel. I would have trouble giving myself an injection.”
ANS: C
When a patient lacks self-confidence, the nurse needs to explore the patient’s feelings.

TOP: Confidence and Abilities KEY: Nursing Process Step: Assessment
13. The nurse takes into consideration that when using printed patient education material for a
65-year-old Middle Eastern patient who speaks perfect English, the nurse should:
a. use patient education material printed in English.
b. determine if the patient can read English.
c. engage a translator to read the English material to the patient.
d. use English material that is printed in bold type on white paper.
ANS: B
Determine if the patient is literate in English. If not, a translator may be able to rewrite the
instructions in the preferred language. Simply reading the English version is not helpful if
the patient is to refer to the material after discharge. Bold print will not help a person who
does not read English.

TOP: Using Printed Materials KEY: Nursing Process Step: Assessment
14. Because a person may learn best in a particular manner, to improve patient education, the
nurse should:
a. ask the patient whether he learns best visually, aurally, or kinesthetically.
b. use a hands-on approach, because it works best for most people.
c. test the patient’s reading comprehension before using visual handouts.
d. use a combination of the three modes of learning to enhance learning.
ANS: D
Many people do not know which mode of learning is their dominant one, and most people
learn best with a combination of patient education/learning techniques.
DIF: Cognitive Level: Knowledge REF: p. 122 OBJ: Theory #3

TOP: Learning Modalities KEY: Nursing Process Step: Implementation
15. Once a patient education plan is formulated and placed in the nursing care plan for a
hospitalized patient:
a. one nurse will be designated to teach the plan on a priority basis.
b. behavioral objectives are used to identify expected outcomes.
c. it is printed and given to the patient as a guide for learning.
d. it outlines all that will be taught before the patient is discharged.
ANS: B
Behavioral objectives identify actions that can be measured; thus they serve as evaluation
tools of expected outcomes. Many people are involved in a patient education plan, with
responsibility designated in the plan. Not all of the patient education plan may be
accomplished during the hospital stay. Priorities identify which learning needs are most
important to teach before discharge and which can be taught by the community nurse after
discharge.
DIF: Cognitive Level: Comprehension REF: p. 125

OBJ: Clinical Practice #2 TOP: Behavioral Objectives
KEY: Nursing Process Step: N/A
Disease
16. In a skilled nursing home, a newly admitted resident becomes terminally ill following a
cerebrovascular accident (CVA). To diminish the family’s anxiety, the nurse teaches the
family members about activities that are being performed to provide care and comfort to
their loved one. This patient education is provided in order to:
a. reduce the likelihood of a lawsuit over the anticipated death.
b. decrease the family’s needs in the expression of their grief.
c. increase the family’s comfort in their affective domain.
d. enable the family to be better prepared for the approaching death.
ANS: C
Patient education that addresses a person’s feelings, beliefs, or values addresses the affective
domain.

TOP: Affective Domain KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
17. The nurse designing a patient education plan for a patient admitted to the hospital for
treatment of a heart problem after years of treating the ailment at home with herbal remedies
and practices common in his cultural group should:
a. help the patient to see that using herbal remedies has not worked in the past.
b. explain that cultural remedies may conflict with conventional medicine.
c. help the patient to identify optimum outcomes that can be achieved through
education and compromise.
d. ask family members to intervene for the cessation of the use of cultural remedies.
ANS: C
A person’s cultural values must be considered in formulating a nursing care plan. Working
with the patient to identify what is of value to the patient can assist the nurse to plan care
that meets the patient’s needs for education.

TOP: Cultural Values and Expectations KEY: Nursing Process Step: Planning
18. The nurse recognizes the American Indian’s need for the intervention of a shaman in dealing
with illness because the shaman helps the patient in seeking:
a. a sense of peace and harmony with nature.
b. a spiritual route to healing.
c. healing through the domination over evil.
d. support from deceased ancestors.
ANS: B
The American Indian has a strong belief that spiritual healing is essential to physical health.
DIF: Cognitive Level: Knowledge REF: p. 123

OBJ: Clinical Practice #2 KEY: Nursing Process Step: Planning
19. The nurse appropriately begins discharge planning when:

a. the primary care provider writes orders to discharge the patient.
b. the patient feels ready to be discharged home.
c. it is anticipated the patient will be discharged in 8 hours.
d. the patient is admitted to the health care facility.
ANS: D
Discharge planning requires looking ahead in order to meet the patient’s ongoing needs at
home. It is a process that begins at the time of admission.

TOP: Discharge Planning KEY: Nursing Process Step: Implementation
Disease
20. A nurse is showing a diabetic patient how to draw insulin out of a syringe. The mode of
learning that the nurse is using is:
a. auditory learning.
b. visual learning.
c. kinesthetic learning.
d. oral learning.
ANS: B
Visual learning is based on learning through what the learner sees.

21. The nurse will plan to offer the patient education session in a quiet area in order to:
a. ensure that the patient can hear what the nurse says.
b. reduce distractions.
c. provide absolute privacy.
d. make the environment more like a classroom.
ANS: B
Patient education sessions are best done in a quiet environment to reduce distractions.

TOP: Enhancing Learning KEY: Nursing Process Step: Planning
22. When a nurse is “talking through” a procedure or assisting the patient to learn, the nurse
encourages the patient to:
a. close her eyes and envision the process.
b. read the listed steps written on a poster board on the wall.
c. write down the steps as she performs them.
d. verbalize each step until the steps are memorized.
ANS: C
Writing down the steps as they are performed provides a guide in the patient’s own words
that can be followed independently.

23. A nurse who is communicating with a school age child about receiving anesthesia for
surgery later this afternoon would best describe the process by saying:
a. “The doctor who will be wearing a mask will put a needle in your arm and then you
go to sleep for a long time.”
b. “You will just float off to dreamland and after you come back your tonsils will have
been cut out.”
c. “After the doctor puts medicine in your arm, you will ride on a pony to where
fairies will take out your tonsils. Then you will ride right back here.”
d. “You will be given a ride on a special bed to a big room where the doctor will give
you some medicine that will make you very sleepy.”
ANS: D
Children interpret language literally, so avoid idioms or stories that might be frightening
because they can be easily misunderstood. Language should be tailored to the child’s
understanding.

TOP: Communication with School Age Child
KEY: Nursing Process Step: Implementation
24. When educating an older adult patient about changing his dressing, the nurse would most
appropriately:
a. be certain the patient is wearing his glasses and/or hearing aid.
b. talk through the process rapidly to keep the patient from becoming tired.
c. wait for the patient to ask any questions about the procedure.
d. point out each mistake during the return demonstration.
ANS: A
Special considerations when teaching the older adult include being certain the patient is
wearing glasses and/or a hearing aid that is turned on and adjusted, if needed. Short
sentences should be used, and the nurse should speak slowly. Pointing out mistakes without
any praise can diminish the confidence of the patient.

TOP: Communication with the Older Adult
KEY: Nursing Process Step: Implementation
25. The nurse would identify an opportunity for a “teachable moment” in the situation of a
patient who:
a. has just been told of the malignancy of his tumor.
b. says, “How will I remember all the things about my new diet?”
c. has just returned from surgery for a deviated septum.
d. is packing belongings in preparation for discharge.
ANS: B
The “teachable moment” occurs when the patient is at an optimal level of readiness to learn
and shows a willingness to apply that information.

TOP: Teachable Moment KEY: Nursing Process Step: Assessment
MULTIPLE RESPONSE
1. Continuous learning needs for the patient upon discharge should be communicated to the:
(Select all that apply.)
a. visiting nurse.
b. family.
c. primary care provider.
d. pharmacy or medical supply facility.
e. home health aide.
ANS: A, B, C
Health care entities that need to be aware of postdischarge continuous learning needs
include the visiting home health nurse, the family, and the primary care provider.
Pharmacies and medical supply facilities are not notified. The home health aide will not be
instructed by the home health nurse.

TOP: Continued Patient Education After Discharge
KEY: Nursing Process Step: Planning
Disease
2. The nurse reminds the patient that health instruction supports the goals of Healthy People
2020, which include: (Select all that apply.)
a. promoting healthy behavior.
b. increasing the life span.
c. providing equipment for self-care.
d. ensuring access to adequate health care.
e. strengthening community relationships.
ANS: A, D, E
Health instruction supports the goals of Healthy People 2020, which include promoting
healthy behaviors, protecting health, ensuring access to quality health care, and
strengthening community health promotion programs.

TOP: Healthy People 2020 KEY: Nursing Process Step: Implementation
Disease
3. The nurse is aware that the major modes of learning are: (Select all that apply.)
a. oral.
b. tactile.
c. auditory.
d. kinesthetic.
e. gustatory.
f. visual.
ANS: C, D, F
Kinesthetic, auditory, and visual are the major modes of learning.

TOP: Modes of Learning KEY: Nursing Process Step: Planning
4. The LPN/LVN is qualified to provide patient education on information relative to: (Select
all that apply.)
a. disease process.
b. postoperative care.
c. prognosis.
d. rehabilitation.
e. disaster preparedness.
ANS: A, B, D, E
LPNs and LVNs are qualified to provide patient education on topics relative to disease
process, postoperative care, rehabilitation, and disaster preparedness. Information on
prognosis is not appropriate.
TOP: Areas of Patient Education KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

Chapter 09: Patient Education and Health Promotion Williams: Dewit'S Fundamental Concepts and Skills For Nursing, 5Th Edition

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Chapter 09: Patient Education and Health Promotion

DIF: Cognitive Level: Analysis REF: p. 121 OBJ: Theory #3

DIF: Cognitive Level: Application REF: p. 121 OBJ: Theory #3

DIF: Cognitive Level: Application REF: p. 124 OBJ: Theory #5

4. An 80-year-old patient is to be taught the process of colostomy irrigation and reattachment

DIF: Cognitive Level: Analysis REF: p. 122

DIF: Cognitive Level: Application REF: p. 121 OBJ: Theory #3

DIF: Cognitive Level: Analysis REF: p. 121 OBJ: Theory #4

DIF: Cognitive Level: Comprehension REF: p. 120 OBJ: Theory #8

DIF: Cognitive Level: Application REF: p. 126 OBJ: Theory #2

DIF: Cognitive Level: Comprehension REF: p. 122 OBJ: Theory #3

DIF: Cognitive Level: Comprehension REF: p. 124 OBJ: Theory #5

DIF: Cognitive Level: Application REF: p. 123 OBJ: Theory #4

DIF: Cognitive Level: Application REF: p. 121 OBJ: Theory #3

DIF: Cognitive Level: Knowledge REF: p. 122 OBJ: Theory #3

DIF: Cognitive Level: Comprehension REF: p. 125

DIF: Cognitive Level: Comprehension REF: p. 122 OBJ: Theory #3

DIF: Cognitive Level: Application REF: p. 123 OBJ: Theory #4

DIF: Cognitive Level: Knowledge REF: p. 123

19. The nurse appropriately begins discharge planning when:

DIF: Cognitive Level: Comprehension REF: p. 121 OBJ: Theory #1

DIF: Cognitive Level: Comprehension REF: p. 121 OBJ: Theory #3

DIF: Cognitive Level: Comprehension REF: p. 122 OBJ: Theory #4

DIF: Cognitive Level: Application REF: p. 120 OBJ: Theory #3

DIF: Cognitive Level: Application REF: p. 124 OBJ: Theory #5

DIF: Cognitive Level: Application REF: p. 124 OBJ: Theory #5

DIF: Cognitive Level: Application REF: p. 121 OBJ: Theory #4

DIF: Cognitive Level: Comprehension REF: p. 122 OBJ: Theory #8

DIF: Cognitive Level: Knowledge REF: p. 120 OBJ: Theory #2

DIF: Cognitive Level: Knowledge REF: p. 121 OBJ: Theory #3

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