# Situation: A 69-year-old woman with newly diagnosed hypothyroidism will go home on a daily levothyroxine tablet in 3 days. She has mild cataracts and wears reading glasses. She speaks only a regional language that the ward nurse does not speak. Her 12-year-old grandson, who lives with her, speaks both languages. The nurse reviews the teaching log. Each session covered four new points of similar difficulty, with the interpreter present and a leaflet in her language that she read along with the explanation. Teach-back results were: - Session 1, quiet room, standard-print leaflet: 1 of 4 points correct - Session 2, open ward with the television on, large-print leaflet: 3 of 4 points correct - Session 3, open ward with the television on, standard-print leaflet: 0 of 4 points correct - Session 4, quiet room, large-print leaflet: 4 of 4 points correct Which factor MOST limited her learning?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630449  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 69-year-old woman with newly diagnosed hypothyroidism will go home on a daily levothyroxine tablet in 3 days. She has mild cataracts and wears reading glasses. She speaks only a regional language that the ward nurse does not speak. Her 12-year-old grandson, who lives with her, speaks both languages.

The nurse reviews the teaching log. Each session covered four new points of similar difficulty, with the interpreter present and a leaflet in her language that she read along with the explanation. Teach-back results were:
- Session 1, quiet room, standard-print leaflet: 1 of 4 points correct
- Session 2, open ward with the television on, large-print leaflet: 3 of 4 points correct
- Session 3, open ward with the television on, standard-print leaflet: 0 of 4 points correct
- Session 4, quiet room, large-print leaflet: 4 of 4 points correct
Which factor MOST limited her learning?

## 보기

1. The noise of the open ward with the television on
2. The standard print of the leaflet she read along **✔ 정답**
3. Noise and print size, which limited her equally
4. Low readiness to learn in her first sessions

**정답: 2**

## 해설

Comparing pairs of sessions that differ in only one factor separates the effects. With the setting held constant, large print raised her score by 3 points in both settings; with print held constant, a quiet room raised it by only 1 point. Print size was the main barrier, which fits an older adult with reduced vision who needs large, high-contrast print.

## 심화 해설

Comparing sessions that differ in one factor
The teaching log shows two changing factors: the setting (quiet room or noisy ward with the television on) and the print size of the leaflet (standard or large). All other conditions were similar: four new points of similar difficulty, the interpreter present, and a leaflet in her language. To find which factor mattered more, compare pairs of sessions in which only one factor differs.

| Session | Setting | Print | Score |
| --- | --- | --- | --- |
| 1 | Quiet | Standard | 1 of 4 |
| 2 | Noisy ward | Large | 3 of 4 |
| 3 | Noisy ward | Standard | 0 of 4 |
| 4 | Quiet | Large | 4 of 4 |

Working out the effects
Hold the setting constant to see the effect of print size. In the noisy ward, large print raised the score from 0 (session 3) to 3 (session 2), a gain of 3 points. In the quiet room, large print raised it from 1 (session 1) to 4 (session 4), again 3 points. Now hold print size constant to see the effect of noise. With standard print, the quiet room raised the score from 0 to 1; with large print, from 3 to 4. The quiet room added only 1 point each time. Print size had three times the effect of noise, so the standard-print leaflet most limited her learning.

Why this fits the client
She is 69 years old and has mild cataracts, which reduce contrast and sharpness. Older adults with reduced vision need large, high-contrast print, good lighting, and their reading glasses. Because she read along with the leaflet during every explanation, a leaflet she could not read easily interfered with every point taught. Noise still mattered, so a quiet setting remains good practice, but it was the smaller barrier.

Watch out! Readiness to learn is a distractor. Her scores went 1, 3, 0, 4: they rose and fell with the conditions rather than improving steadily over time, so the pattern is explained by the environment and materials, not by readiness.

Exam takeaway
For older learners, adapt materials to sensory changes: large font, matte paper with strong contrast, adequate light, and glasses at hand, plus a quiet room when possible. Key point! When two factors vary, compare pairs that differ in only one factor; here large print raised her score by 3 points, while a quiet room raised it by only 1.

## 임상 시나리오

Barriers to LearningComparing teaching sessions
Two factors varied: setting and print size. Scores: quiet/standard 1, noisy/large 3, noisy/standard 0, quiet/large 4 of 4.

With setting held constant, large print added 3 points in both settings; with print held constant, a quiet room added only 1 point.

A 69-year-old with cataracts needs large, high-contrast print, good light, and her reading glasses.

CautionDo not blame low readiness; the scores rose and fell with the conditions, not steadily with time.

## 핵심 개념

- **Readiness to learn** — A learner's physical, emotional, and experiential state that determines whether she is ready to learn.
- **Cataract** — Clouding of the eye lens that reduces sharpness and contrast of vision.
- **Large-print material** — Written teaching material in a larger font, often with high contrast, for readers with low vision.
- **Learning environment** — The physical setting of teaching, including noise, light, and privacy, that affects learning.

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