Student Name:




Please choose a client to focus on learning need related to pharmacologic management. Upon completion of the learning assessment questions below, you will base your teaching presentation (narrated PowerPoint) on the findings of this questionnaire.

ASSESSMENT FINDINGS: (Typed/ Written neatly)


Basic Demographic Info:

Social History:

Body System Review: (Abnormal only)

Current Diagnosis & History of Present Illness:

Medical/Surgical History:

Current Medications/Interventions/Treatments:


EXPERIENCE IN HEALTH CARE: Please ask the following questions of the selected client:

1. Please tell me about your current health problem:

2. What do you currently know about ___________________________(health issue)?

3. What have you been doing for your condition in the past? Present?

4. Is there anything you are interested in learning at the current time?

5. What would you like to know more about? Anything you could understand better?

6. What issues has your health issue caused?

7. Do you fear anything in particular regarding your health?

8. What are the areas you would like to improve upon in regards to your health? Medication regimen? Any particular results of treatment?

[If Skill Based – answer questions 9 – 12, if not skip to question 13]

9. Do you think learning this skill will be easy, moderate, or difficult?

10. Which part do you think may be hardest?

11. Have you performed this skill before, if so, please describe/review your current steps.

12. How much practice do you usually need to learn a new skill?

LEARNING ASSESSMENT: Please ask the following questions of the selected client:

13. How do you prefer to learn? (Watching, Listening, Doing, Reading, Combination)

14. The last time you learned something, how did you go about doing so? Was it effective?

15. When and where do you prefer to learn?

16. When you think of learning a new skill or new information, how do you feel?

17. What ways do you feel I can best help you learn?

STUDENT QUESTIONS: Please answer the following in order to begin your process of designing the teaching session (narrated PowerPoint):

1. What does my client need to learn most? How can I best deliver the information?

2. Is there a specific time or place in which the client would learn best? Why?

3. How will the knowledge gained from the teaching session benefit my client most?

4. Are there specific accommodations I need to make in order to deliver information to my selected client (visual, hearing deficits, etc)?

5. Briefly discuss your plan for design of the teaching session for this particular client. Why did you choose this particular design? How will it foster your client’s understanding?

08/14asn; 08/19 clw