Cultural Awareness and Health Practices
The nurse is providing discharge instructions to a Chinese American client regarding prescribed dietary modifications. During the teaching session, the client continuously turns away from the nurse. The nurse should implement which best action? 1. Continue with the instructions, verifying client understanding. 2. Walk around the client so that the nurse constantly faces the client. 3. Give the client a dietary booklet and return later to continue with the instructions. 4. Tell the client about the importance of the instructions for the maintenance of health care.
1 Rationale: Most Chinese Americans maintain a formal distance with others, which is a form of respect. Many Chinese Americans are uncomfortable with face-to-face communications, especially when eye contact is direct. If the client turns away from the nurse during a conversation, the best action is to continue with the conversation. Walking around the client so that the nurse faces the client is in direct conflict with this cultural practice. The client may consider it a rude gesture if the nurse returns later to continue with the explanation. Telling the client about the importance of the instructions for the maintenance of health care may be viewed as degrading.
The ambulatory care nurse is discussing preoperative procedures with a Japanese American client who is scheduled for surgery the following week. During the discussion, the client continually smiles and nods the head. How should the nurse interpret this nonverbal behavior? 1. Reflecting a cultural value 2. An acceptance of the treatment 3. Client agreement to the required procedures 4. Client understanding of the preoperative procedures
1 Rationale: Nodding or smiling by a Japanese American client may reflect only the cultural value of interpersonal harmony. This nonverbal behavior may not be an indication of acceptance of the treatment, agreement with the speaker, or understanding of the procedure.
6. Which clients have a high risk of obesity and diabetes mellitus? Select all that apply. 1. Latino American man 2. Native American man 3. Asian American woman 4. Hispanic American man 5. African American woman
1, 2, 4, 5 Rationale: Because of their health and dietary practices, Latino Americans, Native Americans, Hispanic Americans, and African Americans have a high risk of obesity and diabetes mellitus. Owing to dietary practices, Asian Americans have a lower risk for obesity and diabetes mellitus.
A critically ill Hispanic client tells the nurse through an interpreter that she is Roman Catholic and firmly believes in the rituals and traditions of the Catholic faith. Based on the client's statements, which actions by the nurse demonstrate cultural sensitivity and spir- itual support? Select all that apply. 1. Ensures that a close kin stays with the client. 2. Makes a referral for a Catholic priest to visit the client. 3. Removes the crucifix from the wall in the client's room. 4. Administersthesacramentofthesicktothecli- ent if death is imminent. 5. Offerstoprovideameansforprayingtherosary if the client wishes. 6. Reminds the dietary department that meals served on Fridays during Lent do not contain meat.
1, 2, 5 Rationale: In times of illness, a Roman Catholic client may turn to prayer for spiritual support. This may include rosary prayers or visits from a priest, who is the spiritual leader in the Roman Catholic faith. Close family members usually want to stay with a dying family member in order to hear the wishes of the client, allowing the soul to leave in peace. A priest, not a nurse, would administer the sacrament of the sick. Roman Catholics would not ask for the crucifix to be removed. Members of other religious groups such as Islam or Judaism may request the removal of the crucifix. Dietary rituals are not a concern at this time.
The nurse educator is providing inservice education to the nursing staff regarding transcultural nursing care; a staff member asks the nurse educator to provide an example of the concept of acculturation. The nurse educator should make which most appropriate response? 1. "A group of individuals identifying as a part of the Iroquois tribe among Native Americans." 2. "A person who moves from China to the United States (U.S.) and learns about and adapts to the culture in the U.S." 3. "A group of individuals living in the Azores that identify autonomously but are a part of the larger population of Portugal." 4. "A person who has grown up in the Philippines and chooses to stay there because of the sense of belonging to his or her cultural group."
2 Rationale: Acculturation is a process of learning a different culture to adapt to a new or changing environment. Options 1 and 3 describe a subculture. Option 4 describes ethnic identity.
When communicating with a client who speaks a different language, which best practice should the nurse implement? 1. Speak loudly and slowly. 2. Arrange for an interpreter to translate. 3. Speak to the client and family together. 4. Stand close to the client and speak loudly.
2 Rationale: Arranging for an interpreter would be the best practice when communicating with a client who speaks a different language. Options 1 and 4 are inappropriate and ineffective ways to communicate. Option 3 is inappropriate because it violates privacy and does not ensure correct translation.
An antihypertensive medication has been prescribed for a client with hypertension. The client tells the clinic nurse that he would like to take an herbal sub- stance to help lower his blood pressure. The nurse should take which action? 1. Advise the client to read the labels of herbal therapies closely. 2. Tell the client that herbal substances are not safe and should never be used. 3. Encouragetheclienttodiscusstheuseofanherbal substance with the health care provider (HCP). 4. Tell the client that if he takes the herbal substance he will need to have his blood pressure checked frequently.
3 Rationale: Although herbal substances may have some beneficial effects, not all herbs are safe to use. Clients who are being treated with conventional medication therapy should be encouraged to avoid herbal substances because the combination may lead to an excessive reaction or to unknown interaction effects. The nurse should advise the client to discuss the use of the herbal substance with the HCP. Therefore, options 1, 2, and 4 are inappropriate nursing actions.
Which is the best nursing intervention regarding complementary and alternative medicine? 1. Advising the client about "good" versus "bad" therapies 2. Discouraging the client from using any alterna- tive therapies 3. Educating the client about therapies that he or she is using or is interested in using 4. Identifying herbal remedies that the client should request from the health care provider
3 Rationale: Complementary and alternative therapies include a wide variety of treatment modalities that are used in addition to conventional therapy to treat a disease or illness. Educating the client about therapies that he or she uses or is interested in using is the nurse's role. Options 1, 2, and 4 are inappropriate actions for the nurse to take because they provide advice to the client.
An Asian American client is experiencing a fever. The nurse plans care so that the client can self-treat the disorder using which method? 1. Prayer 2. Magnetic therapy 3. Foods considered to be yin 4. Foods considered to be yang
3 Rationale: In the Asian American culture, health is believed to be a state of physical and spiritual harmony with nature and a balance between positive and negative energy forces (yin and yang). Yin foods are cold and yang foods are hot. Cold foods are eaten when one has a hot illness (fever), and hot foods are eaten when one has a cold illness. Options 1 and 2 are not health practices specifically associated with the Asian American culture or the yin and yang theory.
Which meal tray should the nurse deliver to a client of Orthodox Judaism faith who follows a kosher diet? 1. Pork roast, rice, vegetables, mixed fruit, milk 2. Crab salad on a croissant, vegetables with dip, potato salad, milk 3. Sweet and sour chicken with rice and vegetables, mixed fruit, juice 4. Noodles and cream sauce with shrimp and vegetables, salad, mixed fruit, iced tea
3 Rationale: Members of Orthodox Judaism adhere to dietary kosher laws. In this religion, the dairy-meat combination is unacceptable. Only fish that have scales and fins are allowed; meats that are allowed include animals that are vegetable eaters, cloven hoofed, and ritually slaughtered.
The nurse is preparing a plan of care for a client, and is asking the client about religious preferences. The nurse considers the client's religious preferences as being characteristic of a Jehovah's Witness if which client statement is made? 1. "I cannot have surgery." 2. "I cannot have any medicine." 3. "I believe the soul lives on after death." 4. "I cannot have any food containing or prepared with blood."
4 Rationale: Among Jehovah's Witnesses, surgery is not prohibited, but the administration of blood and blood products is forbidden. For a Jehovah's Witness, administration of medication is an acceptable practice except if the medication is derived from blood products. This religious group believes that the soul cannot live after death. Jehovah's Witnesses avoid foods prepared with or containing blood.
The nurse educator asks a student to list the 5 main categories of complementary and alternative medi- cine (CAM), developed by the National Center for Complementary and Alternative Medicine. Which statement, if made by the nursing student, indicates a need for further teaching regarding CAM categories? 1. "CAM includes biologically based practices." 2. "Whole medical systems are a component of CAM." 3. "Mind-body medicine is part of the CAM approach." 4. "Magnetic therapy and massage therapy are a focus of CAM."
4 Rationale: The 5 main categories of CAM include whole medical systems, mind-body medicine, biologically based practices, manipulative and body-based practices, and energy medicine. Magnetic therapy and massage therapy are therapies within specific categories of CAM.
