Diversity - Chapter 5 PrepU

A nurse caring for clients of different cultures in a hospital setting attempts to make eye contact with clients when performing the initial assessment. What assumption might the nurse make based on common cultural practices?

A Muslim-Arab woman refuses to make eye contact with her male nurse. Assumption: She is being modest.

Which statement by the nurse is a culturally appropriate reaction to a client's perception of pain? A. "Asian clients have a high pain tolerance." B. "Some procedures hurt more and should have more pain reaction." C. "Males tend to overreact to pain for sympathy." D. "If a client needs to yell in pain, that is his or her right."

D. "If a client needs to yell in pain, that is his or her right."

An experienced nurse tells a less-experienced nurse who is working in a retirement home that older adults are different and do not have the same desires, needs, and concerns as other age groups. The nurse also comments that most older adults have "outlived their usefulness." What is the term for this type of prejudice? A. Harassment B. Whistle blowing C. EA D. Ageism

D. Ageism Rationale: Ageism is a form of prejudice in which older adults are stereotyped by characteristics found in only a few members of their age group. Harassment occurs when a dominant person takes advantage of or overpowers a less dominant person; it may involve sexual harassment or power struggles. Whistle blowing involves reporting illegal or unethical behavior in the workplace. EA is an intentional act or failure to act by a caregiver that causes or creates a risk of harm to an older adult.

A nurse is admitting a client to the unit. Which cultural question is most appropriate?

"What are your dietary needs and preferences?"

Which statement by the nurse demonstrates ethnocentrism?

"That client needs to learn that pain is best managed with traditional medications like morphine."

A client believes in the use of herbal therapy and asks the nurse if he can continue to use a herbal tea therapy. What is the most culturally appropriate nursing response?

"There is no reason the tea cannot be used as long as the ingredients do not interfere with the medication."

The mother of a Black newborn asks the nurse about the bluish-black areas she noticed around the infant's lower back and buttocks. What is the nurse's best response? A. "It will be best if you have these areas treated with laser surgery." B. "This discoloration occurs in some infants and is usually permanent." C. "These areas are normal and should disappear by early childhood." D. "These spots will normally fade in about 2 weeks."

"These areas are normal and should disappear by early childhood."

A nurse is conducting a cultural assessment of a client. Which person would the nurse identify as the expert? A. Client B. Nurse C. Older family member D .Health care provider

A. Client

Which is an example of cultural competence in nursing?

Attending a conference for cultural diversity

Common Health Problems in Whites

Breast cancer Heart disease Hypertension Diabetes mellitus Obesity

A nurse is caring for a 79-year-old Appalachian woman who is placed in a long-term care facility by her son, who is no longer able to care for her. She appears disoriented and reports being bothered by the "bright lights and constant activity." The nurse appropriately documents what condition in the chart?

Culture shock

Common Health Problems in Native Americans and Alaska Natives

Heart disease Cirrhosis of the liver Diabetes mellitus Fetal alcohol syndrome

Common Health Problems in Asians

Hypertension Cancer of the liver Lactose intolerance Thalassemia

Common Health Problems in African Americans

Hypertension Stroke Sickle cell anemia Lactose intolerance Keloids

Which nursing intervention reflects practice according to Madeline Leininger's transcultural nursing theory?

Incorporating the client's request for complementary treatment therapy

Which teaching statement best exemplifies cultural competence in relation to time for the American culture? A. It is important to be on time for your health care appointment. B. It is important to arrive within 20 minutes of your scheduled appointment time. C. It is important to be future-oriented when considering your appointment time. D. It is a sign of respect to be late for your health care appointments.

It is important to be on time for your health care appointment.

A nurse is working in an inner city clinic with a heavy population of Hispanic migrant workers. Which nursing assessment is the priority?

Language assessment

Which nursing action displays linguistic competence?

Learning pertinent words and phrases in the client's language

The nurse is caring for a client who perceives time differently. What action should the nurse take for this client?

Maintain flexibility when the client requests interventions at specific times.

A client of Arab descent has been admitted to the health care facility with varicose veins. What should the nurse avoid while conducting the interview of the client?

Maintaining eye contact

Orientation to Space and Time

People of Arabic and African origin commonly sit and stand close to one another when talking, whereas people of Asian and European descent are more comfortable with more distance between themselves and others. In some South Asian cultures, being late is considered a sign of respect

Racial categories are typically based on specific physical characteristics such as skin pigmentation, body stature, facial features, and hair texture. **Although the term ethnicity is often used interchangeably with race, these terms are NOT the same

Race

In addition to understanding the culture of the client, what other actions are required to provide culturally competent nursing care? Select all that apply.

Recognizing one's own culture and biases Recognizing the culture of the healthcare system

When one assumes that all members of a culture, ethnic group, or race act alike

Stereotyping

A nurse in the hospital is caring for a Native American/First Nations male. Which statement should best guide the nurse's care?

There may be a role for a tribal medicine man in the client's care

The charge nurse overhears two new graduate nurses talking in the break-room. One graduate nurse states, "I hate getting reports from the older nurses; they are just too slow." The charge nurse understands that the nurse is demonstrating what?

ageism

The nurse is caring for a Native American/First Nations client who has been given a diagnosis of terminal cancer. Which reaction does the nurse anticipate?

stoic listening without display of emotion

The Giger and Davidhizar model

takes into account six cultural phenomena: communication, space, social orientation, time, environmental control, and biologic variations.

Can be defined as the coexistence of different ethnic, biological sex, racial, and socioeconomic groups within one social unit. These groups include, but are not limited to, people of varying religion, language, physical size, sexual orientation, age, disability, occupational status, and geographic location.

Culture Diversity

Result in psychological discomfort or disturbances, because the patterns of behavior a person found acceptable and effective in his or her own culture may not be adequate or even acceptable in the new culture

Culture Shock

Antecedents of culture

´Age ´Religious/Spiritual ´Ethnic/Race ´Cultural ´Sexual Orientation ´Education Life Experiences

When a minority group lives within a dominant group, many members may lose the cultural characteristics that once made them different, and they may take on the values of the dominant culture. This process is called

Cultural Assimilation

Occurs when people become aware of cultural differences, feel threatened, and respond by ridiculing the beliefs and traditions of others to make themselves feel more secure about their own values

Cultural Conflict

May be defined as a shared system of beliefs, values, and behavioral expectations that provides social structure for daily living.

Culture

A client who immigrated from another country informs the nurse of dietary requests. The nurse responds to the special dietary needs by stating, "You are now living here, and you should try to start eating those foods common to our diet." This inappropriate response is an example of: A. cultural imposition. B. cultural assimilation. C. cultural diversity. D. cultural blindness.

A. cultural imposition.

What is the priority assessment for the nurse when developing a plan of care for a client from a poverty culture?

Access to care

When completing a transcultural assessment of communication, which assessment by the nurse is most appropriate?

Assessment of eye contact, personal space, and social taboos

A nurse states, "That patient is 78 years old—too old to learn how to change a dressing." What is the nurse demonstrating? A. Cultural imposition B. Clustering C. Cultural competency D. Stereotyping

D. Stereotyping Rationale: Stereotyping is assuming that all members of a group are alike. This is not an example of cultural competence nor is the nurse imposing her culture on the patient. Clustering is not an applicable concept.

Common Health Problems in Hispanics

Diabetes mellitus Lactose intolerance

Campinha-Bacote Model of Cultural Competence

Emphasizes becoming culturally competent and integrating cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire.

A sense of identification with a collective cultural group, largely based on the group members' common heritage

Ethnicity

When reviewing the chart of an older adult client, the nurse notes that the client identifies as Asian. The nurse realizes the client is referring to which ancestral and cultural factor?

Ethnicity

The client in a rehabilitation unit is having a difficult time adjusting to the scheduled activities on the unit, as well as being dependent on others for meals and medications. Which word best describes what the client is experiencing?

Shock

The use of one's culture as a cultural standard is known as:

ethnocentrism

The nurse is collecting the health history of a client and notes the client is apprehensive in answering questions. The client states, "My spiritual healer will be here soon." What is the best response by the nurse?

"We can wait until your spiritual healer arrives and work together to answer these questions."

A client with Asian heritage is admitted to the health care facility with hypoglycemia. After the client is stable, the nurse discovers that the client has not had the prescribed medicines. The client believes that eating saffron will keep his blood sugar under control. What is the most appropriate response by the nurse?

"Why don't you take the medicines, too, and benefit from both?"

Characteristics of Culture

- Culture helps shape what is acceptable behavior for people in a specific group. It is shared by, and provides an identity for, members of the same cultural group. -Culture is learned by each new generation through both formal and informal life experiences. Language is the primary means of transmitting culture. The practices of a particular culture often arise because of the group's social and physical environment. -Cultural practices and beliefs may evolve over time, but they mainly remain constant as long as they satisfy a group's needs. -Culture influences the way people of a group view themselves, have expectations, and behave in response to certain situations. Because a culture is made up of people, there are differences both within cultures and among cultures.

Cultural Competence

- Developing an awareness of one's own existence, sensations, thoughts, and environment to prevent them from having an undue influence on those from other backgrounds - Demonstrating knowledge and understanding of the patient's culture, health-related needs, and culturally specific meanings of health and illness Accepting and respecting cultural differences in a manner that facilitates the patient's and family's abilities to make decisions to meet their needs and beliefs - Not assuming that the health care provider's beliefs and values are the same as the patient's Resisting judgmental attitudes such as "different is not as good" - Being open to and comfortable with cultural encounters - Accepting responsibility for one's own education in cultural competence by attending conferences, reading professional literature, and observing cultural practices

A nurse is caring for an 80-year-old patient who is living in a long-term care facility. To help this patient adapt to the present circumstances, the nurse is using reminiscence as therapy. Which question would encourage reminiscence? A. "Tell me about how you celebrated Christmas when you were young." B. "Tell me how you plan to spend your time this weekend." C. "Did you enjoy the choral group that performed here yesterday? D. "Why don't you want to talk about your feelings?"

A. "Tell me about how you celebrated Christmas when you were young. Asking questions about events in the past can encourage the older adult to relive and restructure life experiences. Asking about a recent event, upcoming plans, or feelings would be unlikely to encourage reminiscence.

A nurse caring for culturally diverse patients in a health care provider's office is aware that patients of certain cultures are more prone to specific disease states than the general population. Which patients would the nurse screen for diabetes mellitus based on the patient's race? Select all that apply. A. A Native American patient B. An African-American patient C. An Alaska Native D. An Asian patient E. A White patient F. A Hispanic patient

A. A Native American patient C. An Alaska Native E. A White patient F. A Hispanic patient Rationale: Native Americans, Alaska Natives, Hispanics, and Whites are more prone to developing diabetes mellitus. African Americans are prone to hypertension, stroke, sickle cell anemia, lactose intolerance, and keloids. Asians are prone to hypertension, liver cancer, thalassemia, and lactose intolerance.

In order to provide culturally competent care, nurses must be alert to factors inhibiting sensitivity to diversity in the health care system. Which nursing actions are examples of cultural imposition? Select all that apply. A. A hospital nurse tells a nurse's aide that patients should not be given a choice whether or not to shower or bathe daily. B.A nurse treats all patients the same whether or not they come from a different culture. C. A nurse tells another nurse that Jewish diet restrictions are just a way for them to get a special tray of their favorite foods. D. A Catholic nurse insists that a patient diagnosed with terminal bladder cancer see the chaplain in residence. E. A nurse directs interview questions to an older adult's daughter even though the patient is capable of answering them. F. A nurse refuses to care for a married gay man who is HIV positive because she is against same-sex marriage.

A. A hospital nurse tells a nurse's aide that patients should not be given a choice whether or not to shower or bathe daily. D. A Catholic nurse insists that a patient diagnosed with terminal bladder cancer see the chaplain in residence. Rationale: Cultural imposition occurs when a hospital nurse tells a nurse's aide that patients should not be given a choice whether or not to shower or bathe daily, and when a Catholic nurse insists that a patient diagnosed with terminal bladder cancer see the chaplain in residence. Cultural blindness occurs when a nurse treats all patients the same whether or not they come from a different culture. Culture conflict occurs when a nurse ridicules a patient by telling another nurse that Jewish diet restrictions are just a way for Jewish patients to get a special tray of their favorite foods. When a nurse refuses to respect an older adult's ability to speak for himself or herself, or if the nurse refuses to treat a patient based on that patient's sexual orientation, the nurse is engaging in stereotyping.

The nurse practitioner sees patients in a community clinic that is located in a predominately White neighborhood. After performing assessments on the majority of the patients visiting the clinic, the nurse notes that many of the minority groups living within the neighborhood have lost the cultural characteristics that made them different. What is the term for this process? A. Cultural assimilation B. Cultural imposition C. Culture shock D. Ethnocentrism

A. Cultural assimilation Rationale: When minority groups live within a dominant group, many members lose the cultural characteristics that once made them different in a process called assimilation. Cultural imposition occurs when one person believes that everyone should conform to his or her own belief system. Culture shock occurs when a person is placed in a different culture perceived as strange, and ethnocentrism is the belief that the ideas, beliefs, and practices of one's own cultural group are best, superior, or most preferred to those of other groups.

A client is admitted with end-stage pancreatic cancer and is experiencing extreme pain. The client asks the nurse whether an acupuncturist can come to the hospital to help manage the pain. The nurse states, "You won't need acupuncture. We have pain medications." Which characteristic has the nurse displayed? A. Cultural imposition B. Stereotyping C. Cultural conflict D. Culture shock

A. Cultural imposition

A nurse is telling a new mother from Africa that she shouldn't carry her baby in a sling created from a large rectangular cloth. The African woman tells the nurse that everyone in Mozambique carries babies this way. The nurse believes that bassinets are safer for infants. This nurse is displaying what cultural bias? A. Cultural imposition B. Clustering C. Cultural competency D. Stereotyping

A. Cultural imposition Rationale: The nurse is trying to impose her belief that bassinets are preferable to baby slings on the African mother—in spite of the fact that African women have safely carried babies in these slings for years.

A nurse caring for older adults in a skilled nursing home observes physical changes in patients that are part of the normal aging process. Which changes reflect this process? Select all that apply. A. Fatty tissue is redistributed. B. The skin is drier and wrinkles appear. C. Cardiac output increases. D. Muscle mass increases. E. Hormone production increases. F. Visual and hearing acuity diminishes.

A. Fatty tissue is redistributed. B. The skin is drier and wrinkles appear. F. Visual and hearing acuity diminishes. Rationale: Physical changes occurring with aging include these: fatty tissue is redistributed, the skin is drier and wrinkles appear, and visual and hearing acuity diminishes. Cardiac output decreases, muscle mass decreases, and hormone production decreases, causing menopause or andropause.

Which area is typically included in a cultural assessment? A. Food preferences B. Ethics C. Marital status D. Employment status

A. Food preferences

When providing care to a client, the nurse refers to the client's ethnic group. Which aspects would the nurse include as pertaining to this concept? Select all that apply. A. Religious beliefs B. Language C. Skin color D. Eye shape E. Shared beliefs of origin

A. Religious beliefs B. Language E. Shared beliefs of origin

A nurse is providing care to a client from a culture different from the nurse's own. The nurse is having difficulty relating to the client. What intervention by the nurse is most appropriate?

Ask the client how the client wants to be treated based on the client's values and beliefs.

The nurse is caring for a terminally ill client who immigrated from Mexico. Which nursing intervention regarding spiritual care is appropriate?

Ask the client if a spiritual leader is desired.

The nurse admits a client to the critical care unit to rule out a myocardial infarction. The client has several family members in the waiting room. Which nursing action is most appropriate? A. Insist that only one family member can be in the room at a time. B. Assess the client's beliefs about family support during hospitalization. C. Explain to the family that too many visitors will tire the client. D. Allow all the visitors into the room.

Assess the client's beliefs about family support during hospitalization.

A young Hispanic mother comes to the local clinic because her baby is sick. She speaks only Spanish and the nurse speaks only English. What is the appropriate nursing intervention? A. Use short words and talk more loudly. B. Ask an interpreter for help. C. Explain why care can't be provided. D. Provide instructions in writing.

B. Ask an interpreter for help. Rationale: The nurse should ask an interpreter for help. Many facilities have a qualified interpreter who understands the health care system and can reliably provide assistance. Using short words, talking loudly, and providing instructions in writing will not help the nurse communicate with this patient. Explaining why care can't be provided is not an acceptable choice because the nurse is required to provide care; also, since the patient doesn't speak English, she won't understand what the nurse is saying.

Which nursing actions are appropriate when collecting a health history for a client whose primary language differs from the dominant language? Select all that apply. A. Speak in detailed sentences using exact medical terminology. B. Have a bilingual nurse assist with the health history. C. Ask the client's adolescent child to answer questions. D. Request assistance from a certified interpreter. E. Use the facility telephonic interpreting system.

B. Have a bilingual nurse assist with the health history. D. Request assistance from a certified interpreter. E. Use the facility telephonic interpreting system.

A nurse is using the ESFT model to understand a patient's conception of a diagnosis of chronic obstructive pulmonary disease (COPD). Which interview question would be MOST appropriate to assess the E aspect of this model—Explanatory model of health and illness? A. How do you get your medications? B. How does having COPD affect your lifestyle? C. Are you concerned about the side effects of your medications? D. Can you describe how you will take your medications?

B. How does having COPD affect your lifestyle? Rationale: The ESFT model guides providers in understanding a patient's explanatory model (a patient's conception of her or his illness), social and environmental factors, and fears and concerns, and also guides providers in contracting for therapeutic approaches. Asking the questions: "How does having COPD affect your lifestyle?" explores the explanatory model, "How do you get your medications?" refers to the social and environmental factor, "Are you concerned about the side effects of your medications?" addresses fears and concerns, and "Can you describe how you will take your medications?" involves therapeutic contracting.

A nurse is interviewing a newly admitted patient. Which question is considered culturally sensitive? A. "Do you think you will be able to eat the food we have here?" B. "Do you understand that we can't prepare special meals?" C. "What types of food do you eat for meals?" D. "Why can't you just eat our food while you are here?"

C. "What types of food do you eat for meals?" Asking patients what types of foods they eat for meals is culturally sensitive. The other questions are culturally insensitive.

A nurse caring for adults in a provider's office researches aging theories to understand why some patients age more rapidly than others. Which statements describe the immunity theory of the aging process? Select all that apply. A. Chemical reactions in the body produce damage to the DNA. B. Free radicals have adverse effects on adjacent molecules. C. Decrease in size and function of the thymus results in more infections. D. There is much interest in the role of vitamin supplementation. E. Lifespan depends on a great extent to genetic factors. F. Organisms wear out from increased metabolic functioning.

C. Decrease in size and function of the thymus results in more infections. D. There is much interest in the role of vitamin supplementation. Rationale: The immunity theory of aging focuses on the functions of the immune system and states that the immune response declines steadily after younger adulthood as the thymus loses size and function, resulting in more infections. There is much interest in vitamin supplements (such as vitamin E) to improve immune function. The cross-linkage theory proposed that a chemical reaction produces damage to the DNA and cell death. The free radical theory states that free radicals—molecules with separated high-energy electrons—formed during cellular metabolism can have adverse effects on adjacent molecules. The genetic theory of aging holds that lifespan depends to a great extent on genetic factors. According to the wear-and-tear theory, organisms wear out from increased metabolic functioning, and cells become exhausted from continual energy depletion from adapting to stressors.

A nursing instructor teaching classes in gerontology to nursing students discusses myths related to the aging of adults. Which statement is a myth about older adults? A. Most older adults live in their own homes. B. Healthy older adults enjoy sexual activity. C. Old age means mental deterioration. D. Older adults want to be attractive to others.

C. Old age means mental deterioration. Rationale: Although response time may be longer, intelligence does not normally decrease because of aging. Most older adults own their own homes. Although sexual activity may be less frequent, the ability to perform and enjoy sexual activity lasts well into the 90s in healthy older adults. Older adults want to be attractive to others.

A nurse convinces a client who is a Jehovah's Witness that receiving blood products is more important than the legalistic components of religion. What client reaction may be expected following this mandated change? A. The client states, "I can't get over my feelings of legalism as a Jehovah's Witness." B. The client states, "I am glad that nurse told me what to do." C. The client states, "I feel like I abandoned my religion." D. The client states, "Why isn't blood administration forced on all who need that treatment?"

C. The client states, "I feel like I abandoned my religion."

A nurse is teaching a novice nurse how to provide care for patients in a culturally diverse community health clinic. Although all these actions are recommended, which one is MOST basic to providing culturally competent care? A. Learning the predominant language of the community B. Obtaining significant information about the community C. Treating each patient at the clinic as an individual D. Recognizing the importance of the patient's family

C. Treating each patient at the clinic as an individual In all aspects of nursing, it is important to treat each patient as an individual. This is also true in providing culturally competent care. This basic objective can be accomplished by learning the predominant language in the community, researching the patient's culture, and recognizing the influence of family on the patient's life.

Occurs when one ignores differences and proceeds as though they do not exist.

Cultural Blindness

The belief that everyone else should conform to your own belief system

Cultural Imposition

The nurse caring for several clients on a hospital unit notices that the white client makes eye contact with the staff, while an older adult client of Japanese descent does not make eye contact when speaking to the staff. What cultural concept explains this difference?

Cultural relativity

Common Health Problems in Eastern European Jews

Cystic fibrosis Gaucher's disease Spinal muscular atrophy Tay-Sachs' disease

A 12-year-old black client has experienced significant blood loss and may require a blood transfusion. The client's mother, father, and sisters are currently present at the bedside in the emergency department. How should the nurse direct questions and education about the client's condition and treatment? A. Address the mother, because black families are commonly matriarchal. B. Direct questions to the family collectively to avoid presuming who is dominant. C. Ask the child's father what should be done, but make eye contact with everyone in the room. D. Assess who is the dominant member of the family and then address that person.

D. Assess who is the dominant member of the family and then address that person.

A nurse providing health services for a 55 plus community setting formulates diagnoses for patients. Which of the following nursing diagnoses would be most appropriate for many middle adults? A. Risk for Imbalanced Nutrition: Less Than Body Requirements B. Delayed Growth and Development C. Self-Care Deficit D. Caregiver Role Strain

D. Caregiver Role Strain Rationale: Many middle adults help care for aging parents and have concerns about their own health and ability to continue to care for an older family member. Caregivers often face 24-hour care responsibilities for extended periods of time, which creates physical and emotional problems for the caregiver. Risk for Imbalanced Nutrition: Less Than Body Requirements would be most appropriate for an adolescent with an eating disorder or an older adult who has conditions (such as ill-fitting dentures, financial restraints, or GI issues) preventing proper nutrition. Delayed growth and development would be most appropriate for infancy to school-age patients, and self-care deficit would be most appropriate for older adults whose health prevents them from performing ADLs.

A nurse is caring for patients of diverse cultures in a community health care facility. Which characteristics of cultural diversity that exist in the United States should the nurse consider when planning culturally competent care? Select all that apply. A. The United States has become less inclusive of same-sex couples. B. Cultural diversity is limited to people of varying cultures and races. C. Cultural diversity is separate and distinct from health and illness. D. People may be members of multiple cultural groups at one time. E. Culture guides what is acceptable behavior for people in a specific group. F. Cultural practices may evolve over time but mainly remain constant.

D. People may be members of multiple cultural groups at one time. E. Culture guides what is acceptable behavior for people in a specific group. F. Cultural practices may evolve over time but mainly remain constant. Rationale: A person may be a member of multiple cultural, ethnic, and racial groups at one time. Culture guides what is acceptable behavior for people in a specific group. Cultural practices and beliefs may evolve over time, but they mainly remain constant as long as they satisfy a group's needs. The United States has become more (not less) inclusive of same-sex couples. The definition of cultural diversity includes, but is not limited to, people of varying cultures, racial and ethnic origin, religion, language, physical size, biological sex, sexual orientation, age, disability, socioeconomic status, occupational status, and geographic location. Cultural diversity, including culture, ethnicity, and race, is an integral component of both health and illness.

A client is experiencing culture shock. Which findings would the nurse likely assess? Select all that apply.

Disorientation Stress

A parent informs the nurse that immunizations are against the parent's cultural and religious beliefs and the parent does not want the child to receive immunizations. The nurse proceeds to inform the parent that the child will be consistently ill and will not be allowed to start school unless immunized. The nurse also informs the parent that the nurse had all of the nurse's own children vaccinated. The nurse's behavior an example of:

cultural imposition.

Direct Eye Contact in certain cultures...

may be considered impolite or aggressive by many Asians, Native Americans, Indochinese, Arabs, and Appalachians; these groups of people tend to avert their eyes while speaking. Hispanics may look downward in deference to age, biological sex, social position, economic status, or authority. Muslim-Arab women often indicate modesty by avoiding eye contact with men, and Hasidic Jewish men may avoid direct eye contact with women

A nurse is working with a culturally diverse group of clients. The nurse understands that cultural norms:

require an individualized approach by the nurse.