Nclex PN - Culture

The nurse is caring for a Southeast Asian woman who presented to the emergency department with complaints of a headache and nausea. The client is accompanied by her adult son. Upon examination, the nurse notes long pale red welts on both arms. Which actions should the nurse take *next? Select all that apply.* 1. Ask if she has used any home remedies. 2. Assess cultural health beliefs and practices. 3. Report the use of coin rubbing to social services. 4. Remove the adult son from the room immediately. 5. Recognize the redness is a result of a traditional form of healing.

1,2,5 (Rationale: The nurse should ask the client if she has used any home remedies. The nurse should assess cultural health beliefs and practices and understand that "coining or coin rubbing" is a traditional form of healing. The nurse should recognize the redness as a result of a traditional form of healing. Coining is an attempt to heal an illness and is not harmful to the client. The son should not be removed from the room unless the client requests. The nurse should not report the use of coining to social services because the practice is not abusive.)

The nurse is caring for a Jewish client who follows a kosher diet. Which foods should the nurse use in planning meals for the client? *Select all that apply.* 1. Tuna 2. Pork 3. Chicken 4. Potatoes 5. Apples

1,3,4,5 (Rationale: Clients who follow a kosher diet avoid meat from carnivores, pork products, and fish without scales or fins. Fruits and vegetables are considered kosher as long as there are no bugs present. Tuna, chicken, potatoes, and apples are considered kosher and appropriate.)

The nurse is assisting with collecting data from an African-American client admitted to the ambulatory care unit who is scheduled for a hernia repair. Which information about the client is of lowest priority during the data collection 1. Respiratory 2. Psychosocial 3. Neurological 4. Cardiovascular

2 (Rationale: The psychosocial data is the lowest priority during the initial admission data collection. In the African-American culture, it is considered intrusive to ask personal questions during the initial contact or meeting. Additionally, respiratory, neurological, and cardiovascular data include physiological assessments that would be priority.)

The nurse knows that spatial behavior is related to territoriality in many Latino cultures. Which client needs are associated with territoriality? *Select all that apply.* 1. Utility 2. Privacy 3. Security 4. Autonomy 5. Self-identity 6. Philosophy

2, 3, 4, 5 (Rationale: Spatial behavior should be assessed for every client. Territoriality is common to all individuals and groups. Territoriality meets the needs for security, privacy, autonomy, and self-identity. In cultures where priority is given to the group over the individual (Asian cultures, many Latino, and most Arab cultures), group rights and shared space are important considerations to make when caring for the clients. Utility is defined as practicality or helpfulness. Philosophy is defined as attitude or thinking.)

The nurse is caring for a group of clients who are taking herbal medications at home. Which client should be given instructions with regard to avoiding the use of herbal medications? 1. A 60-year-old male client with rhinitis 2. A 24-year-old male client with a lower back injury 3. A 10-year-old female client with a urinary tract infection 4. A 45-year-old female client with a history of migraine headaches

3 (Children should not be given herbal therapies, especially in the home and without professional supervision. There are no general contraindications for the clients described in options 1, 2, and 4.)

The nurse is planning to reinforce nutrition instructions to an African-American client. When reviewing the plan, the nurse is aware that which food may be a common dietary practice of clients with African-American heritage? 1. Raw fish 2. Red meat 3. Fried foods 4. Rice as the basis for all meals

3 (Rationale: African-American food preferences usually include chicken, pork, greens, rice, and fried foods. Asian-Americans eat raw fish, rice, and soy sauce. Hispanic-Americans prefer beans, fried foods, spicy foods, chili, and carbonated beverages. European-Americans prefer carbohydrates and red meat.)

The nurse is reinforcing instructions to a Native-American client regarding the procedure for collecting a urine sample. The nurse observes that the client continually stares at the floor during the instructional session. The nurse interprets this as being indicative of which behavior? 1. Rudeness 2. Disinterest 3. Attentiveness 4. Embarrassment

3 (Rationale: Many Native-American clients often stare at the floor when the nurse is talking. This culturally appropriate behavior indicates that the listener is paying close attention to the speaker. Rudeness, disinterest, and embarrassment are not correct interpretations of the client's behavior.)

The nurse educator is providing an in-service education to the nursing staff regarding transcultural nursing care. A staff member asks the nurse educator to describe the concept of acculturation. Which response is appropriate? 1. "It is a subjective perspective of the person's heritage and a sense of belonging to a group." 2. "It is a group of individuals in a society that is culturally distinct and has a unique identity." 3. "It is a group that shares some of the characteristics of the larger population group of which it is a part." 4. "It is a process of learning a different culture to adapt to a new or changing environment."

4 (Rationale: Acculturation is a process of learning a different culture to adapt to a new or changing environment. Ethnic identity is the subjective perspective of belonging to the group of one's heritage. An ethnic group is a group of persons in a society that is culturally distinct and has a unique identity. A subculture is sharing some of the characteristics of a larger population group.)

The nurse is preparing to assist a client of Orthodox Jewish faith with eating lunch. A kosher meal is delivered to the client. Which nursing action is appropriate when assisting the client with the meal? 1. Unwrapping the eating utensils for the client 2. Replacing the plastic utensils with metal utensils 3. Carefully transferring the food from paper plates to glass plates 4. Allowing the client to unwrap the utensils and prepare his own meal for eating

4 (Rationale: Kosher meals arrive on paper plates and with plastic utensils sealed. Primary health care providers should not unwrap the utensils or transfer the food to another serving dish. Although the nurse may want to be helpful by assisting the client with the meal, the only appropriate option for this client is option 4.)

The nursing instructor is providing a session on cultural beliefs related to health and illness and gives some examples. A client of African-Caribbean descent tells the nurse that the present illness may have resulted from a curse from a competitor. Which statement describes the belief of this client? 1. "Illness is a result of lack of exercise." 2. "Illness is caused by prolonged sitting." 3. "Illness is due to an imbalance between yin and yang." 4. "Illness is a disharmonious state that may be caused by demons and spirits."

4 (Rationale: There are some persons from the African-Caribbean who believe that illness is viewed as a disharmonious state that may be caused by demons and spirits. The goal of treatment, from the traditional African perspective, is to remove the harmful spirit from the body of the ill person. Some traditional Asian-Americans believe that illness is caused by an imbalance between yin and yang and by prolonged sitting or lying, or by overexertion.)

The nurse determines that which herbal therapies can be prescribed for use as an antispasmodic? *Select all that apply.* 1. Aloe 2. Kava 3. Ginger 4. Chamomile 5. Peppermint oil

4,5 (Test-Taking Strategy(ies): Focus on the subject, antispasmodics. Remember that angelica, chamomile, and peppermint oil act as antispasmodics. Rationale: Chamomile has a mild sedative effect and acts as an antispasmodic and anti-inflammatory. Peppermint oil acts as an antispasmodic and is used for irritable bowel syndrome. Topical aloe promotes wound healing. Aloe taken orally acts as a laxative. Kava has an anxiolytic, sedative, and analgesic effect. Ginger is effective in relieving nausea.)

The nurse consults with a dietitian regarding the dietary preferences of an Asian-American client. Which food should the nurse suggest to include in the diet plan? 1. Rice 2. Fruits 3. Red meat 4. Fried foods

1 (Asian-American food preferences usually include raw fish, rice, and soy sauce. African-American food preferences include chicken, pork, greens, rice, and fried foods. Hispanic-Americans prefer beans, fried foods, spicy foods, chili, and carbonated beverages. European-Americans prefer carbohydrates and red meat.)

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

(Test-Taking Strategy(ies): Focus on the subject, an Asian-American, and the client's diagnosis, fever. Remember that cold foods (yin foods) are eaten when one has a hot illness, and hot foods (yang foods) are eaten when one has a cold illness. 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.)

The nurse is assigned to care for a client who is traditional Chinese. The nurse enters the room and following a greeting and introduction to the client, the nurse begins to discuss the plan of care for the day. During the discussion, the client turns away from the nurse. The nurse should take which action? 1. Continue with the discussion. 2. Return later to continue with the discussion. 3. Ask the client whether he can hear the nurse. 4. Leave the room and ask for another nurse to be assigned to the client.

1 (Rationale: In the Chinese (Asian) culture, direct eye contact is often viewed as being rude. If the client turns away from the nurse during a conversation, the best action is to continue with the conversation. Asking the client whether he can hear the nurse or leaving the room and returning later to continue with the discussion may be viewed as a rude gesture by the client.)

The nurse is caring for an African-American client admitted for a planned surgery. The nurse enters the room and after a greeting and introduction to the client describes the routine for preparing for surgery. The client looks away from the nurse. Which nursing action is appropriate? 1. Continue with the explanation. 2. Tell the client that the surgery is the reason the admission. 3. Leave the room and return later to continue with the explanation. 4. Walk around to the client and ask the client what the problem might be.

1 (Rationale: In the African-American culture as in some other cultures, direct eye contact may be viewed as being rude. If the client looks away from the nurse during a conversation, the best action is to continue with the conversation. Walking around to the client so that the nurse faces the client is in direct conflict with the cultural practice. The client may view the nurse's leaving the room and returning later to continue with the explanation as a rude gesture. Option 2 is nontherapeutic.)

The nurse is reinforcing discharge instructions to a Chinese client regarding prescribed dietary modifications. During the teaching session, the client continually turns away from the nurse. Which nursing action is *most appropriate*? 1. Continue with the instructions, verifying client understanding. 2. Walk around the client so that the nurse continually faces the client. 3. Identify the importance of the instructions for the maintenance of health care. 4. Give the client a dietary booklet and return later to continue with the instructions.

1 (Rationale: Most Chinese people maintain a formal distance with each other, which is a form of respect. Many Chinese are uncomfortable with face-to-face communication, especially when direct eye contact is involved. 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 the cultural practice. Identifying the importance of the instructions for the maintenance of health care may be viewed as degrading. Returning later to continue with the explanation may be viewed as a rude gesture.)

An Appalachian family has brought a toddler to the emergency department with a fractured arm. The nurse knows that nonverbal communication is important to evaluate with assessing the family. Which factors are involved in nonverbal communication? *Select all that apply.* 1. Touch 2. Intonation 3. Body posture 4. Use of space 5. Eye behavior 6. Facial expressions

1, 3, 4, 5, 6 (Rationale: Communication involves nonverbal messages, which include touch, facial expressions, eye behavior, body posture, and the use of space. Nonverbal communication is powerful and honest, its importance and meaning vary among cultures; therefore, it is essential that the nurse has an awareness of the role that nonverbal cues may have in the communication process. Intonation is specific to verbal communication.)

The nurse is caring for a new immigrant from the Philippines who is in labor. The client is 4 cm dilated and 30% effaced. This is her first child. The mother is grimacing. Her pulse, respiratory rate, and blood pressure are elevated. The nurse offers to check on a prescription for an epidural. The mother declines. The nurse hypothesizes the client may be declining the epidural for which reasons? *Select all that apply.* 1. Filipino mothers fear drug addiction. 2. Filipino mothers decrease their pain through a verbal release. 3. Filipino mothers prefer to accept treatments for pain from their parteras. 4. Filipino mothers are often stoic and view childbirth pain as a normal part of life. 5. Filipino mothers believe pain is a form of spiritual atonement for one's past deeds.

1, 5 (Rationale: Childbirth experiences differ among different cultures. Filipino mothers fear drug addiction. They also believe that pain is a form of spiritual atonement. Hispanic and Arab-American mothers may be more vocal during childbirth. Mexican mothers have parteras (specially trained persons) attend them during the childbirth process. Vietnamese mothers are quiet during childbirth and view it as a normal part of life.)

The nurse is providing care to a client diagnosed with multiple sclerosis. The nurse knows that which populations are affected by this disease? *Select all that apply.* 1. Multiple sclerosis affects women twice as often as men. 2. Native-Americans are always immune from this disease. 3. Adults who live in colder climates never acquire this condition. 4. People who had a traumatic back injury are more likely to be affected. 5. Multiple sclerosis occurs in adults between the ages of 20 and 50 years. 6. Multiple sclerosis most often affects Caucasians of Northern European ancestry.

1, 5 ,6 (Rationale: Multiple Sclerosis (MS) is a commonly occurring disease that affects people (women twice as often as men) between the ages of 20 and 50 years. It also most often affects Caucasians of Northern European ancestry.)

The nurse knows when preparing the Filipino-American client for a surgical procedure it is important to assess for which culturally relevant influences? *Select all that apply.* 1. Familial hierarchy 2. Cultural practices 3. Reactions to surgery 4. Pain management plans 5. Practitioner's time management

1,2,3,4 (Rationale: To provide culturally competent care to a surgical client, begin by assessing the family hierarchy to determine who needs to be involved in the client's decisions regarding surgery. It is important to identify cultural and religious beliefs and practices that affect a client's and/or family's reactions to surgery and other treatment measures. Pain management plans are important to address because some Filipinos believe that pain medication leads to addiction. Practitioner's time management would not be a factor in the nursing assessment.)

A Spanish-speaking client arrives at the triage desk in the emergency department and states to the nurse, "No speak English, need interpreter." Which action should the nurse take? 1. Have one of the client's family members interpret. 2. Have the Spanish-speaking triage receptionist interpret. 3. Seek an interpreter from the hospital's interpreter services. 4. Obtain a Spanish-English dictionary and attempt to triage the client.

3 (Rationale: The nurse should have a professional hospital-based interpreter translate for the client. English-speaking family members may not appropriately understand what is asked of them and may paraphrase what the client is actually saying. Also, client confidentiality and accurate information may be compromised when a family member or a nonhealth care provider acts as interpreter. Using a Spanish-English dictionary is time-consuming and not the best action; accurate interpretation is best done by a professional hospital-based interpreter.)

The nurse is caring for an older Appalachian client recovering from open heart surgery. In order to provide culturally appropriate care, the nurse should be aware that which aspects of reporting pain may be impacted by the Appalachian culture? *Select all that apply.* 1. Appalachian clients may want to appear to be stoic. 2. Appalachian clients may be afraid of addiction tendencies. 3. Appalachian clients may be very expressive in reporting pain. 4. Appalachian clients may not want to appear to be complainers. 5. Appalachian clients may not understand pain scale because of illiteracy.

1,2,4 (Rationale: In the Appalachian culture, clients often appear stoic and do not want to complain. Clients may not want to appear to be a complainer or a bother to someone, so often they do not report their pain. Addiction tendencies may be a concern to clients from many different backgrounds. It is a common myth that all Appalachian clients are illiterate. The nurse must not assume that all Appalachian clients are illiterate)

The nurse is caring for an older Orthodox Jewish client whose condition is terminal. The nurse is implementing a plan of care and wishes to communicate this plan with the family and client. The nurse should be aware of which end-of-life religious practices when planning and communicating with the client and family? *Select all that apply.* 1. The client may demonstrate a high level of anxiety. 2. Religious laws are suspended during times of severe illness. 3. During the process of dying, visitors and conversation should be kept to a minimum. 4. Clients that are of the Orthodox Jewish faith are usually very quiet and do not verbalize pain. 5. If the client dies, care is given so that the body is not be touched by a person of the opposite sex.

1,2,5 (Rationale: Outward expressions of anxiety are commonly seen among Orthodox Jewish members, especially the older individual. The Orthodox Jew strictly follows the laws of Judaism; however, during times of severe illness, Jewish laws are not observed if doing so will endanger the client's health. In the Orthodox Jewish faith, if the client dies, care is given so that the body is not be touched by a person of the opposite sex. During times of illness or death, the Orthodox Jewish community including family and friends will frequently visit and are considered the nucleus of the Jewish culture. Clients of the Orthodox Jewish faith are generally very verbal about what they are feeling, especially in the older population.)

A nursing student is asked to identify the practices and beliefs of the Amish society. Which should the student identify? *Select all that apply.* 1. Many choose not to have health insurance. 2. They believe that health is a gift from God. 3. The authority of women is equal to that of men. 4. They remain secluded and avoid helping each other. 5. They use both traditional and alternative health care, such as healers, herbs, and massage. 6. Funerals are conducted in the home without a eulogy, flower decorations, or any other display. Caskets are plain and simple, without adornment.

1,2,5,6 (Rationale: The Amish society maintains a culture that is distinct and separate from the non-Amish society, but they are not completely secluded especially in their own community and Amish families help each other. Family life has a patriarchal structure, and although the roles of women are considered equally important to those of men, they are very unequal in terms of authority. Amish society rejects materialism and worldliness. Members value living simply, and they may choose to avoid technology, such as electricity and cars. They highly value responsibility, generosity, and helping others, and they often work as farmers, builders, quilters, and homemakers. The Amish use traditional health care and alternative health care, such as healers, herbs, and massage. They believe that health is a gift from God but that clean living and a balanced diet help maintain it. They may choose not to have health insurance and instead maintain mutual aid funds for those members who need help with medical costs. Funerals are conducted in the home without a eulogy, flower decorations, or any other display. Caskets are plain and simple, without adornment. At death, women are usually buried in their bridal dresses.)

The nurse is caring for a non-English-speaking client. Best practices for client safety and quality of care incorporates which actions by the nurse? *Select all that apply.* 1. Use interpreters who are familiar with health care. 2. Avoid eye contact with the client while communicating. 3. Avoid the use of relatives as interpreters to prevent misinterpretation. 4. Use dialect-specific interpreters who are the same gender if possible. 5. Become familiar with common health care words used in the client's language. 6. Remember most non-English-speaking clients cannot understand English phrases.

1,3,4,5 (Rationale: Guidelines for communicating with non-English-speaking clients include the use of dialect-specific interpreters who are the same gender and age, the use of interpreters who are familiar with health and health care, avoiding the use of relatives as interpreters to decrease the occurrence of bias and misinterpretation, using common health care terms in the client's language, maintaining eye contact with the client when communicating unless it is not culturally accepted, and realizing that clients can often understand English better than they can speak English.)

The nurse is caring for an elderly Hispanic client who is a migrant farm worker and has been admitted for asthma. The nurse is unfamiliar with the cultural practices and beliefs of the client's home land. Which questions are appropriate for the nurse to ask when caring for this client? *Select all that apply.* 1. What do you believe is causing your illness? 2. Why don't you take some asthma medication? 3. Why do you wear that amulet around your neck? 4. Are there any remedies you have used in the past? 5. Who do you usually see for help when you are sick?

1,4,5 (Rationale: When caring for clients of an unfamiliar culture, the nurse should inquire about the clients' health beliefs and practices, their primary health care provider, and their beliefs regarding the origin of illness in order to provide culturally competent care. Asking the client "why don't you take some asthma medication," may have an accusatory undertone. This type of question will not assist the nurse in developing a rapport. A person's reason for wearing an amulet is not relevant to this situation, and this question may be perceived as intrusive.)

The nurse is caring for a Hispanic client who reports that she is a practicing Roman Catholic. Which actions by the nurse demonstrate spiritual and cultural sensitivity? *Select all that apply.* 1. Ensure meals include Halal foods. 2. Turn the client's bed toward the East, toward Mecca. 3. Allow the client to observe communion daily if requested. 4. Facilitate anointing of the client by a priest if requested. 5. Advocate for the client in the belief to not receive blood products.

3, 4 (Rationale: During response to illness, practicing Roman Catholics may request to be anointed while sick. They may also practice daily Holy Communion. Meals permissible by Muslims include Halal foods. Muslims also prefer to turn their bed toward the East, toward Mecca. Jehovah's Witness belief system includes refusal of blood products.)

A client is seen in the clinic for a physical examination. Laboratory studies are performed and reveal that the hemoglobin and hematocrit are low, indicating the need for further diagnostic studies and possibly a blood transfusion. The client is a Jehovah's Witness and states he will never have a blood transfusion. Which would be an appropriate action by the clinic nurse? 1. Try to convince the client of the need for the transfusion. 2. Support the client's decision not to receive a blood transfusion. 3. Speak to the family regarding the need for a blood transfusion. 4. Discuss with the client the results of the low hemoglobin and hematocrit levels.

2 (Rationale: Cultural and ethnic background influences an individual's response to health, illness, surgery, and death. Awareness of cultural differences enhances the nurse's knowledge of how a health care experience may be perceived by the client or family. In the Jehovah's Witness religion, the administration of blood and blood products is forbidden. Therefore, the nurse should support the client's decision. The nurse should respect the autonomy of the client and not try to convince the client or the family that a transfusion must be taken. The nurse may explain the laboratory tests, but this should not be done in an effort to convince the client of the need for a blood transfusion.)

The nurse is preparing a session regarding nutrition for a group of culturally diverse pregnant women. The nurse determines that the *priority* nursing intervention includes which action? 1. Obtain the weight of each client. 2. Identify the cultural food preferences of each client. 3. Determine the socioeconomic status of each client. 4. Describe the importance of avoiding eating at fast-food restaurants.

2 (Rationale: The priority nursing intervention is to identify the cultural food preferences of each client. This information is needed in order to adequately provide information regarding appropriate nutrition. The socioeconomic status may be an important component, particularly when the nurse is determining whether a client's financial situation permits the purchase of appropriate food items. A baseline weight also may be important. Encouraging appropriate nutrition and the need to avoid fast-food restaurants is also important. However, an adequate nutritional plan can be formulated only if cultural food preferences are identified.)

The nurse is assigned to collect data from a Hispanic-American client during the hospital admission. On *initial* meeting of the client, the nurse should plan to do which? 1. Avoid touching the client. 2. Greet the client with a handshake. 3. Smile and use humor throughout the entire admission process. 4. Avoid any affirmative nods during the conversations with the client.

2 (Rationale: To demonstrate respect, compassion, and understanding, primary health care providers should greet Hispanic-American clients with a handshake. However, handshakes that are too firm or vigorous are considered to be rude or intrusive. On establishing rapport, providers may further demonstrate approval and respect through touch, smiling, and affirmative nods of the head. Given the diversity of dialects and the nuances of language, culturally congruent use of humor is difficult to accomplish and therefore should be avoided.)

The nurse caring for a Chinese-American client plans to use communication according to Chinese-American cultural beliefs and practices. Which techniques are considered disrespectful in the Chinese-American's view of communication? *Select all that apply.* 1. Sitting side-by-side 2. Maintaining eye contact 3. Closing the conversation abruptly 4. Touching the opposite sex in public 5. Allowing silent pauses during conversation

2, 3, 4 (Rationale: Chinese-Americans may be uncomfortable with face-to-face conversations. They may prefer to sit side-to-side or at right angles to carry on conversation. Among American Indian, Chinese, and Japanese cultures, silence is sometimes used to allow the listener to consider what the speaker has said before continuing. Maintaining eye contact may be considered ill-mannered and disrespectful. In Eastern cultures including Chinese, East Indian Hindu, Filipino, and Korean, schedules and time may be much more flexible concepts. Some Asians will spend a lot of time getting to know someone and will view abrupt endings to a conversation as rude. Although touch is possibly acceptable among same-sex acquaintances, touching in public between opposite sexes is not acceptable.)

The hospice nurse is caring for five clients from various religious backgrounds. Which observations should the nurse expect for the clients of the various religious backgrounds? *Select all that apply.* 1. A priest hearing the confession of the client of the Methodist faith 2. A client of the Muslim faith having their bed positioned toward Mecca 3. An Asian client's family desiring the client to be moved to a room number of 44 4. Ensuring meals on Friday do not include warm-blooded meats for the client of the Baptist faith 5. A Hindu-believing family arranges to have the clients' body cremated within 24 hours of death

2,5 (Rationale: Those of the Muslim faith desire their body to be facing Mecca. Those of the Hindu faith believe in cremation within 24 hours to release their soul from earthly attachments. A priest hears confessions of the Catholic faith, not the Methodist faith. The number 4 is avoided by those of an Asian background because it symbolizes death. Catholics, not Baptists, avoid warm-blooded meats on Fridays.)

An antihypertensive medication has been prescribed for a client with hypertension. The client tells the nurse that she would like to take an herbal substance to help lower her blood pressure. Which statement by the nurse is *most important* to provide to the client? 1. "Herbal substances are not safe and should never be used." 2. "I will teach you how to take your blood pressure so that it can be monitored closely." 3. "You will need to talk to your primary health care provider (PHCP) before using an herbal substance." 4. "If you take an herbal substance, you will need to have your 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 advised to avoid herbal substances with similar pharmacological effects, because the combination may lead to an excessive reaction or unknown interaction effects. Therefore, the nurse would advise the client to discuss the use of the herbal substance with the PHCP.)

A client is diagnosed with cancer and is told that surgery followed by chemotherapy will be necessary. The client states to the nurse, "I have read a lot about complementary therapies. Do you think I should try any?" The nurse should respond by making which appropriate statement? 1. "I would try anything that I could if I had cancer." 2. "No, because it will interact with the chemotherapy." 3. "Tell me what you know about complementary therapies." 4. "You need to ask your primary health care provider about it."

3 (Rationale: Complementary (alternative) therapies include a wide variety of treatment modalities that are used in addition to conventional treatment to treat a disease or illness. These therapies complement conventional treatment, but they should be approved by the person's primary health care provider (PHCP) to ensure that the treatment does not interact with prescribed therapy. Although the PHCP should approve the use of a complementary therapy, it is important for the nurse to explore the complementary therapies firstwith the client,whichwould eliminate option 4. The statement in option 2 is inappropriate. Similarly, option 1 is an inappropriate response to the client. Option 3 addresses the client's question and encourages discussion.)

Which statement made by the nursing student indicates a *need for further teaching* by the nursing instructor on the concept of ethnocentrism? 1. "It is a tendency to view one's own ways as best." 2. "It is believing that one's own ways are the only acceptable way." 3. "It is imposing one's beliefs on individuals from another culture." 4. "It is acting in a manner in which one's culture is superior to other cultures."

3 (Rationale: Ethnocentrism is a tendency to view one's own ways of life as the most desirable, acceptable, or best, and to act in a superior manner toward another culture. Cultural imposition is the tendency to impose one's own beliefs, values, and patterns of behavior on individuals from another culture)

A 24-year-old Chinese-American who delivered her baby yesterday is breastfeeding her infant girl. The client's mother asked the nurse not to include cold foods on her daughter's tray because they are not good for the baby. The nurse responds by telling the client that she can have what she wants; it is not up to her mother. This response of the nurse demonstrates which cultural characteristic? 1. Subculture 2. Assimilation 3. Ethnocentrism 4. Cultural relativism

3 (Rationale: Ethnocentrism is the perception that one's own way is best. In the nursing profession, there is a tendency to be ethnocentric. Nurses must remain cognizant of the fact that their ways are not necessarily the best and that other people's ideas are not inferior to their own. Nurses must remember that the ideas of laypersons may be valid for them and will influence their health care behavior. Subculture is a culture within a group or culture. Assimilation is defined as accommodation or adjustments. Cultural relativism is the view that all beliefs, customs, and ethics are relative to the individual within their own social context.)

The nurse checks the food on a tray delivered for an Orthodox Jewish client and notes that the client has received a cheeseburger and potato fries with whole milk as a beverage. Which action should the nurse take? 1. Deliver the food tray to the client. 2. Replace the whole milk with lactose-free milk. 3. Call the dietary department and ask for a different meal. 4. Ask the dietary department to replace the beef with pork.

3 (Rationale: In the Orthodox Jewish tradition, members avoid meat from carnivores, pork products, and certain fish. The nurse should not deliver the food tray to the client and should ask the dietary department to deliver a different meal. Meat and dairy are served separately, thus the dairy-meat combination is not acceptable, making option 2 incorrect. Option 4 is incorrect because pork and pork products are also not allowed in the diet.)

The nurse is planning to reinforce instructions to the Hispanic-American client about nutrition and dietary restrictions. When developing the plan for the instructions, the nurse is aware of which related fact? 1. This ethnic group eats primarily raw fish. 2. This ethnic group enjoys eating red meat. 3. This ethnic group views food as a primary form of socialization. 4. This ethnic group enjoys foods that lack color, flavor, and texture.

3 (Rationale: Mexican foods are rich in color, flavor, and texture, and spiciness is available by adding sauces. In the Mexican culture, any occasion is seen as a time to celebrate with food and enjoy the companionship of family and friends. Because food is a primary form of socialization in the Mexican culture, Hispanic-Americans may have difficulty adhering to a prescribed diet. Asian-Americans eat raw fish, rice, and soy sauce. European-Americans prefer carbohydrates and red meat.)

The nurse is assigned to care for an Asian-American client. The nurse, when planning care for this client, considers that the client may believe what is the cause of illness if they follow traditional beliefs? 1. Illness is a punishment for sins. 2. Illness is caused by supernatural forces. 3. Illness is caused by an imbalance between yin and yang. 4. Illness is a disharmonious state that may be caused by demons and spirits.

3 (Rationale: Some traditional Asian-Americans believe that illness is caused by an imbalance between yin and yang, by prolonged sitting or lying, or by overexertion. In some African-Caribbean cultures, illness is viewed as a disharmonious state that may be caused by demons and spirits. Some traditional Native-Americans may believe that illness is caused by supernatural forces.)

Why should the nurse who is focusing on facilitating positive outcomes regarding health care services become familiar with the cultural beliefs and practices of a childbearing woman? 1. Safe sex practices are not universally implemented transculturally. 2. Culture can have a dramatic impact on an individual's sexual practices. 3. A culturally diverse woman may have beliefs that impact the delivery of health care services. 4. Understanding the cultural beliefs and practices of one's clients is a nursing responsibility.

3 (Rationale: The nurse providing care for women in their childbearing years must be familiar with the cultural framework within which the client lives and operates. Once this is achieved, appropriate communication techniques can be used to facilitate client assessment and care and to identify health promotion educational strategies and delivery of services. A client is more able to trust a nurse or primary health care provider who understands the woman's cultural beliefs regarding health care. Culture, including ethnicity and religious affiliation, may affect sexual practices including those identified as safe sex practices. It is the responsibility of the nurse to become familiar with and understand the cultural beliefs of the clients being cared for.)

The nurse is preparing to deliver a food tray to a client whose religion is Judaism and follows Kosher preferences. The nurse checks the food on the tray and notes that the client has received a roast beef dinner with whole milk as a beverage. Which action should the nurse take? 1. Deliver the food tray to the client. 2. Replace the whole milk with fat-free milk. 3. Ask the dietary department to replace the roast beef with pork. 4. Call the dietary department and ask for a new meal tray without the milk.

4 (Rationale: In following Kosher preferences, the dairy-meat combination is not acceptable. Pork and pork products are not allowed in the traditional Jewish religion. If the client wants milk, it can be obtained from the unit's kitchen and served according to the client's preferences. Obtain a new meal tray that does not have both meat and milk. Delivering the tray as is, changing the milk product, and serving pork will violate Kosher practice.)

The nurse is providing care to a Cuban-American client who is terminally ill. Numerous family members are present most of the time, and many of the family members are very emotional. Which nursing action is *most appropriate*? 1. Restrict the number of family members visiting at one time. 2. Inform the family that emotional outbursts are to be avoided. 3. Contact the primary health care provider (PHCP) to speak to the family regarding their behavior. 4. Request permission to move the client to a private room, and allow the family members to visit.

4 (Rationale: In the Cuban culture and many other cultures, loud crying and other physical symptoms of grief are considered socially acceptable. Of the options provided, option 4 is the only option that identifies a culturally sensitive approach on the part of the nurse. The nurse should not restrict the number of visitors, limit expression of emotions so long as it does not harm the client, or contact the PHCP regarding family behavior.)

A Hispanic-American mother brings her child to the clinic for an examination.Which is *most important* when gathering data about the child? 1. Avoiding eye contact 2. Using body language only 3. Avoiding speaking to the child 4. Touching the child during the examination

4 (Rationale: In the Hispanic-American culture, eye behavior is significant. It is believed that the "bad/evil eye" can be given to a child if a person looks at and admires a child without touching the child. Therefore, touching the child during the examination is very important. Although avoiding eye contact indicates respect and attentiveness, this is not the most important intervention. Avoiding speaking to the child and using body language only are not therapeutic interventions.)

The nurse is assisting in preparing a plan of care for a client who is a Jehovah's Witness. The client has been told that surgery is necessary. Considering the client's religious preferences, the nurse should first verify with the client and then document which information? 1. Faith healing is primarily practiced. 2. Medication administration is not allowed. 3. Surgery is prohibited in this religious group. 4. The administration of blood and blood products is forbidden.

4 (Rationale: In the Jehovah's Witness religion, surgery is not opposed, but the administration of blood and blood products is forbidden. Medication is an acceptable practice except if the medication is derived from blood products. Faith healing is forbidden in this religious group.)

The nurse educator is describing the yin and yang theory of the ancient Chinese philosophy of Tao to a group of nursing students. The nurse educator explains that in this theory, foods are classified as hot and cold and are transformed into yin and yang energy when metabolized by the body. The nursing student understands this theory when the student makes which statement? 1. The client believes that yin foods are hot foods. 2. The client believes that yang foods are cold foods. 3. The client consumes hot foods when a "hot" illness is present. 4. The client consumes cold foods when a "hot" illness is present.

4 (Rationale: In the yin and yang theory, health is believed to exist when all aspects of the person are in perfect balance. Foods are classified as hot or cold and are transformed into yin and yang energy when metabolized by the body. Yin foods are cold, and yang foods are hot. Cold foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illness.)