BNS (VNSG 1323) CH. 6 PRACTICE QUESTIONS

The nurse is caring for a client who speaks very limited English. Which nursing action is appropriate when communicating with the client? A) Obtaining a certified interpreter. B) Asking the family to speak for the client. C) Speaking slowly and loudly when communicating. D) Using a computerized application to identify key medical words.

Answer: A All clients have a right to proper communication with a health provider. Obtaining a certified interpreter is the most appropriate way to ensure accurate communication between a client and the provider. Speaking slowly and loudly when communicating may not help the language barrier. Asking the family to speak for the client is not appropriate, as it violates family roles and boundaries and could turn into privacy issues. Using a computerized application to identify key medical words does not allow full communication to take place, and thus, key health information can be missed.

A nurse at a small, rural hospital which lacks professional interpreter services has admitted a client who does not speak English. How should the nurse best communicate with this client? A) Utilize a telephone-based interpreting service in order to communicate clearly with the client. B) Base the client's care on the nurse's preexisting knowledge of the client's culture. C) Ask a family member to remain with the client at all times. D) Rely on written, rather than spoken, instructions and questions when interacting with the client.

Answer: A Telephonic interpreting is a professional and convenient alternative to in-house interpreting. It would be inappropriate and ineffective to use written communication if the client does not speak English. The client's family members are an asset in communication, but they should not completely replace professional interpretation services. It is unrealistic to expect family members to remain present at all times.

A nurse is assessing the skin of an African American client to observe the baseline skin coloring. Which body part of the client would be suitable for the performing of this assessment? A) Back B) Abdomen C) Face D) Arms

Answer: B In an African American client, the most suitable place for inspection is the abdomen because it is less tanned compared with the other body parts. Apart from the abdomen, palms of the hands and feet can also be inspected. Face, back, and arms are not good choices for inspection because they are usually tanned.

An 8-year-old African American child is admitted to the pediatric unit for a tonsillectomy. On physical examination, the nurse finds that the child has keloid scarring on the chest. What should be the nurse's reaction? A) Request biochemical investigations. B) Consider the keloid normal for the ethnic background. C) Inform the physician and request a visit. D) Apply a dressing to the keloid.

Answer: B The appearance of keloids should be considered as normal in African Americans. Keloids are irregular, elevated, thick scars found commonly in dark-skinned clients. Informing the physician and requesting biochemical investigations is inappropriate because the keloid is not an appropriate nursing action because it is not a wound that would heal.

The nurse asks a client who has recently given birth to begin breastfeeding her baby. However, the client informs the nurse that she cannot breastfeed the baby for a day because she believes that the mother's milk on the first day is not purse. What is the appropriate action for the nurse in this case? A) Telling the mother that her beliefs are mere superstition and of little value. B) Educating the mother about the advantages of colostrum and breastfeeding. C) Feeding the baby with artificial milk till the mother starts breastfeeding. D) Calling the nurse supervisor and informing him or her about the client.

Answer: B The nurse should educate the mother about advantages of colostrum and breastfeeding. The nurse can also provide relevant examples to the client. In some cultures, people believe that colostrum is harmful for the baby and breastfeeding should not be done for the first day. Feeding the baby with artificial milk may be an alternative if the mother does not agree even after health education but should not be the first action. Calling the nurse supervisor may not be helpful. Additionally, telling the mother that her beliefs are superstitions is likely to offend her.

An Asian American client who has recently given birth notes the presence of a dark blue area on the back of the baby. What should be the nurse's explanation to the mother? A) "It may be due to any intrauterine abnormalities." B) "It is normal for a baby of Asian ethnicity." C) "It may be due to your food habits during pregnancy." D) "I have called the doctor to check the baby."

Answer: B The nurse should explain to the client that the dark spots on the back of the baby are Mongolian spots and are common in Asian American people. Calling a doctor and performing investigations are not appropriate nursing actions. The spots are normal and are not caused by an intrauterine abnormality or improper food habits during the pregnancy.

A nurse needs to bathe a Malaysian client at the health care facility. Keeping in mind the cultural beliefs of the client., what is the most appropriate action of the nurse before washing the client's hair? A) Give an oil massage before washing the hair. B) Seek permission from the client. C) Acquire a special shampoo to bathe the client. D) Arrange the articles required.

Answer: B Considering that the client is Malaysian, the nurse should see permission from the client before washing the client's hair. People from this culture believe that the head is a very sacred part of the body, and only close relatives can touch it. Arranging the articles required, using a special shampoo, and giving an oil massage do not relate to the situation.

A nurse at a long-term care facility has completed a comprehensive assessment of an 83-year-old Asian American woman who has just moved to the facility. The assessment reveals that the new resident has a lactase deficiency. How should the nurse integrate this knowledge into resident's care? A) The nurse should liaise with the resident's physician to ensure that a B-vitamin is ordered. B) The nurse should arrange for a vegetarian diet. C) The nurse should ensure that the resident is not given dairy products. D) The resident should be provided with supplementary dietary enzymes for the digestion of fats prior to each meal.

Answer: C Lactase is a digestive enzyme that converts lactose, the sugar in milk, into simpler sugars glucose and galactose. A lactase deficiency, common among African Americans, Hispanics, and Chinese, causes intolerance to dairy products. Without lactase, people have cramps, intestinal gas, and diarrhea approximately 30 minutes after ingesting milk or foods that contain it. Consequently, the nurse should arrange for the resident's diet to exclude dairy products. Vitamin supplements are not necessary for this client.

A nurse has been cautioned by a nursing educator to ensure that stereotyping does not influence the nurse's beliefs, behaviors and interactions with clients from other cultures. What action by the nurse would be considered stereotyping? A) Arranging for an interpreter to assist with the admission assessment of a client who is a recent immigrant. B) Making adjustments to a client's diet based on the client's stated religion. C) Ascribing attributes to members of a particular culture that are unsupported by facts. D) Allowing race and ethnicity to inform the nurse's assessments and client education.

Answer: C Stereotypes are preconceived ideas usually unsupported by facts. Consideration of race, culture, language and religion in nursing care are not evidence of stereotyping, provided the nurse's beliefs are informed by data and critical thinking.

The nurse overhears a colleague state, "All people from that client's country are rude." What is the appropriate nursing response? A) Agree and state, "Yes, I've noticed the same thing." B) Report the colleague to the nurse manager. C) Respond by saying, "Stereotypes keep us from accepting others as unique individuals." D) Say nothing and ignore the comment.

Answer: C Stereotypes are preconceived ideas usually unsupported by facts. They tend to be neither real nor accurate. They can be dangerous because they interfere with accepting others as unique individuals. The nurse can professionally educate the colleague about the harm involved in stereotyping individuals.

An 8-year-old client with stunted growth, pallor, and weakness is admitted to the health care facility. On interviewing the mother, the nurse finds that the client is from the Mediterranean region and the symptoms had aggravated when the boy participated in a sports activity. Being aware of the ethnic variations, what action is most appropriate for the nurse? A) Ensuring that the client takes a well-balanced diet. B) Ensuring that the client does not overexert himself. C) Ensuring that the client is not prescribed fluroquinolones. D) Ensuring that the client regularly takes hematinics.

Answer: C The nurse should ensure that the client is not prescribed fluoroquinolones because the client may be having G-6PD deficiency, as suggested by the signs and symptoms. G-6PD is an enzyme that helps red blood cells to metabolize glucose. African Americans and people from Mediterranean countries commonly lack this enzyme. The disorder is manifested in males because the gene is sex-linked, but females can carry and transmit the fault gene. Ensuring the client does not overexert himself, takes hematinics, and is taking a well-balanced diet are important considerations, but the priority should be to avoid drugs that precipitate red blood cell loss.

Which behaviors demonstrated by the client would the nurse consider as reflection of the client's pride in ethnicity? ( Select all that apply.) A) Requesting assistance when transferring from bed to chair. B) Listening to folk music and dance. C) Asking to wear person unique clothing. D) Crying when given a diagnosis of cancer. E) Requesting native cuisine.

Answers: E, B and C Pride in one's ethnicity is demonstrated by valuing certain physical characteristics, giving children ethnic names, wearing unique items of clothing, appreciating folk music and dance, and eating native dishes. Feeling emotional when given a concerning diagnosis and asking for assistance do not reflect pride in ethnicity.

The cardiologist advises the client to undergo angioplasty, a procedure to clear blocked coronary arteries. The client refuses the procedure and the nurse later discovers that the client believes in naturopathy and is taking herbal extracts to clear their coronary arteries. Which action should the nurse take? A) Warn the client that majority of the herbalists are unqualified. B) Tell the client that herbal therapy has not proven to be ineffective. C) Ask the client to opt for herbal therapy and also undergo the procedure. D) Tell the client that herbal medicines could lead to other complications.

Answer: C The nurse should suggest that the client try both interventions. Considering the individuality of health beliefs and the risk of not undergoing angioplasty in a timely manner, the nurse should encourage the client to undergo the surgery and simultaneously continue his herbal extract treatment. In stating that herbs are not effective, the nurse does not respect the client's beliefs. Assuming that herbal medicines could lead to further complications is nontherapeutic because the nurse includes personal opinion in the discussion. The nurse should avoid showing disapproval of the client's choice of healing because this does not make for therapeutic communication.

Which stereotypical ideas about older adult clients does the nurse associate with the concept of ageism? ( Select all that apply) A) Financially independent. B) Cognitively enhanced C) Physically impared D) Burdensome to family E) Uninterested in intimacy

Answer: C, D, and E Ageism, a form of negative stereotypical thinking about older adults, promotes false beliefs about older adults being physically and cognitively impaired, lacking interest in sex, and being burdensome to families and society. Ageism is not associated with concepts of cognitive enhancement or financial independence.

A 79-year-old client identifies herself as being Japanese, but notes that she has lived in the United States since the 1950s. When planning this client's diet, what principle should the nurse follow? A) The client will be able to tolerate a wider variety of foods than many clients are able to tolerate. B) The client likely adheres to the traditional Japanese diet that she grew up with. C) The client is likely familiar with foods from a wide variety of cultures. D) The client is likely to follow a typical American diet and many of the unhealthy practices associated with this diet.

Answer: D Acculturation is a common phenomenon and can have a positive or negative effect on eating habits. Generally, as immigrants adopt the "typical American diet" their intake of fat, sugar, and calories increases and their intake of fruit, vegetable, fiber, and protein decrease. After many decades in the United States, the client is unlikely to follow a traditional Japanese diet. The client may or may not be familiar with foods or be able to tolerate foods from a wide variety of cultures.

The nurse is taking a client history. With which client is direct eye contact appropriate? A) 44-year-old Asian American B) 55-year-old Native American C) 60-year-old Arab American D) 32-year-old Anglo-American

Answer: D Anglo-Americans generally make and maintain eye contact throughout communication. Although it may be natural for Anglo-Americans to look directly at a person while speaking, that is not always true of people from other cultures. It may offend Asian Americans or Native Americans, who are likely to believe that lingering eye contact is an invasion of privacy or a sign of disrespect and Arabs, who may misinterpret direct eye contact as sexually suggestive.

A nurse is assigned the care of a client who speaks only French. The nurse does not know the language. What action is appropriate for the nurse in this case? A) Communicate with the client non-verbally. B) Refuse to take charge of the client. C) Ask another nurse to take care of the client. D) Request a professional interpreter.

Answer: D In a situation in which the nurse is assigned care of a non-English speaking client, the nurse should request a professional interpreter. However, the nurse should not refuse to take charge of the client because the nurse cannot refuse duty. Non-verbal communication with the client through gestures would not give complete information, and therefore it is not appropriate for this situation. The nurse may receive help from another nurse who is appropriately bilingual.

A Native American client has been admitted to the health care facility with reports of profuse diarrhea. What action is appropriate for the nurse while interviewing the client, keeping in mind the client's cultural beliefs? A) Avoid asking personal questions. B) Do not sit close to the client. C) Do not ask open-ended questions. D) Do not write notes during the interview.

Answer: D When interviewing a Native American client, the nurse should not write notes during the interview. Instead, the nurse may make notes of the main points after the interview. Native Americans traditionally preserved their heritage through oral transfer rather than written history, so they may be skeptical of nurses who write down what they say. The nurse may ask open-ended questions and sit next to the client. However, the nurse should not probe into the client's personal life in the initial interview, although it may be acceptable to do so later.

Which factors contribute to the concept of a culture? (Select all that apply.) A) Beliefs about health practices B) Styles used for communication. C) Art and music D) Type of disease contracted E) Language F) Items and clothing worn

Answers: A, B, C, E, and F Culture includes, but is not limited to, language, communication style, traditions, religion, art, music, dress, health beliefs, and health practices. The type of disease contacted influences physiologic status.

A group of nurses who provide care in a large, urban hospital have attended an education session on transcultural nursing encompasses which nursing action? (Select all that apply.) A) Each nurse builds an extensive knowledge base about cultures that are present in the region served by the hospital. B) The nurses educate the clients on the importance of culture, race, and language. C) The nurses create plans of care that fit within each individual client's belief system. D) The nurses carry out an assessment of each client's cultural identity. E) The nurses ensure that members of all racial and ethnic groups receive the same care.

Answers: A, C, and D Transcultural nursing involves awareness of cultures, consideration of beliefs, and active assessment of each client's culture. This does not mean, however, that every client receives identical care or that nurses teach clients about considerations such as race, culture, language and ethnicity.