Chapter 5 Cultural Assessment

A client says to the nurse, "Why don't you wear a white cap like nurses do on the soap operas?" This is an ethnocentric statement based on the: * nursing personality. * past history. * media. * genetics.

* media. Explanation: Ethnocentrism is a way of looking at the world through a personal lens that has been influenced by personality, genetics, family/relationships, and media. None of the remaining options play a role in the client's comment to the nurse.

A 35-year-old client was admitted to the hospital following an automobile accident with a fractured leg. Which action should the nurse prioritize after learning this client's family is of Italian descent? * monitor hemoglobin and hematocrit for possible anemia * daily aspirin is prescribed to prevent blood clots * monitor diet to avoid dairy products * monitor blood glucose levels

* monitor hemoglobin and hematocrit for possible anemia Explanation: People with Mediterranean or African heritage commonly lack the enzyme G-6-PD which helps red blood cells metabolize glucose. This deficiency makes red blood cells vulnerable during stress, which can result in the destruction of red blood cells at a much greater rate than in unaffected people. If the production of red blood cells cannot match the rate of destruction, anemia develops. The use of aspirin is contraindicated with this disorder, because it can increase the rate of red blood center destruction. Individuals with lactase deficiency must avoid dairy products. Monitoring blood glucose is not a priority in this situation.

A nurse is admitting a client to the unit. Which cultural question is most appropriate? * "Will you be able to eat the normal food provided?" * "What are your dietary needs and preferences?" * "Do you have food restrictions?" * "Will you be making requests for special food based on your religion?"

"What are your dietary needs and preferences?" Explanation: By asking about dietary needs and preferences, the nurse can gain insight into religious and cultural dietary practices. Asking about "normal" foods assumes that a cultural dietary request is abnormal. The other options will produce limited insight and imply that a cultural dietary need is a restriction or hindrance.

A nurse overhears another nurse make a statement that indicates racism. The nurse makes this determination based on which characteristic indicative of social value? * Skin color * Size * Language * Dress

* Skin color Explanation: Racism uses skin color, not size, language or dress, as the primary indicator of social value.

The nurse has just attended a seminar on concepts of cultural diversity. Which statement made by the nurse would require further education? * "Culture helps to define identity within specific groups of people." * "Culture cannot be influenced, and you are born with your culture." * "Language is the primary way that people share their culture." * "Culture can be seen in attitudes and institutions of certain populations."

* "Culture cannot be influenced, and you are born with your culture." Explanation: Culture is learned through life experiences from one generation to the next. Culture helping to define identity, language being the primary way that people share their culture, and culture being seen in attitudes of certain populations are correct options; these are all components that define culture.

An older adult client who only speaks the nondominant language has been admitted to the emergency department after suffering a fall and suspected hip fracture in the home. Who is the best person to perform translation services for the client? * a hospital translator * a family member * a trusted friend * a bilingual hospital employee

* a hospital translator Explanation: A qualified interpreter who is familiar with health care terminology is the best choice for providing translation for clients. Such a person is more likely to be objective and well versed in the requisite vocabulary than is a friend, family member, or hospital employee.

A client who practices Islam dies at the hospital surrounded by family members. Which action by the nurse demonstrates cultural sensitivity related to the client's death? * consulting the family member prior to performing post-mortem care * informing the family members they may say their goodbyes so that care can be provided * having the family members consult with the funeral home for transport * allowing the family to remain present when the nurse washes the client prior to shrouding

* consulting the family member prior to performing post-mortem care Explanation: Only family members may touch or wash the body of a deceased individual who practiced the Islamic faith, so the nurse should ask for permission prior to providing post-mortem care. The family may choose to remain, but the nurse will not be allowed to wash the body. It will be the nurse's responsibility to arrange for transport to the funeral home after care is rendered by the family.

The nurse is caring for a client who is postoperative 24 hours from an appendectomy. The client is hesitant to get out of bed. How should the nurse respond? * "You need to get up and walk to prevent complications." * "Can you describe what you are feeling when you try to move?" * "I will come back later and help you get up." * "Would like to wait until your family arrives to get out of bed?"

* "Can you describe what you are feeling when you try to move?" Explanation: The client who is hesitant to move and get out of bed may be expecting pain. Some clients, however, my control their emotions and expressions of physical discomfort in front of strangers. Telling the client to get up and walk to prevent complications is important, but the nurse needs to assess why the client is hesitating to get up. Leaving the client or waiting for the family does not address the reason why the client is hesitant to get up.

The nurse just attended a seminar on cultural diversity. Which statement by the nurse would require further education? * "Ethnicity begins at birth or through adoption of characteristics." * "People of the same ethnicity share many of the same cultural and social beliefs." * "Ethnicity can often determine dialect and political interests." * "Ethnicity and race are the same thing and are affected by cultural practice."

* "Ethnicity and race are the same thing and are affected by cultural practice." Explanation: People are often born into an ethnic group, or ethnicity develops by immersion in a community. People of the same ethnicity often speak similar dialects and share similar values. Ethnicity and race are terms used interchangeably; however, they are not the same thing. Race refers specifically to physical characteristics.

Which nursing intervention reflects culturally appropriate care when addressing a client? * "Good morning, Mr. Smith. I am your nurse, John." * "You can sit in this chair, Sally." * "Thank you for coming to the clinic today." * "I see you are here because you have a sinus infection."

* "Good morning, Mr. Smith. I am your nurse, John." Explanation: The nurse can demonstrate professionalism and culturally appropriate care by addressing clients by their last names and introducing oneself. The nurse should follow up thoroughly with requests, respect the client's privacy, and ask open-ended rather than direct questions until trust has been established.

A nurse who usually works on the surgical unit is asked to float to the oncology unit because of staffing needs. Which statement by the nurse indicates the possibility of the nurse experiencing culture shock? * "I am very stressed now because I do not understand how things work on this unit." * "Can someone please give me an orientation to this unit?" * "The way we do things on the surgical unit are so much better than the procedures of this unit." * "I was expecting all the clients on the oncology unit to be depressed."

* "I am very stressed now because I do not understand how things work on this unit." Explanation: The nurse is experiencing culture shock because of the new environment. When the culture one has learned differs from the culture in one's environment, a person can become disoriented and stressed. The acute experience of not comprehending the culture of the current environment is called culture shock. Asking for an orientation to a new unit is proper procedure for a float nurse. The third statement indicates ethnocentrism, not culture shock. The fourth statement indicates stereotyping.

The nurse is teaching a Black client about common health conditions. Which statement by the client most directly addresses a health problem with an increased incidence in this population group? * "I need to watch the amount of high-density lipids I eat." * "It is important to monitor my blood pressure." * "Getting a mammogram in my thirties is important." * "Increasing dairy will improve my bones."

* "It is important to monitor my blood pressure." Explanation: Monitoring the blood pressure is important for identifying the risk for hypertension and stroke, which are common health conditions among the Black population. The other statements are correct for preventing diabetes, breast cancer, and osteoporosis, but these diseases are not disproportionately common health conditions for the population.

A nurse is demonstrating ethnocentrism. Which statement would reflect this concept? * "Irish people are all heavy drinkers." * "Asians are always the smartest in the class." * "My Russian heritage is superior to all others." * "Anybody on welfare is just lazy."

* "My Russian heritage is superior to all others." Explanation: Ethnocentrism is viewing one's own culture as the only correct standard by which to view people of other cultures. Stereotypes are preconceived and untested beliefs about people. They are exaggerated descriptors of character or behavior that are commonly reiterated in mass media, idiomatic expressions, and folklore. They may be demeaning ("People on welfare are lazy, just living off handouts"; "Irish people are all heavy drinkers") or idealizing ("Asians are always the smartest in the class"; "Nurses are patient people"). Either way, they mislead and deny the individuality of the person.

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? * "I will leave the questionnaire here. Please fill it out when your spiritual healer arrives." * "We can wait until your spiritual healer arrives and work together to answer these questions." * "I can wait until your spiritual healer arrives, but you are the only one who can answer these questions." * "These questions need to be answered so we can provide you with the best care."

* "We can wait until your spiritual healer arrives and work together to answer these questions." Explanation: The culturally sensitive nurse understands that some cultures rely on a spiritual healer to restore harmony and health. If the client requests the spiritual healer to be present, the nurse should respect the client's beliefs and decision. Leaving the questionnaire with the client is not acceptable because the nurse needs to make sure the questionnaire is completed with the client. Telling the client that he or she is the only one who can fill out the questionnaire is not necessary and rude. Telling the client that the questions need to be answered so the health care team can provide the best care is important, but recognizing and supporting the client and his or her beliefs is the priority.

A new client comes to the primary care clinic and asks for help treating head lice. The interview reveals that the client lives with nine other people in a one-bedroom apartment. Which statement by the client is nurse's priority concern? * "We do not have running water." * "I often worry about my future." * "I am receiving government assistance." * "We do not have air-conditioning."

* "We do not have running water." Explanation: The priority in this situation is the lack of running water. The already challenging task of eradicating head lice in a crowded living space is worsened by the lack of running water. The concern for one's future needs to be addressed, but the need for water is the first priority. That the client receives government assistance might serve as an indicator of the client's economic challenges but is not a priority nursing concern. The lack of air conditioning would be a concern in a heat wave, but not as much a priority as the lack of running water.

A nurse is admitting a client to the unit. Which cultural question is most appropriate? * "Will you be able to eat the normal food provided?" * "What are your dietary needs and preferences?" * "Do you have food restrictions?" * "Will you be making requests for special food based on your religion?"

* "What are your dietary needs and preferences?" Explanation: By asking about dietary needs and preferences, the nurse can gain insight into religious and cultural dietary practices. Asking about "normal" foods assumes that a cultural dietary request is abnormal. The other options will produce limited insight and imply that a cultural dietary need is a restriction or hindrance.

A client from a minority culture has been hospitalized for 6 days for postoperative infection. The client's weight is decreasing each day, and the nutritional intake is declining. Which nutritional assessment question is most appropriate? * "Why aren't you eating your food?" * "Are you aware that you are losing weight?" * "What type of food do you eat at home?" * "Don't you like what is on your food tray?"

* "What type of food do you eat at home?" Explanation: Cultural food preferences often put the client at risk for inadequate nutrition. By exploring what foods the client eats at home, the nurse can assess the client's cultural dietary preferences and work to incorporate these foods into the meal plan. The other choices are judgmental and indicate that the client should eat what is presented regardless of cultural preference.

A client is admitted to the health care facility with hypoglycemia. After the client is stable, the nurse discovers that the client has not taken the prescribed medicines. The client believes that eating saffron will keep blood sugar under control. What is the most appropriate response by the nurse? * "Saffron does not have any effect on blood sugar level." * "What would you think about taking the medicines, too, and benefitting from both?" * "Yes, I agree that you should continue taking saffron for diabetes." * "Let me inform the health care provider that you are not taking your medicines."

* "What would you think about taking the medicines, too, and benefitting from both?" Explanation: Although the nurse may disagree with the client's beliefs concerning the cause of health or illness, respect for these beliefs helps the nurse to achieve health care goals. Asking the client to consider the benefits of medicine is appropriate because the nurse, without disrespecting the client's beliefs, persuades the client to have medicines also. Stating that saffron does not have any effect on blood sugar level is inappropriate, as it disregards the client's beliefs. Agreeing with the client may encourage him or her and indicate low faith in the present treatment. It is inappropriate to call the health care provider and report on the client.

A client has been admitted to the unit for chest pain. A nurse told the family that they could not be with the client. The family became very upset, and now the client wants to leave. What is the most culturally appropriate response by the charge nurse? * "Would you feel more comfortable with your family with you?" * "If you leave, you will be asked to sign a form indicating that you are leaving against medical advice." * "Sometimes family can cause stress, and we try to maintain a stress-free care environment." * "Why do you think you need to leave?"

* "Would you feel more comfortable with your family with you?" Explanation: Some cultures are very family oriented; others may have members who are skeptical of modern health care. The request for the client's family to leave most likely frightened the client. Asking the client how to make the client more comfortable is the best option. Asking the client why the client wants to leave is judgmental, implying there is no real reason to leave. Citing the hospital's policy regarding clients who leave against medical advice is not culturally sensitive and does not address the client's concerns. Clearly in this client's case, having the family present reduces, not causes, stress, so the comment about maintaining a stress-free environment is not valid.

The nurse is caring for a client who practices Catholicism and was newly diagnosed with cancer. The client states, "God is punishing me for my past sins." How should the nurse respond? * "You sound upset. Would like you to talk about it?" * "Why do you think God is punishing you?" * "Would you like me to get someone from your church to visit you?" * "You didn't get cancer as punishment."

* "You sound upset. Would like you to talk about it?" Explanation: The culturally sensitive nurse should provide the client with the opportunity to talk and express feelings in a nonjudgmental environment. Asking why God is punishing him or her or telling the client that cancer is not a punishment dismisses the client's feelings. Asking the client to get someone from church does not address the client's feelings.

Which client admitted to the emergency department might require the nurse to include interventions aimed at addressing culture shock in the plan of care? * A client who immigrated 25 years ago reporting chest pain * A client who recently immigrated and fell from a ladder * A client whose parents were immigrants and is admitted with flu-like symptoms * A client who is bilingual and has a history of asthma

* A client who recently immigrated and fell from a ladder Explanation: Culture shock is bewilderment over behavior that is culturally strange to a person who has recently entered that culture from a different culture. Individuals who are exposed to a different culture for the first time can be at risk for culture shock. The client who recently immigrated is experiencing a different culture for the first time and is at risk for culture shock. The clients in the other options have been in the new culture longer and are less likely to experience culture shock.

When talking with a client, the nurse notes that the client keeps backing up. What would be the most appropriate response? * Ask the client about personal space preferences. * Back away from the client. * Ask the client why he or she is backing away. * Move closer to the client.

* Ask the client about personal space preferences. Explanation: It is most appropriate to ask the client what is preferred in regard to personal space. If the nurse needs to invade the client's personal space to do an examination or take vital signs, it is important to discuss the matter. It is not appropriate to back away without assessing preference. It may make the client feel judged if the nurse asks why he or she is backing away. Moving closer to the client just perpetuates the problem.

The nurse is caring for a terminally ill client who immigrated from Mexico. Which nursing intervention regarding spiritual care is appropriate? * Inquire if the client desires the Sacrament of the Sick. * Ask the client if a spiritual leader is desired. * Do nothing unless the client requests spiritual assistance. * Call a Roman Catholic priest to visit the client.

* Ask the client if a spiritual leader is desired. Explanation: The appropriate response is to ask the client if a spiritual leader is desired, which is observant of the client's preferences. The nurse should not generalize that a Latino client is Roman Catholic, nor should the nurse refrain from inquiring about spiritual needs.

When completing a transcultural assessment of communication, which assessment by the nurse is most appropriate? * Assessment of eye contact, personal space, and social taboos * Assessment of religious beliefs and prayer schedules * Assessment of racial identification and cultural affiliation * Assessment of income level to determine poverty status

* Assessment of eye contact, personal space, and social taboos Explanation: Components of the transcultural assessment of communication are the cultural values associated with communication—eye contact, personal space, and social taboos. Religious assessment, racial identification, and income levels are not part of the transcultural assessment of communication.

The clinic nurse is obtaining demographic data from a client. The client states, "Why do you need to know what my ethnicity is?" How should the nurse respond? * "Collecting this information allows us to develop a personalized plan of care to meet your needs." * "We require the information for identification purposes." * "Understanding your background will prevent us from doing anything to offend you." * "Insurance companies requires us to ask all clients."

* Collecting this information allows us to develop a personalized plan of care to meet your needs." Explanation: Identifying and understanding the client's ethnicity will assist the nurse and healthcare team to develop and provide individualized culturally competent care. Ethnicity is not used for client identification. Insurance companies may request this data; however, it is not the priority reason for the nurse to collect the data.

A staff nurse meets with the charge nurse and is reporting that all the new nurses are leaving messes on the unit. The staff nurse states, "These youngsters think they can waltz in here and get our jobs." What is this nurse demonstrating? * Cultural conflict * Cultural assimilation * Cultural blindness * Cultural diversity

* Cultural conflict Explanation: Cultural conflict occurs when people become aware of cultural differences (the younger nurses) and feel threatened (most likely by their younger age) and respond by ridiculing the beliefs or actions of others to make themselves feel more secure. Cultural assimilation occurs when one adapts to a new culture. Cultural blindness occurs when one ignores a cultural difference. Cultural diversity encompasses culture, race, ethnicity, religion, language, gender, socioeconomic status, and more.

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? * Stereotyping * Cultural conflict * Cultural imposition * Culture shock

* Cultural imposition Explanation: The nurse has demonstrated cultural imposition by assuming that traditional pain relief measures are superior and the client should conform to the nurse's belief regarding pain control. This is not an example of cultural conflict because the nurse did not ridicule the request; it was simply dismissed. The nurse is not stereotyping, as no generalization is made about a group of people. The nurse is not demonstrating culture shock because the view of pain medications that the nurse expresses is consistent with the majority, Western culture.

Upon moving to another country, a college student is very confused by many local customs. He is especially bothered by the custom of men and women eating in separate areas and it makes him angry and resentful of the new culture. What are the feelings experienced by this student? * Culture shock * Stereotyping * Ethnocentrism * Cultural assimilation

* Culture shock Explanation: The student is experiencing culture shock, which is defined as the feelings a person experiences when placed in a different culture. Stereotyping is the assumption that all members of a culture, subculture, or ethnic group act alike. Ethnocentrism is the belief that one's ideas, beliefs, and practices are the best, are superior, or are most preferred to those of others. Cultural assimilation occurs when members of a minority group live within a dominant group and lose the cultural characteristics that make them different.

The nurse is caring for a client who does not speak the dominant language. In order to facilitate unencumbered communication with the client, the nurse will take which action(s)? Select all that apply. * Determine in which language the client communicates effectively. * Review facility policy on communication with clients who do not speak the dominant language. * Schedule a certified interpreter when collecting client health history. * Request that the client's spouse carries out language interpretation at discharge. * Ask the client's child, who speaks the dominant language, to explain treatment options to the client.

* Determine in which language the client communicates effectively. * Review facility policy on communication with clients who do not speak the dominant language. * Schedule a certified interpreter when collecting client health history. Explanation: All clients have the right to unencumbered communication with a health care provider. Using children as interpreters or requiring clients to provide their own interpreters is a civil rights violation. In addition, the use of untrained interpreters, volunteers, or family is considered inappropriate because it undermines confidentiality and privacy. It also violates family roles and boundaries. The best form of communication with a client who does not speak or has limited ability in the dominant language is through a certified interpreter. A certified interpreter is a translator who is certified by a professional organization through rigorous testing based on appropriate and consistent criteria.

The nurse is caring for a client who is postoperative 3 days from coronary artery bypass graft. The client has a prescription to ambulate. What is the best action by the nurse? * Allow the client to slowly ambulate independently. * Instruct the family to assist the client with ambulation. * Discuss with the client the need for assistance during ambulation. * Obtain a prescription for physical therapy consult to ambulate the client.

* Discuss with the client the need for assistance during ambulation. Explanation: For members of some cultures, providing care and performing nursing interventions can intrude into personal space. The nurse should discuss with the client the need for assistance during ambulation and prepare the client for potential closeness. The client may ambulate independently, but the nurse should still assist. Having the family or physical therapy ambulate the client does not address the issue related to culture and nursing interventions.

The client is admitted to the hospital with a ruptured ovarian cyst. The client has expressed that it is very important that the spouse be present to receive all medical information. Using the concepts of culturally competent care, which is the best response? * Explain to the client that the client is required to make all decisions related to the client's own health care. * Document the client's request in the nursing care plan. * Bring the client's spouse into the hallway to discuss surgical options for the client. * Explain to the client that it is not a good idea to have the spouse in the room when discussing such a private matter.

* Document the client's request in the nursing care plan. Explanation: A culturally sensitive nurse is one who respects a client's requests while ensuring that the requests reflect safe medical practice. This client's request does not interfere with client safety. Thus, the request should be respected and communicated through documentation to other healthcare personnel. Telling the client that the client must make all health care decisions does not address the client's request. There is no need to move to the hallway to discuss the client's care with the client's spouse, and this would likely be offensive.

How is culture learned by each new generation? * Ethnic heritage * Involvement in religious activities * Formal and informal experiences * Belonging to a subculture

* Formal and informal experiences Explanation: Culture is a shared system of beliefs, values, and behavioral expectations that provide social structure for daily living. Culture includes the beliefs, habits, likes, dislikes, customs, rituals, and ethnic heritage that are learned through formal and informal experiences within one's family and within the cultural group to which one belongs. Involvement in religious experiences can be part of the culture learned through formal and informal experiences.

The nurse is caring for a client from another culture who is diagnosed with lung cancer. Which nursing action best demonstrates culturally sensitive care? * Explaining the biomedical culture to the client. * Implementing a standardized care plan for the client with lung cancer after explaining the procedure in the client's native language. * Incorporating the client's need for daily prayer into the nursing care plan. * Treating all clients the same based on the diagnosis to demonstrate unbiased care.

* Incorporating the client's need for daily prayer into the nursing care plan. Explanation: Nurses should be culturally competent and sensitive to provide care that respects (not just not offends) and incorporates the client's culture. Incorporating the client's culture creates an individual plan of care and not a treatment plan for all clients with the same diagnosis. The nurse should not use unmodified standardized care plans that do not account for cultural differences. Explaining the biomedical culture to the client does not ensure culturally sensitive care. The nurse should attempt to understand the client's culture, not have the client understand the culture of the health care system.

Which nursing intervention reflects practice according to Madeline Leininger's transcultural nursing theory? * Contacting a chaplain for every client * Providing the same care to each client who has had a myocardial infarction * Planning dietary interventions according to physiological condition * Incorporating the client's request for complementary treatment therapy

* Incorporating the client's request for complementary treatment therapy Explanation: Leininger's theory of transcultural nursing includes assessing a cultural nature, accepting each client as an individual, having knowledge of health problems that affect particular cultural groups, and planning of care within the client's health belief system to achieve the best health outcomes. Therefore, incorporating the client's request for complementary treatment therapy is an example of this theory. The others do not support this theory.

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. * Language * Religious beliefs * Shared beliefs of origin * Skin color * Eye shape

* Language * Religious beliefs * Shared beliefs of origin Explanation: Although the terms race and ethnic group sometimes refer to the same people, race takes biologic characteristics as the markers of separate social status, and ethnic group takes social characteristics (such as language, religious tenets, shared beliefs of origin) as markers of cultural identity.

A nurse is assessing a client and determines that the client belongs to a minority group. Based on the nurse's understanding about minority groups, the nurse would anticipate that the client would likely experience which effects? Select all that apply. * Less power * Health disparities * Greater advantages * Improved access to care * Increased economic privileges

* Less power * Health disparities Explanation: The term minority refers to a group of people within a society whose members have different ethnic, racial, national, religious, sexual, political, linguistic, or other characteristics from most of society. Being of a minority group often results in having less power and being disadvantaged, including health disparities in a society. Greater advantages, improved access to care, and economic privileges are not associated with minorities.

Which stereotypical ideas about older adult clients does the nurse associate with the concept of ageism? Select all that apply. * Physically impaired * Cognitively enhanced * Burdensome to family * Financially independent * Uninterested in intimacy

* Physically impaired * Burdensome to family * Uninterested in intimacy Explanation: 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.

The nurse is assessing an infant of Asian descent and notes dark blue spots on the infant's lower back. What action should the nurse take next? * Press lightly on the pigmented area and observe the infant's reaction. * Ask the parents to leave the room and conduct a thorough assessment. * Contact the health care provider. * Document and report the findings to authorities.

* Press lightly on the pigmented area and observe the infant's reaction. Explanation: Mongolian spots are a type of hyperpigmentation that results in dark blue areas on the lower back, abdomen, thighs, and arms. To differentiate Mongolian spots from a bruise or injury, the nurse should press on the Mongolian spot. Mongolian spots do not produce pain when pressure is applied. The nurse will not ask the parents to leave the room as they are the legal guardians of the infant and should be present for the assessment. This action is only taken if suspicion of abuse is readily apparent. The nurse should assess before calling the health care provider. The nurse needs to complete the assessment before documenting it. Because this is not an ominous finding warranting further investigation, the nurse would not contact the authorities.

A client has recently immigrated and is exhibiting symptoms of culture shock. The client reports feeling unaccepted in the new culture. The client states, "I can't do anything right here." What is the priority nursing diagnosis? * Powerlessness related to the loss of familiar cultural practice * Situational low self-esteem related to culture shock and feelings of fear and incompetence * Spiritual distress related to low self-esteem * Social isolation related to culture shock and feelings of low self-worth

* Situational low self-esteem related to culture shock and feelings of fear and incompetence Explanation: The client is experiencing low self-esteem, which is often associated with culture shock. It is situational in nature and will likely improve with cultural assimilation. The client does not indicate powerlessness, spiritual distress, or social isolation.

The nurse is caring for a client admitted with an upper respiratory infection. The client tells the nurse about following the holistic belief of hot/cold. Which food items should the nurse provide to the client based on this information? * Soup, hot tea, and toast * Turkey sandwich, milk, and gelatin * Chicken salad, water, and a frozen fruit juice bar * Fruit salad, apple juice, and pudding

* Soup, hot tea, and toast Explanation: The client believes in the hot/cold theory of disease, so the client needs to treat cold diseases with hot food and hot diseases with cold food. The most appropriate choice would be the soup, hot tea, and toast. The other options are all cold foods, which the client would not use to treat a cold disease such as an upper respiratory infection.

The labor and delivery nurse is getting report from the previous shift regarding a client with Asian heritage. The departing nurse states that the client did not ask for pain medication because "Asian people can handle pain." The nurse receiving report understands that this an example of what? * Culture shock * Stereotyping * Ageism * Ethnocentrism

* Stereotyping Explanation: Stereotyping is a fixed attitude about people who share common characteristics. Clients with Asian heritage often do not express pain or emotions. Therefore, the misconception is they do not feel pain. Culture shock is bewilderment over behavior that is culturally atypical for the client. Ethnocentrism is the belief that one's culture is better than other cultures. Ageism is a negative belief that older adults are physically and cognitively impaired.

A newly hired young nurse overheard the charge nurse talking with an older nurse on the unit. The charge nurse said, "All these young nurses think they can come in late and leave early." What cultural factor can the new nurse assess from this conversation? * Stereotyping * Cultural blindness * Cultural conflict * Cultural imposition

* Stereotyping Explanation: The charge nurse is clearly exhibiting ageism, which is a form of stereotyping. Cultural assimilation is when one begins to assume some characteristics of a culture outside of one's own. Cultural blindness occurs when cultural differences are ignored. Cultural imposition occurs when one pushes one's cultural beliefs onto another person.

The nurse is caring for several clients of different cultures. Which client situation would the nurse recognize as the client with highest risk of culture shock? * The client from Ethiopia states, "All these machines attached to me scare me and I need to get them off." * The client from Mexico states, " I am having difficulty reading these pamphlets you gave me." * The client from France states, "I miss my family back home." * The client from England states, "I do not understand what all these new medications are for."

* The client from Ethiopia states, "All these machines attached to me scare me and I need to get them off." Explanation: Culture shock occurs when a person is immersed in an environment different from the one the person is accustomed to, resulting in rapid disorientation and distress. The client stating the machines scare him is experiencing culture shock. Difficulty reading a different language, missing absent family, and not understanding the purpose of medications are not indicative of culture shock.

In addressing health promotion for a client who is a member of another culture, the nurse should be guided by which principle? * The client may have a very different understanding of health promotion. * Health promotion is a concept that is largely exclusive to Western cultures. * A culture's conceptualization of health promotion is a result of that culture's level of socioeconomic development. * The nurse should avoid performing health promotion education if this is not a priority in the client's culture.

* The client may have a very different understanding of health promotion. Explanation: As a component of cultural assessment, the nurse should seek to understand the cultural lens through which the client may understand health promotion. Health promotion is not a concept exclusive to Western cultures, though it may be considered differently among non-Western cultures. Even if health promotion is not a priority in a client's culture, the nurse should still address issues related to health promotion in a respectful and relevant manner. Health promotion is not directly linked to socioeconomic development levels.

A client is seeking care at the local clinic. The nurse is completing a cultural assessment. Which scenario would demonstrate cultural assimilation? * The client does not speak the dominant language and requires an interpreter. * The client's child learned the dominant language as a second language. * The client and child cook traditional foods for the family. * The client enjoys watching television programs from the home country.

* The client's child learned the dominant language as a second language. Explanation: The child is demonstrating an example of cultural assimilation by taking on the language of the dominant culture. When a minority group lives within a dominant group, its members may adapt some of their cultural practices that once made them different. This process is referred to as cultural assimilation. Watching television from the home country, cooking traditional foods, and speaking only the original language demonstrate the original culture and an attempt to bring the minority culture into the dominant culture.

The nurse is preparing to administer prescribed medication to a client who is Native American/First Nations. The nurse enters the room and observes a tribal traditional healer performing a healing ritual for the client. What action would be the most appropriate by the nurse? * Ask the healer to leave the room. * Wait in the room until the healer is done. * Unless asked to stay, leave the room and return when the healer is finished. * Administer the medication while the healer continues the ritual.

* Unless asked to stay, leave the room and return when the healer is finished. Explanation: Tribal traditional healers (sometimes referred to as shamans by western cultures) are tribal leaders or medicine men that are used in many Native American/First Nations cultures to relieve illness. The culturally competent nurse should allow privacy for the healing ritual and return when it is completed. The culturally competent nurse should incorporate the client's beliefs into the client's care, as long as the health belief and practice is safe. Administering the medications while the shaman continues the ritual or asking the shaman to leave may be perceived as disrespectful to the client.

The client, visiting from a foreign country, arrived at the facility seeking medical assistance following an accident. The client has limited proficiency in the dominant language. An onsite certified interpreter is unavailable. To assist in interpretation, what is an appropriate nursing intervention? * Use a contracted video interpretation service. * Access voice-to-text apps on the nurse's own mobile device. * Ask the client's child to translate. * Obtain a dual-language communication book.

* Use a contracted video interpretation service. Explanation: Federal law in the United States requires the same health care and social services for those individuals who have limited proficiency in the dominant. Many agencies contract with other companies to provide translation services either through video or by telephone. These companies use certified interpreters. Other avenues for interpretation are mobile apps and communication books. Neither of these avenues meets the needs for clients who require interpretation services. Using family members may be a civil rights violation.

The nurse is preparing the discharge plan for a new mother and her newborn son. Which new teaching should the nurse ensure is included after noting the family is Jewish? * care following the scheduled circumcision * proper breastfeeding techniques * when to schedule the next follow-up appointment * the proper sleeping position for the newborn

* care following the scheduled circumcision Explanation: Orthodox Judaism and some members of non-orthodox Jewish denominations consider circumcision as a sacred ritual which is performed on the 8th day of the infant's life. Clients of other faiths may request the circumcision be completed before the newborn is discharged home from the hospital and some will choose not to circumcise their newborn. The other choices should be part of every client's discharge teaching.

Nurses are responsible for delivering culturally competent care for all clients. Culturally competent care does not account for: * individual values. * developmental level. * client's height. * available technology.

* client's height. Explanation: In partnership with the person, family, and others; the nurse develops an individualized plan considering the person's characteristics or situation including but not limited to: values, beliefs, spiritual and health practices, preferences, choices, developmental level, coping style, culture, environment, and available technology. A physical characteristic such as one's height does not contribute to cultural competence.

Nurses are socialized into the: * nursing specialties. * healthcare culture. * caring paradigm. * diagnostic process.

* healthcare culture. Explanation: Culture enables people of similar cultural heritage to understand the meanings of each other's words as part of the particular context, to read each other's nonverbal behavior fairly accurately, and to communicate through symbols. All of these characteristics apply to health care, so health care can be considered a culture into which one can be socialized. The other answers pertain to the career, practice, or intellectual aspects of nursing but not as much to the social aspect of nursing.