Chapter 5 (LR)
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?
"Can you describe what you are feeling when you try to move?"
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?
"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 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? You Selected: "We can wait until your spiritual healer arrives and work together to answer these questions."
"We can wait until your spiritual healer arrives and work together to answer these questions."
A nurse is admitting a client to the unit. Which cultural question is most appropriate?
"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 interviews a client to determine the client's health beliefs and behaviors. The nurse uses this information for which aspects of care?
-Conducting an assessment -Developing client outcomes -Providing client education
A nurse is presenting an in-service program to a group of nurses about culture and cultural diversity. When describing culture, which characteristics would the nurse include?
Culture has recognizable patterns. Culture is dynamic.
A nurse is assessing a client's culture. Which aspect would be the easiest for the nurse to recognize?
Material Explanation: The easiest level of culture to recognize is material — in artwork, drama, tools, clothes, food, buildings, and rituals. Values and beliefs are harder to recognize. Sometimes they can be accessed by asking about items of material culture.
A nurse is conducting a seminar for a group of nurses about the cultural competency in nursing. When describing culture, which terms would be appropriate for the nurse to use?
Pervasive Recognizable Ritualistic Holistic
Which stereotypical ideas about older adult clients does the nurse associate with the concept of ageism?
Physically impaired Burdensome to family Uninterested in intimacy
Avoiding older adult clients because their care is time consuming an example of which behavior by the nurse?
stereotyping
A preconceived and untested belief about an individual or group of individuals is:
stereotyping.
A nurse is working in a clinic that serves a community with a high population of immigrants. Which nursing assessment is the priority?
Language assessment
A Catholic priest baptizes a stillborn baby of a Catholic family. What type of practice is this considered?
A ritual Explanation: Rituals are common and observable expressions of culture in hospitals, clinics, homes, schools, and work settings. A stigma is social disapproval. Cultural competence is care delivered with an awareness of aspects of a client's culture. A health disparity is a health difference between groups of people.
What is the priority assessment for the nurse when developing a plan of care for a client living in poverty?
Access to care Explanation: Poverty has long been a barrier to adequate health care. If clients cannot access health care, it does not matter if they have affordable housing, health insurance, or financial assistance. It is not possible to create a plan of care with client involvement without adequate support and access to care.
The emergency department nurse is caring for a client injured in a motor vehicle collision. The client recently immigrated to the country. The nurse should implement interventions aimed at addressing which issue?
Culture shock Explanation: Culture shock is bewilderment over behavior that is culturally atypical for the client. The client who recently immigrated from another country would experience culture shock over being in a new culture, including a new culture of health care in the new country of residence. Ethnocentrism is the belief that one's culture is better than other cultures. Generalization is the belief that a person shares cultural characteristics with others from a similar background. Ageism is a negative belief that older adults are physically and cognitively impaired.
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 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.
A client reports to the primary health care facility for routine physical examination after cardiac rehabilitation following myocardial infarction. How should the nurse conduct the interview?
The nurse should avoid using medical terminology.
A client who immigrated from another coutnry informs the nurse of dietary requests. The nurse responds to the special dietary needs by stating, "You are now living here, and you should try to start eating those foods common to our diet." This inappropriate response is an example of:
cultural imposition.
When an American client states, "I only want an American doctor," the client is expressing:
ethnocentrism. Explanation: Viewing one's own culture as superior to all others is ethnocentrism. Cultural relativity is the belief that to understand a person, you must understand that person's cultural context. Cultural pervasiveness refers to how widespread the effects of a culture are. Racism is the belief that one's race is superior to others.
The nurse is caring for a client who is admitted for hypertension (HTN). The nurse notes that the client has not been eating the food provided, and family members have brought in homemade food. What would be the best response by the nurse?
"Can you tell me what foods you prefer to eat and what your family is bringing you?" Explanation: The nurse should attempt to provide culturally sensitive food; however, the nurse should assess what foods the client wants to eat. The nurse should educate the client on food preferences that are also appropriate to the disease-specific dietary restrictions. Even though the diet may be healthier, the nurse should first assess the client's preferences. The nurse should verify the client's understanding of the diet but should avoid closed-ended questions such as asking if the client understands the specific diet for HTN.
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." 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.
The nurse just attended a seminar on cultural diversity. Which statement by the nurse would require further education?
"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.
A nurse is demonstrating ethnocentrism. Which statement would reflect this concept?
"My Russian heritage is superior to all others."
A nurse is admitting a client to the unit. Which cultural question is most appropriate?
"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.
Nursing, as a profession, has long held the belief that providing nursing care to an individual patient means providing nursing care to the entire family. What does this mean when put into a holistic framework of patient care?
Active participation by individuals and families in health promotion is integral to this framework of patient care. Explanation: Active participation by individuals and families in health promotion supports the self-care model historically embraced by the nursing profession. This model is congruent with the philosophy that seeks to balance and integrate the use of traditional medicine and advanced technology with the influence of the mind and spirit on healing. Families are not always caretakers when the patient is not acutely ill; it is not necessary for the nurse, patient and the patient's family to integrate the physical and emotional environment of the patient. It is necessary for the patient to integrate their physical and emotional environment. The holistic framework of patient care is not a model that is congruent with the philosophy of traditional patriarchal medicine.
Nursing, as a profession, has long held the belief that providing nursing care to an individual patient means providing nursing care to the entire family. What does this mean when put into a holistic framework of patient care?
Active participation by individuals and families in health promotion is integral to this framework of patient care. Explanation: Active participation by individuals and families in health promotion supports the self-care model historically embraced by the nursing profession. This model is congruent with the philosophy that seeks to balance and integrate the use of traditional medicine and advanced technology with the influence of the mind and spirit on healing. Families are not always caretakers when the patient is not acutely ill; it is not necessary for the nurse, patient and the patient's family to integrate the physical and emotional environment of the patient. It is necessary for the patient to integrate their physical and emotional environment. The holistic framework of patient care is not a model that is congruent with the philosophy of traditional patriarchal medicine.
A nurse is caring for a client diagnosed with pancreatitis. Which is a priority need for nursing management of this client?
Acute pain in the abdomen Explanation: Acute pain in the abdomen is a physiologic need of the client that receives attention on a priority basis. According to Maslow's hierarchy of human needs, physiologic needs are the most important. These needs are to be fulfilled before others. The client may experience depression, lack of self-confidence, and inabiliy to care of the family after diagnosis from the pancreatitis, which are psychological issues. Physiologic needs need to addressed before psychological needs, which are needs for safety and security, love and belonging, esteem and self-esteem, and self-actualization.
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. Explanation: It is most appropriate to ask the client what is prefered 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 assessing an older adult who immigrated at the age of 3 years. The client speaks the dominant language and lives in a neighborhood with many households from the country of origin. Which action by the nurse is most appropriate?
Ask the client about special cultural beliefs or practices
The nurse is caring for a terminally ill client who immigrated from Mexico. Which nursing intervention regarding spiritual care is appropriate?
Ask the client if a spiritual leader is desired. 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.
The nurse admits a client to the critical care unit to rule out a myocardial infarction. The client has several family members in the waiting room. Which nursing action is most appropriate?
Assess the client's beliefs about family support during hospitalization. Explanation: Asking the client about the client's beliefs exemplifies that the nurse recognizes the importance of respecting differences rather than imposing standards. If the client believes family support is significant to health and recovery, the nurse should respect the client's beliefs and allow the visitors into the room.
When completing a transcultural assessment of communication, which assessment by the nurse is most appropriate?
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.
Which scenario is an example of cultural competence in nursing?
Attending a conference for cultural diversity Explanation: Cultural competence can be shown by actively learning about culture through attending a conference. Assessing the rate at which an illness leads to death does not develop cultural competence. One's own church is a familiar culture, and attending it does not breed cultural expansion or competence. The provider should never assume that beliefs or values are shared.
A nursing student's parents are both physicians. The nursing instructor may feel the student has
Been socialized in healthcare Explanation: Socialization happens by the process of living and experiencing in family and society. If the student comes from a family of healthcare professionals, this too is part of the socialization process.
The nurse correctly differentiates race from ethnicity by noting that race is based on which characteristics?
Biological Explanation: The biological characteristics of race are based on either physical appearance or place of origin. Ethnicity is associated with social, spiritual, and religious characteristics.
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 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.
A nurse is conducting a cultural assessment of a client. Which person would the nurse identify as the expert?
Client Explanation: When gathering cultural information, the interviewee is the expert. Other family members may provide information about the culture, but the client is the expert. The nurse and health care provider are responsible for obtaining information related to the culture.
A client believes that the illness is caused by an imbalance of yin and yang. The nurse states, "You can call it whatever you believe, but you have a metabolic disorder." What is this nurse demonstrating?
Cultural blindness Explanation: The nurse is demonstrating cultural blindness, which occurs when one ignores differences and proceeds as though they do not exist.
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 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.
Which term describes the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture?
Cultural imposition Explanation: Cultural imposition is the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture. Cultural blindness occurs when one ignores differences and proceeds as though they do not exist. Acculturation is the process by which members of a cultural group adapt to, or learn how to, take on the behaviors of another group. Cultural taboos are activities or behaviors that are avoided, forbidden, or prohibited by a particular cultural group.
The nurse caring for several clients on a hospital unit notices that one client makes eye contact with the staff, while another client from a different ethnic background does not make eye contact when speaking to the staff. What cultural concept explains this difference?
Cultural relativity Explanation: Cultural relativity refers to the concept that cultures relate differently to the same situations, such as the meaning of eye contact. Some cultures view eye contact as demonstrating engagement in a conversation, whereas other cultures view avoidance of eye contact with a "superior" (the nurse in this scenario) as a sign of respect. Cultural dissonance, cultural negativity, and cultural neutrality do not apply to this scenario involving eye contact.
A family recently immigrated to a new country. The parent reports that the teenager is showing signs of fear, has vague reports of stomach pain, and feels humiliated by peers because of their culture. What is the priority assessment for the nurse?
Culture shock Explanation: The client is experiencing symptoms associated with culture shock. Culture shock occurs when a person is immersed in a different culture that is perceived as strange. The person may feel foolish, fearful, incompetent, or humiliated, and these feelings can lead to frustration and anxiety. 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 his or her beliefs onto another person.
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?
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?
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.
Which nursing action displays linguistic competence?
Learning pertinent words and phrases in the client's language
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?
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.
The nurse is caring for a client who perceives time differently. What action should the nurse take for this client?
Maintain flexibility when the client requests interventions at specific times. Explanation: People view time differently. Social time can reflect attitudes regarding punctuality that vary among cultures. The nurse should maintain a flexible attitude and adapt the time of interventions to the client's needs and requests. It is not realistic to have the client set all the times for the interventions or to have the interventions at a specific time or interventions at random times during the shift.
A nurse is providing care to a client who is from a different culture. Which aspect about culture would be most important for the nurse to integrate into the client's care?
Not all members of the same culture act and think alike. Explanation: Culture is shared unequally by its members; that is, not all members of the same culture act and think alike. Culture is also dynamic and changes as people come into contact with new beliefs and ideas. Some learning of culture is purposeful and some is absorbed without awareness. Much of culture is implicit, a combination of habit and assumptions about the world, such that habits are enacted without reflection in the daily course of living. This makes culture difficult for members to describe.
The labor and delivery nurse is getting report from the previous shift regarding a client with Asian heritage. The nurse is told 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?
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 nurse convinces a client who is a Jehovah's Witness that receiving blood products is more important than the legalistic components of religion. What client reaction may be expected following this mandated change?
The client states, "I feel like I abandoned my religion." Explanation: When clients are forced to participate in care that conflicts with their values, feelings of guilt and abandonment are likely. These feelings may deepen and threaten the client's well-being. The other answer choices are not related to mandated change.
Transcultural nursing is a specialty and formal area of practice. Which statements apply Dr. Madeleine Leininger's theory of Culture Care Diversity and Universality to nursing practice? Select all that apply. a. The nurse carefully assesses the decision maker in the care environment. b. The nurse should use curiosity and ethnocentrism when assessing the client's cultural practices. c. The nurse objectively assesses personal beliefs prior to the provision of culturally competent care. d. The nurse explains how culture does not affect the overall plan of care. e. The nurse consults clergy for assistance in the provision of care. f. The nurse will accommodate cultural dietary preferences as much as possible.
c. The nurse objectively assesses personal beliefs prior to the provision of culturally competent care. e. The nurse consults clergy for assistance in the provision of care. a. The nurse carefully assesses the decision maker in the care environment. f. The nurse will accommodate cultural dietary preferences as much as possible.
A nurse is caring for a client with bacterial pneumonia and a temperature of 104°F (40.0°C). Yesterday, the client's temperature was 102°F (38.9°C). The health care provider on call prescribes cool compresses for the client to help lower the fever. The client insists that the nurse bring warm blankets because they will help the client to recover more quickly. The nurse recognizes that the client's request is an example of:
cultural ritual.
A nurse is working with a culturally diverse group of clients. The nurse understands that cultural norms:
require an individualized approach by the nurse. Explanation: Knowing a cultural norm does not enable one to predict a person's response. Generalizing about cultural norms in contemporary societies is inappropriate because people belong to more than one subcultural group and are influenced uniquely by multiple and diverse groups. Exceptions to cultural norms always exist. Therefore the nurse needs to approach each person as an individual.
