Culture, Spirituality, and Alternative/Complementary Modalities

A nurse is conducting a spiritual assessment on a client admitted for surgery and developing a plan of care based on this assessment. To help ensure that the nurse is most successful in meeting the client's spiritual needs and promote a comfortable working relationship with the client, which aspect would be most important initially for the nurse?

developing an awareness of one's own beliefs about the connection between spirituality and health

A nurse is teaching a client how acupressure works to relieve pain. Which explanation would the nurse most likely use?

"It substitutes sensory stimuli for pain-producing stimuli."

An elderly Jewish client received a lunch tray that consists of a cheeseburger, French fries, and an apple. The client tells the nurse to remove the tray. What is the nurse's understanding of why the client wants the tray removed?

Clients of the Jewish faith do not allow the mixture of dairy and meat.

The Orthodox Jewish family of a client admitted for cochlear implantation expresses outrage at their child being served a pork dish after they identified their religion to the nursing staff. What is the nurse's best response?

Recognize their request and respectfully take corrective action.

After unsuccessful CPR efforts, the nurse must prepare an Islamic client for the morgue. Which nursing action should the nurse take?

asking the client's family if they want to perform the ritualistic washing

A client in the hospital for gout reports an excruciating migraine but declines analgesic medications when offered. Later the nurse observes a visitor performing what appears to be a type of physical manipulation of the client's head and neck. The client reports that the visitor is a therapist. The best action for the nurse to take is to:

advise the client how the client might receive adjunct services.

In the hospital setting, the child of a client who is dying tells the nurse, "It is hard to just sit here for hours and not say or do anything." As the nurse responds to the child's statement, what issue is most important for the nurse to focus on during their discussion?

Know that being present with the person is important.

The nurse is performing an admission assessment of a new client. When assessing potential cultural influences on the client's care, the nurse should address what domains? Select all that apply.

-Decision-making processes -Nutrition -Communication -Expressions of pain

The single parent of a young teenager is being treated for complicated bronchitis at a small rural hospital. The parent does not live in the area and has a poor command of English. The facility is experiencing delays in accessing a translator. In considering whether to allow the teenager to translate medical information for his parent, the nurse should consider that:

these circumstances may allow the child to translate.

The nurse is caring for a group of clients in an acute medicine setting. What statement by a client would most warrant a referral to spiritual care, with the client's permission?

"It feels like one round of bad news after another for me, like I am being punished."

A nurse is completing an admission assessment. The nurse asks the client about social support systems and the client asks the nurse to explain social support systems. Which statement describes a social support system?

"It is a group of providers at home and in the community that help a client in times of need."

A birthing couple informs the nurse that they would like to have the placenta after the baby is born. What is the nurse's best response?

"Let me check about how to go about doing this."

A client with chronic pain comes to the clinic for an evaluation. During the visit, the client asks the nurse about possibly using acupuncture for pain relief. Which response by the nurse would be most appropriate?

"Restoring the energy balance in your body could help with pain relief."

A young woman is being admitted in the company of her parents. The father requests that there be no male caregivers for his daughter, as is customary in the family's culture. How should the nurse respond?

"We will do our best to comply with your request, but there may be times were a male caregiver is unavoidable."

The nurse is setting goals for end-of-life care with a client who states, "I'm not a religious person, but I consider myself a spiritual person." Based on this conversation, what is the best question to ask about the client's spirituality?

"What are the beliefs that guide your daily decisions?"

A client admitted with acute pyelonephritis now reports having a severe migraine, but declines PRN analgesics. What should the nurse discuss with this client? Select all that apply.

-Ask the client which migraine treatments are helpful when at home. -Alternative therapies such as relaxation or music can help.

The nurse is providing care for a client who immigrated three months ago. The nurse observes that the client is reluctant to make eye contact when responding to the nurse's questions. What is the nurse's best response?

Consider the norms around nonverbal communication in the client's culture.

A hospital client has told the nurse that their religion involves the burning of incense and has asked permission to do so on the unit. The nurse is aware that this practice would violate the hospital's fire regulations. What is the nurse's best action?

Dialogue with the client about alternative rituals or the possibility of performing the ritual outdoors.

A client learns that she is pregnant, and asks the nurse for the names of abortion clinics. The nurse does not believe abortion is moral alternative. What is the most appropriate response by the nurse?

Give the client the available preprinted list of clinics.

A school nurse is called to assess a preadolescent, a newly immigrated Vietnamese person attending a new school. A teacher tells the nurse that the student sits in the back of the class and won't speak when spoken to, although the parents confirmed the student speaks English. Which assessment finding is most likely?

The student is experiencing cultural shock.

The parent of an Indonesian young adult reports through an interpreter to the nursing supervisor that the staff nurse sometimes shouts at the client. The nurse tells the supervisor that she has not been shouting at the client. What would the supervisor expect to note after observing a care interaction between the staff nurse and the young adult adolescent client?

There is a language barrier present.

A Muslim couple is in the labor process. The male healthcare provider recommends that the membranes be ruptured because contractions have not been effective in causing dilation. The Muslim couple expresses to the nurse that this is unacceptable because the provider is male. What action does the nurse take?

Work with the healthcare provider to locate a female healthcare provider for the procedure.

A pregnant client late in her first trimester comes to the clinic for a follow-up visit. The woman tells the nurse that she has been having morning sickness, but she "tried using this band on her wrist," and it helped cut down on the number of episodes she was having. The nurse interprets this therapy as an example of

acupressure.

The family of a client with a terminal illness tells the hospice nurse supervisor that they have lost hope for a peaceful death for their loved one. While talking to this family about their concerns, the nurse would immediately explore their concerns about which health care issue?

effective management of the client's physical discomfort

A client discusses with the nurse the possibility of using alternative therapies for management of hypertension and diabetes. Which is an expected alternative therapy used by the client?

ginseng

An Orthodox Jewish pregnant woman comes to the labor and birth suite with her birth attendant. Her partner is also present in the room. The woman is about to give birth when the nurse observes the partner move to the head of the bed outside the view of the birth. The nurse interprets this action as:

reflecting of the couple's religious beliefs and practices.

A client with diabetes comes to the clinic for a follow-up visit. During the visit, the client, who is Jewish, tells the nurse that a holiday will be coming up next week that requires the client to fast for the day. The client takes an oral antidiabetic medication daily and checks blood glucose levels twice a day. Which response by the nurse would be most appropriate?

"Tell me more about what is involved so we can plan for this better."

A diabetic patient is reviewing the hospital menu to order lunch. The client asks the nurse for suggestions for "cold" foods to order. What is the nurse's understanding of why the client asking about suggestions for "cold" foods?

The client is balancing the disease with cold foods.

The nurse is admitting a hospital client who does not speak English and who is accompanied by the client's school-aged child. The client appears to be in pain, but the nurse is unable to assess the character or history of the client's pain. How should the nurse best communicate with the client?

Enlist the help of a hospital interpreter; ask the son to translate if none is readily available.

The nurse teaches a client with a pain disorder a progressive relaxation exercise. What client statement indicates the goal of progressive relaxation was attained?

"My pain is better, and now I feel relaxed."

A Muslim client is scheduled to be discharged in 2 days, but insists on fasting until after dark. The nurse anticipates which explanation from the client?

"My religion requires me to fast all day until sunset."

A newly admitted client with bone cancer tells the nurse that the folk healer has not been able to help him. What principle of culturally competent care will the nurse keep in mind during the client's conventional medical course of treatment?

All people have the right to care based on their personal preferences and values.

A client is experiencing inadequate pain control. The client consulted with the healthcare provider to bring in a licensed acupuncturist to the hospital to perform a treatment. What action does the nurse take?

Assist the client as needed in facilitating the acupuncturist's visit.

A nurse is caring for a client of the Buddhist faith who is dying. The client's family is at the bedside. Which intervention would the nurse implement to support the client's death with dignity?

Ensure that the room is calm, dimly lit, and quiet.

An alert and oriented adult client who is a Jehovah's Witness refuses a life-saving blood transfusion. The client's partner, who is not a Jehovah's Witness, requests that the client receive the blood. Which is the most appropriate action by the nurse?

Respect the client's right to refuse the transfusion.

The nurse is attending a family meeting where a recent immigrant's treatment plan is being discussed. The client is a retired English teacher and defers to the oldest son when the care team asks the client questions. How should the nurse best interpret the client's action?

The client's action may reflect cultural and familial norms.

A client is resting in bed. The nurse visits the client to reassess the client's pain. The nurse notices that a visitor is in the room and is touching the client in various places on the client's body. The nurse understands that this type of practice is called:

therapeutic touch.

After the family leaves, a Muslim client admitted for gastroenteritis explains that prayers must be performed five times a day even while in the hospital. The client later asks which direction is west. What should the nurse recognize in this client? Select all that apply.

-The client is demonstrating an active faith practice. -The client is advocating to be able to meet religious needs. -The client is successfully communicating spiritual needs.

A client who has been using benzodiazepines for anxiety wants to add an alternative therapy. The nurse suggests biofeedback. How will the nurse best describe biofeedback to the client?

It is a way to concentrate on the body's response during a stressful situation.

The nursing assistant moves the wheelchair of a client with a disability, and the client responds by saying, "Don't touch my wheelchair!" How would the nurse best begin to explain this situation to the nursing assistant?

It is important to ask the client before repositioning the wheelchair.

A Jehovah's Witness client is admitted after a serious car accident and continues to experience severe anemia after significant blood loss. The family remains adamantly opposed to blood product support. What is the nurse's best intervention?

Offer the client alternative treatment options to consider.

A client is 2 days postoperative of a hip replacement. The prescriber removed the gauze dressing and gave the patient and nurse instructions to keep the site open to air. In the afternoon, the nurse observed the client rubbing an oil on the surgical site. What is likely the client's rationale regarding the application of the complementary oil?

Tea tree oil has antibacterial properties

The nurse has observed that a client who identifies as a Mormon has drunk the coffee that was on the breakfast tray. How should the nurse best interpret this observation?

The client's personal religious practices may differ from those of the larger religious group.

A young Middle Eastern woman's father and brother arrive at the hospital to learn that the physician arrived early and discussed the results of the client's skin biopsy directly with her. They become agitated and begin yelling. The best action for the nurse to take is to:

ask the the father and brother if they would like the physician to meet with the family.

A client with a history of posttraumatic stress is panting and breathing heavily while shouting out some strange words. The nurse reviews the nursing assessment and understands that the client is practicing a form of relaxation called power breathing. The best action for the nurse to take is to:

allow privacy, but check on the client frequently.

A client who is being treated for cancer has expressed interest in exploring complementary and alternative therapies. What is the nurse's best action?

All treatments should be encouraged unless there are known and significant contraindications.

A client admitted for post-mastectomy breast reconstruction is experiencing acute, moderate anxiety. The client asks, "How can I feel better about the surgery?" What is the nurse's best response?

"Let me stay with you. Focus on my voice and breathe deeply."

A client on vacation experiences severe allergy symptoms, headache, and sinusitis (without respiratory distress). This client adamantly declines any supportive medications when offered. The nurse questions the client and learns the client receives weekly acupuncture treatments for these symptoms. What is the nurse's best response?

"Let us try this until you can have acupuncture."

The client who experiences residual arm pain after a fall has been referred to an acupuncture treatment center. What is the nurse's best response to the client's question, "How is acupuncture supposed to help me?"

"Pain is relieved by releasing endorphins, which balance the flow of energy."

A client is admitted for an exacerbation of irritable bowel syndrome who insists on being allowed to keep a head covering on at all times. What is the best response by the nurse?

"Please help me to understand this practice."

A hospital client's health status has declined sharply, and a referral to palliative care has been made. A nurse has suggested a referral to spiritual care, but a colleague states, "That is not likely necessary because the client's health record states 'no religion.'" How should the nurse best respond to the colleague's statement?

"The absence of an identified religion does not mean that a client does not have spiritual needs."

The nurse facilitating the medication management group notices that a particular client consistently chooses a position on the perimeter of the group. In order to be culturally mindful about the origin of this behavior, what question would the nurse ask the client?

"Where will you be comfortable sitting and still remain a part of the group?"

The family member of a client diagnosed with dissociative identity disorder (DID) asks a nurse if hypnotic therapy might help the client. How should the nurse respond?

"Yes, a client is often not consciously aware of alter personalities."

An alert and oriented client refuses chemotherapy. The client's family believes that the client should receive it. Which is the nurse's best response to the client?

"You understand that this decision is ultimately yours to make."

A nurse is working in a rural health clinic that serves a large Amish population. The nurse is developing a program to address common health promotion strategies. Which aspect would be most important for the nurse to integrate into the program to promote its success? Select all that apply.

-Importance of the extended family in providing support -Focus on being in tune with nature for health maintenance -Need to ask for permission before physically touching a client

A nurse is making a home visit to a client who is receiving chemotherapy as part of the treatment plan for cervical cancer. The client reports nausea as a side effect of treatment. The client asks the nurse, "I do not want to put any other medicines in my body. Do you have any suggestions for a natural remedy to help with my nausea?" Which suggestion would the nurse most likely make? Select all that apply.

-Lavender -Ginger -Peppermint

A client in home hospice care verbalizes to the caregiver a desire to meet with the client's minister. The caregiver does not want the minister to visit or to interact with the minister because of different values and beliefs and asks the home health nurse how to handle this situation. To prevent further disagreement between the client and caregiver, what is the best recommendation for the nurse to implement?

Arrange for an alternative caregiver to be available for the client when the minister visits.

The nurse is caring for a client who is a recent immigrant from China. Through the hospital interpreter, the client expresses an unwillingness to eat the fried fish that was on the meal tray, describing it as "too hot." What is the nurse's best action?

Ask the interpreter to ask the client about the specific meaning of the description of "hot."

The nurse is assessing a client whose history includes type 2 diabetes and atrial fibrillation, treated with warfarin. The client tells the nurse that the client began taking ginseng supplements several days ago in an effort to boost the immune system. After providing health education, what is the nurse's priority action?

Collaborate with the care team to have the client's prothrombin time and international normalized ratio (INR) assessed.

The nurse has recently accepted a position in a community with an ethnically and culturally diverse population. What action should the nurse first perform in order to enhance cultural competence?

Thoughtfully reflect on the characteristics of their own culture.

A young child is being treated for a broken arm while visiting family in another state. In the hospital, the child begins to experience a seizure and the child's parents take out a jar of oil and begin to apply it to the child. What is the nurse's best response?

"Could we please step outside to speak for a moment?"

The nurse is preparing the family to see the client who just died. The family invites the nurse to pray with them. The nurse is not comfortable with this request due to a different belief system. What is the nurse's best response?

"I will stay with you while you visit."

A client has been prescribed valproic acid for the treatment of bipolar disorder. The client tells the nurse, "I know that vitamin B can help with depressive episodes, so I am going to give that a try." What is the nurse's best response?

"Be sure to dialogue with your care provider before you start taking vitamin B supplements."

A client with a history of combat-related post-traumatic stress is admitted for treatment of complicated pneumonia. The first night, he experiences nightmares and frightens everyone with his screaming. He declines offers of anxiolytics, replying that he just needs privacy to perform his Reiki treatment. The nurse's best response is:

"Can you explain to me how you use Reiki?"

A client in a long-term nursing care facility who decides to be placed on hospice care expresses to the nurse, "I have outlived my family and friends; I have lost hope and there is no need for me to continue on." What underlying client concerns would the nurse first address with this client?

loneliness and feelings of isolation

A client comes to the emergency department reporting a headache. The client is diagnosed with hypertension and is given a prescription for an antihypertensive. In reviewing the discharge instructions, the client declines the prescription and tells the nurse "it is in God's hands now." What is the nurse's best response to the client?

"Can you tell me more about what that means?"