Culture, Spirituality, and Alternative/Complementary Modalities - ML8

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 weekly Shabbat demands I completely fast." "I must fast to prepare for meditation tomorrow." "My religion requires me to fast all day until sunset." "Today is the Sabbath and I cannot eat or drink."

"My religion requires me to fast all day until sunset." The Muslim religion celebrates the period of Ramadan, which requires fasting from sunrise to sunset. The Sabbath does not require this in any religion. Fasting is not a typical preparation for meditation. The Jewish Shabbat does not demand fasting.

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 sense of frustration and depression perceptions of survivor guilt and shame negative mood and mental illness

loneliness and feelings of isolation At the end of life when a person expresses a deep sense of loss, emptiness, and no hope for quality of life, it is frequently a reflection of severe loneliness and isolation. The client is experiencing more than frustration leading to depression, and survivor guilt is typically associated with a traumatic event. The current situation can negatively affect the client's mood, but it is not an indication of an incipient mental illness.

A transgender female is being admitted for her final physical conversion surgery. She lists her next of kin as the partner with whom she lives. Throughout the admission process the nurse understands that the: hospital will not recognize her partner as the NOK until after the surgery is done. nurse is not obligated to take care of this client if she has moral objections. client is being impulsive and is probably still uncertain of her gender preference. nurse should respect this client, who is at the end of a long therapeutic process.

nurse should respect this client, who is at the end of a long therapeutic process. The nurse must respect the client's life choices. A transgender client must go through therapy and live in the desired gender for a long period before surgical interventions are done. This client is not being impulsive. Surgery is not a magical portal for the hospital to recognize a client's NOK. The nurse must manage any personal conflicts in a professional, dignified, and discrete manner but cannot decline to care for the client.

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. expressions of pain nutrition communication decision-making processes inflammation

decision-making processes nutrition communication expressions of pain Culture is a concept that encompasses nearly every dimension of the illness experience, including the way that decisions are made, communication, the way pain is expressed, and the role of nutrition and food preferences. Inflammation, however, is a physiologic concept that is not directly influenced by culture.

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? Position the client's arms so that they are straight. Ensure that the room is calm, dimly lit, and quiet. Allow the family to tie sacred threads on the client's wrists. Place the client's bed so that it faces the east.

Ensure that the room is calm, dimly lit, and quiet. In the Buddhist religion, death is associated with rebirth. To ensure dignity, the environment surrounding the dying client should be serene. Placing the bed to face east, tying sacred threads on the client's wrists, and straightening the arms are actions appropriate for a dying person who follows Hinduism.

A deceased client is a member of a culture where the family is expected to bathe the body after death. What should the nurse do to support the client and family at this time? Explain that facility personnel are responsible for the task of bathing. Ask the family to observe the nurse bathing the body. Provide the needed supplies to the family. Participate with the family when bathing the body.

Provide the needed supplies to the family. In cultures where the family is expected to bathe the body, the family should be given the necessary supplies and left alone in the room with the body. The nurse should not interfere by participating with the family or directing the bathing procedure. The nurse should not bathe the body and expect the family to observe the process. Cultural practices are to be acknowledged and honored and facility personnel can permit the family to complete the task of bathing.

A client is experiencing uncontrollable back pain and a physical therapist suggests a back massage. The client asks the nurse how massage will help the pain. What is the best response by the nurse? "Massage is point stimulation used for orthopedic and neurological conditions." "A massage will relax muscles but does not work on ligaments and tendons." "Massage is an alternative therapy that uses herbal supplements." "Massage is widely practice by all hospitalized clients."

"Massage is point stimulation used for orthopedic and neurological conditions." Massage uses point stimulation of pushing and pulling of the skin, muscles, tendons, and ligaments to relieve orthopedic and neurological conditions. Massage will relax muscles, ligaments, and tendons. Massage is not widely used by hospitalized clients nor does it include the use of herbal supplements.

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 most helpful when used in conjunction with antianxiety medications. It can balance the positive and negative energies emitted from the anxiety. It is used to assist with controlling feelings and emotions toward others. It is a way to concentrate on the body's response during a stressful situation.

It is a way to concentrate on the body's response during a stressful situation. Biofeedback uses the senses such as heart rate and respiratory rate to sensitize the client to ways to find calm. The client uses the responses of the body to relax. This therapy can assist the client in finding alternative ways to deal with stressors. Rather than controlling emotions, biofeedback allows the person to recognize and respond to physical signs of emotional stress before the emotions are fully formed. When biofeedback is not effective or is still being learned, antianxiety medications are useful; however, biofeedback works well alone. This therapy does not balance energies.

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? "Where did you first learn about the possible benefits of vitamin B?" "Be sure to dialogue with your care provider before you start taking vitamin B supplements." "Are you hoping that you will eventually be able to replace your medication with supplements?" "Unfortunately, it is not safe to take supplements or herbal remedies while you are taking medications."

"Be sure to dialogue with your care provider before you start taking vitamin B supplements." The priority action is educate the client about the need to inform the care provider before taking supplements, over-the-counter medications, or herbal remedies. Many contraindications exist, but it is inaccurate to state that all herbal remedies are contraindicated. The source of the client's beliefs and the client's long-term plans are relevant, but the need for consultation with the provider is the priority.

An anxious client is admitted for treatment of an exacerbation of irritable bowel disease. The client asks the nurse if biofeedback will help after reading about biofeedback online. What is the best response by the nurse? "Stress is hard to control and you may need a medication to relax." "Biofeedback will help reduce stress." "Biofeedback does not work for irritable bowel disease." "The device is just another expensive electronic toy."

"Biofeedback will help reduce stress." The nurse should acknowledge that biofeedback is an evidence-based treatment for stress reduction and commend the client for reading and asking about the modality. It is considerate to ask the availability of this device and respectful to ask for more information as needed. It is demeaning to insist that biofeedback does not work, is not a serious treatment, or is not indicated for the client's condition. The nurse should not tell the client that a medication for relaxation is needed.

A nurse is teaching a client how acupressure works to relieve pain. Which explanation would the nurse most likely use? "It blocks the perception of pain in the brain." "It alters how the stimulus is transmitted at the spinal cord." "It substitutes sensory stimuli for pain-producing stimuli." "It interrupts the pain chemicals at the site of injury."

"It substitutes sensory stimuli for pain-producing stimuli." Acupressure involves cutaneous stimuli that substitute sensory stimuli for pain-producing stimuli. Interrupting pain chemicals at the site of injury is the method of action for local anesthetic and anti-inflammatory drugs. Altering spinal cord transmission reflects the action of intraspinal anesthesia and analgesia. Narcotics block the perception of pain in the brain.

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? "Realize that this medication will assist with keeping your blood pressure under control." "Can you tell me more about what that means?" "God knows when it is time to die, and by not taking these meds you are attempting suicide." "Life is short, live it up!"

"Can you tell me more about what that means?" By asking for clarification about the client's feelings, the nurse can gain understanding about the client's intentions. This also develops a more trusting and nurturing relationship between the client and nurse. The client is not attempting suicide. The medication will assist with the blood pressure, but the client is expressing a statement that the nurse needs to understand.

A young client is admitted with a diagnosis of somatic symptom disorder, but declines analgesic medications. The nurse learns that the client finds relief in regular hypnotherapy practice. The best response of the nurse should be: "Explain how you find the procedure helpful." "Hypnosis does not help with severe pain." "You have to believe in hypnosis for it to work." "Hypnosis is all entertainment and theater."

"Explain how you find the procedure helpful." The nurse is demonstrating acceptance and respect by asking the client to describe their experience with pain. Evidence-based research shows that hypnosis is effective whether or not the person being hypnotized believes in the treatment. It is not true that hypnosis does not provide relief for severe pain. It is silly and demeaning to deny the therapeutic effect of hypnosis.

The spouse of a client on hospice care expresses frustration to the nurse and states, "My spouse wants me to 'have hope' during this time, but I don't know what that means I should do." What is the nurse's most appropriate response? "Have you considered that you provide hope by listening and supporting what is important to her?" "Perhaps we should ask your spouse exactly how hope is defined during the process of dying." "Sometimes people who are seriously ill act hopeful so that others do not suffer." "I wonder if you have considered obtaining spiritual counseling for your spouse?"

"Have you considered that you provide hope by listening and supporting what is important to her?" It is common for a spouse to ask what to do to be supportive of a dying partner. Hope-fostering actions include listening to the partner's wishes, communicating and sharing feelings, and being aware of what is important to the spouse. It is not necessary to have philosophical discussions about what hope means to the partner. Suggesting that the client is acting in a certain way and not being genuine is not an appropriate response. Although spiritual counseling may be helpful, this approach does not address the spouse's question and desire to be supportive.

The nurse is assessing a client who is in her first trimester of pregnancy. The client states that her nausea has been problematic at times, but says that she is able to partially control it using ginger supplements. What is the nurse's best response? "Have you let your care provider know that you are taking ginger?" "Take the lowest dose that you can because it can make your blood glucose levels fluctuate." "Have you spoken with your care provider about the possibility of taking doxylamine?" "Where did you first learn that ginger might be helpful for treating your nausea?"

"Have you let your care provider know that you are taking ginger?" A priority is ensuring that the care provider is aware of the client's use of a herbal supplement during pregnancy. Ginger is not associated with hyperglycemia or hypoglycemia. Exploring the source of the client's information or the possible use of pharmacologic alternatives are secondary to ensuring there is communication with the care provider.

A client with a vaginal yeast infection asks the nurse if it is a good idea to start taking acidophilus along with the prescribed vaginal cream. What assessment question would the nurse ask prior to answering the client's question? "Do you experience gastrointestinal problems?" "How much sugar do you consume each day?" "Have you recently lost or gained any weight?" "How often do you eat yogurt with live cultures?"

"How often do you eat yogurt with live cultures?" If the client consumes one cup of yogurt containing live lactobacillus acidophilus daily, there is no need to take additional acidophilus. Although acidophilus is used for gastrointestinal problems, this client is not using it for this reason. Diets high in sugar have been associated with yeast infections and weight fluctuations are a part of a comprehensive assessment, but do not provide background information to answer the client's question.

The nurse is providing care for a client who was prescribed escitalopram three weeks ago. What statement by the client should be of greatest concern to the nurse? "My sister recommended doing a colon cleanse, so I am planning on doing it next weekend." "I have read a lot about the possible benefits of acupuncture online, so I think I will try it." "I have started taking St. John's wort because I have read it can help my mood." "I know that a lot of people who have depression are vitamin deficient, so I am taking a multivitamin each morning."

"I have started taking St. John's wort because I have read it can help my mood." Concurrent use of St. John's wort and sustained serotonin reuptake inhibitors can lead to excessive serotonin levels. The risks associated with colon cleanses, multivitamins, and acupuncture are significantly lower, though any complementary or alternative therapy should be discussed with the provider.

A pregnant client, who is originally from another country, is admitted to the hospital in labor. During the admission process, the spouse tells the nurse that the client will not receive any pain medication during the process. The spouse then waits in the waiting room. As the birthing process continues, the nurse asks the client if she needs pain medication. She declines the offer and reminds the nurse by saying, "My spouse told you I cannot have any pain medicine." What is the nurse's best response to the client? "I am sorry. I do not want to offend your husband." "I am going to talk to the provider about this." "I think that this is extreme. Pain medication will not affect the child." "I want to advocate for you and assist with the pain during this process."

"I want to advocate for you and assist with the pain during this process." Being a client advocate is important during the birthing process. Respecting the client's decisions is important, but decisions can be changed during this painful process. A nurse should advocate for the client and the client's needs but also respect the client's wishes.

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 prefer not to pray." "Let me find a different nurse willing to join." "May I lead the prayer?" "I will stay with you while you visit."

"I will stay with you while you visit." The nurse is showing respect for the religious belief of the family by offering to be present. The nurse telling the family that he or she does not pray is disrespectful. Leading the prayer is not necessary as the family needs this for healing. The nurse should not invite others.

The nurse is providing care for a client who is a Muslim. The client has recently received a diagnosis of type 1 diabetes and is receiving health education. What statement by the nurse best addresses this client's religious beliefs? "Insulin used to be derived from pigs, but now it is produced synthetically." "You might have to begin eating some foods that are contrary to Islam in order to maintain stable blood glucose." "Diabetes likely will not have any bearing on the practices of fasting that you have followed in the past." "You will be able to manage your diabetes while maintaining a vegetarian diet, but it requires careful management."

"Insulin used to be derived from pigs, but now it is produced synthetically." A client who adheres to Islam may be concerned that insulin is porcine derived, since pork products are proscribed. Fasting produces special challenges that must be carefully addressed. There is no need to discard dietary restrictions to maintain glucose levels. Islam does not dictate a vegetarian diet.

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? "Nothing you give me seems to touch my pain today. It is hard to take." "I am feeling pretty anxious right now, so is there any way I can get something for that?" "It feels like one round of bad news after another for me, like I am being punished." "I do not really have a close family or a lot of friends that I can call on."

"It feels like one round of bad news after another for me, like I am being punished." A client's allusion to feeling "punished" suggests that they are feeling some distress about the relationship with a cosmic power. A referral to spiritual care may be helpful. Untreated pain, lack of social support, and anxiety are all problems that the nurse must address, but none is as directly suggestive of spiritual distress.

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." "This should be a decision between the physician and couple." "Why would you want to do that?" "Centers for Disease Control and Prevention policy does not allow the hospital to give the parents the placenta."

"Let me check about how to go about doing this." The nurse's best response is be sensitive to the client's desires and to check with the institutional policy. This is not a violation of the CDC policy. Asking the couple why they would want to do this disrespects their cultural background. The couple does not need to involve the physician in the decision.

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? "Acupuncture is still very experimental." "Let us try this until you can have acupuncture." "There are very good medications available." "I can give you injections if that's what you like."

"Let us try this until you can have acupuncture." The nurse should respect the client's choice of alternative treatments. It is respectful to offer choices until the client can again access acupuncture treatment. Acupuncture is not experimental. The nurse should not ignore the client's right to choose any treatment, but at the same time an attempt should be made to get the client to accept treatment that will be immediately beneficial.

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?" "This treatment is often better than the pain medication that you are taking." "Pain is relieved by releasing endorphins, which balance the flow of energy." "Sometimes it is recommended when other treatments do not seem to be helping." "Now that you have chronic pain, it is one of the few treatments that may work."

"Pain is relieved by releasing endorphins, which balance the flow of energy." The main goal of acupuncture is self-healing and the treatment relieves pain by releasing endorphins, the body's natural pain-killing chemicals. Furthermore, it can also affect serotonin release in the brain, which can enhance a person's mood. The statements about acupuncture being better than pain medication, or acupuncture is used when other treatment does not help, or focusing solely on a person's chronic pain are negative and do not provide the client with hope or faith in future or prior treatment received.

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? "This type of treatment is not effective in relieving pain." "You need to get your body into different positions which could increase your pain." "Restoring the energy balance in your body could help with pain relief." "Acupuncture is helpful for acute pain but not chronic pain."

"Restoring the energy balance in your body could help with pain relief." Acupuncture is a complementary therapy used for a wide range of conditions, including acute and chronic pain. It addresses a person's qi, either increasing or decreasing the flow of qi, restoring the balance of energy (yin and yang) in the body. This change in flow is believed to contribute to healing. Although the therapy requires the person to lie still for a period of time, it does not require the person to assume different positions during that time.

A nurse is talking to a client about measures to relieve neck pain. The client talks about a family tradition of placing two pieces of silverware in a form of an "X" on the painful area. Which statement by the nurse is appropriate in caring for this client? "My grandmother told me to use a heating pad." "This technique has no science behind it." "Tell me more about the procedure." "Do you think this is appropriate to relieve the pain?"

"Tell me more about the procedure." A nurse should be interested in learning about cultures and how their practices are beneficial and useful for clients. Telling the client that there is no science behind the technique breaks down communication and indicates superiority of traditional Western medicine. Asking a question about appropriateness does not aid in learning about the client's culture. Sharing the nurse's personal experience is not appropriate.

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? "Omit your medication on the day that you must fast." "Take your medication, but check your glucose every 4 hours." "You should not fast because it will cause your diabetes to go out of control." "Tell me more about what is involved so we can plan for this better."

"Tell me more about what is involved so we can plan for this better." The client's statement indicates that adhering to the client's religious beliefs is important. Therefore the nurse needs to gather more information before determining the best action for the client. Once this information is obtained, the nurse can then determine the best course of action after consulting with the client's primary care provider. Telling the client not to fast is inappropriate because it ignores the client's beliefs. Omitting the medication or more frequent checking of glucose levels does not address the client's spiritual needs.

A client hospitalized with Crohn's disease is experiencing a migraine aura. The client requests that the client's chiropractor be allowed to visit even though it is after visiting hours. What is the nurse's best response? "Chiropractors are not real doctors and cannot practice here." "Tell me what helps your migraines outside of the hospital." "You can't have a visitor if you are having migraine pain." "I can bring you a PRN medication for your migraine."

"Tell me what helps your migraines outside of the hospital." Unless previous arrangements have been made for chiropractic care or craniosacral therapeutic massage, the nurse should engage the client in a discussion of what treatments have been helpful outside of the hospital. This is best done before the full migraine symptoms present. It is demeaning and opinionated to dismiss chiropractors as not "real doctors." Offering a medication may be premature without a full migraine assessment history. The nurse must also have full knowledge of all available medication orders to offer medication at this point. Having pain is not a reason to deny a client from having a visitor.

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? "It is best to encourage the client to make contact with a spiritual advisor of the client's own choosing rather than doing it for the client." "The absence of an identified religion does not mean that a client does not have spiritual needs." "In that case, it is likely best that we respect the client by not pushing the matter." "Because the client does not belong to an organized religion, a nurse can likely perform the role of a spiritual advisor."

"The absence of an identified religion does not mean that a client does not have spiritual needs." An absence of religion does not mean an absence of spirituality; the two concepts are not synonymous. A referral is likely still necessary. All nurses assess and address spirituality, but that does not mean that nurses are able to act in the role of a spiritual advisor.

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." "Thank you for sharing your wishes with me, but your daughter is my client, and she will be the one making those choices." "We cannot agree to caregiver gender preferences as client safety is our most important consideration." "I am sorry, but if we restrict caregivers based on gender, this is considered sexual discrimination and is illegal."

"We will do our best to comply with your request, but there may be times were a male caregiver is unavoidable." The nurse should respect the cultural needs of the client and her family and make every effort to teach them about hospital practice, including the fact that a male caregiver may be unavoidable. It may require negotiations and compromise, but the family should be reassured that every effort will be made to respect their wishes. The nurse should recognizes that a chaperone may be required at some point in the client's care. The nurse should check with the client when they are alone together to ensure she feels safe and that her parent's wishes are also her own, but the nurse should not challenge the parents in front of the client as this is considered disrespectful. Simply stating no effort will be made because safety is more important is dismissive of the request. Assigning a same-sex caregiver is not sexual discrimination by the legal definition.

Which questions should the nurse ask when completing a cultural assessment for a new client? Select all that apply. "What are some of your personal values?" "What are some of your health-related beliefs and practices?" "What is your age?" "What are your spiritual beliefs?" "What is your address?"

"What are some of your health-related beliefs and practices?" "What are some of your personal values?" "What are your spiritual beliefs?" Important components of a cultural assessment include values orientation, cultural sanctions and restrictions, communication, health-related beliefs and practices, nutrition, socioeconomic considerations, organizations providing cultural support, educational background, religious affiliation, and spiritual considerations. Components of cultural assessments do not include asking the client about their age and address.

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?" "Have you ever practiced a particular spiritual tradition?" "Are there rituals that you observe during parts of the year?" "Do you think about things as being right or wrong?"

"What are the beliefs that guide your daily decisions?" The concept of spirituality encompasses a person's values and beliefs that guide one's life, personal hopes, and attitudes toward life and death. It further focuses on the meaning and purpose of people's lives. Rituals, rites, and practices refer to specific religious beliefs.

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? "What are your reasons for staying so far away from the people in the group?" "Where will you be comfortable sitting and still remain a part of the group?" "Are there problems for you being in a group with so many different people?" "Do you think that sitting in a group makes you vulnerable to being touched?"

"Where will you be comfortable sitting and still remain a part of the group?" In being culturally sensitive to the client's need, the nurse will ask where the client will be comfortable sitting and still able to participant in the group. Asking the client the reasons for a particular behavior, thinking that the client is having problems with the group, and making an assumption about the cultural meaning of being touched by another person are not useful questions.

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." "Yes, but only after other types of therapy have failed." "No, hypnosis is a controversial treatment." "No, hypnosis is rarely used in the treatment of DID."

"Yes, a client is often not consciously aware of alter personalities." Hypnosis is often a first-line treatment for a client with DID. Because of dissociation from painful events, hypnosis is often a very effective tool. Alter personalities may emerge when the client is under hypnosis.

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. Short-term use of opioids has a high addiction risk. Using opioids will prolong the inpatient hospital stay. Alternative therapies such as relaxation or music can help. The client with pyelonephritis cannot use analgesics. Ask the client which migraine treatments are helpful when at home.

Ask the client which migraine treatments are helpful when at home. Alternative therapies such as relaxation or music can help. The nurse should respect the client's opposition to analgesics, but this should be explored. A discussion will likely reveal a variety of alternative options, many of which may be known to the client already. Opioids are not the best drug of choice for migraines. Short-term use of opioids will not independently prolong the hospital stay and do not carry a higher risk of addiction.

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? There are often people who will tend to disregard some forms of treatment. The client believes that the world is governed by forces of good and evil. Often people view being out of balance as the cause of disease and illness. All people have the right to care based on their personal preferences and values.

All people have the right to care based on their personal preferences and values. To deliver culturally competent nursing care the nurse must remember that all people are to be treated as individuals who have the right to their personal beliefs, preferences, and practices. People in all cultures may disregard or refuse to participate in various forms of treatment protocols. The statement that the world is governed by forces of good and evil reflects the magico-religious view of illness, and the view of illness as being out of balance is the naturalistic perspective of what causes illness, and these views may not be germane to the client's cultural background.

A nurse enters the room of a female client and finds her crying. The client has just been told that her breast cancer has returned. The client says, "I do not know why God is punishing me like this." How does the nurse best respond? Remind the client that everything happens for a reason. Tell the client that her belief in God will get her through this. Allow the client to continue to verbalize her feelings. Ask the client if she would like to pray with a chaplain.

Allow the client to continue to verbalize her feelings. The nurse should allow the client to continue to verbalize her feelings and concerns. This action is client-focused and demonstrates effective therapeutic communication. Based on the interaction that follows, the nurse can then determine the client's health beliefs and practices based on her spirituality and religion and plan further actions. Assess before forming a nursing plan. Telling the client that her belief in God will get her through is nontherapeutic and does not address the client's concern. Asking the client if she would like to pray or see the chaplain does not meet the client's immediate need to express strong feelings. Reminding the client that her faith is strong or that everything happens for a reason is a cliché that should be avoided unless the client wishes to explore these ideas.

The client on hospice explains to the nurse, "I asked my child to pray with me because I am a very spiritual person, but my child declined and is not a believer anymore." Based on this conversation with the client, what is the best action for the nurse to initiate? Talk to the child in a private setting about the client's desires. Communicate with other family members about the client's request. Ask if the client would like to meet with the hospital chaplain. Suggest to the client that meditation may be a viable option.

Ask if the client would like to meet with the hospital chaplain. The best action is to ask the client if a chaplain can meet the spiritual need for prayer. It would not be useful to address this client's need with the child who cannot meet this need. It is not clear if other family members are available and can meet this need. It is not appropriate for the nurse to make an assumption that meditation is the equivalent of prayer for this client.

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 suggest culturally appropriate foods for the client. Ask the interpreter to ask the client to leave the food in the fridge for a few minutes before starting eating. Ask the interpreter to ask the client about the specific meaning of the description of "hot." Ask the interpreter to ask the client's family to bring a favorite food from home.

Ask the interpreter to ask the client about the specific meaning of the description of "hot." In many Asian cultures, foods are categorized on a continuum of cold to hot that is independent of their physical temperature. Consequently, it is important for the nurse to assess the precise meaning of the client's statement before taking further action such as changing the client's diet. It is appropriate to assess the client's food preferences, but this data should come from the client, not the interpreter.

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? Document the client's request for alternative therapies in the client's health record. Teach the client about the risks of infection that accompany acupuncture. Educate the client about potential risks associated with acupuncture. Assist the client as needed in facilitating the acupuncturist's visit.

Assist the client as needed in facilitating the acupuncturist's visit. Acupuncture is a widely accepted alternative therapy, and the nurse should help realize the client's request unless it is contraindicated. Acupuncture is not associated with major risks. The nurse should document the client statements, healthcare provider feedback, and other relevant observations. It is not sufficient to document the client's wishes without trying to assist the client to achieve personal care goals.

A client is asking the nurse about using capsaicin for self-treatment for arthritis. What information does the nurse need to include in the client's teaching about the supplement? Select all that apply. Capsaicin is regulated by the Food and Drug Administration (FDA). The placebo effect can occur with capsaicin treatment. The capsaicin may have unknown mechanisms of action. Clinical trials are completed on capsaicin for arthritis treatment. Unexpected reactions can occur with treating arthritis with capsaicin.

Capsaicin is regulated by the Food and Drug Administration (FDA). Unexpected reactions can occur with treating arthritis with capsaicin. The capsaicin may have unknown mechanisms of action. The placebo effect can occur with capsaicin treatment. Capsaicin is a dietary supplement used for joint pain. The FDA does regulate alternative therapies but under a category known as herbal supplement. There is a requirement for certain information to be disclosed to the consumer and labeled on the bottle. There is always a possibility of toxic effect, unexpected reactions, and placebo effect. Scientific evidence and clinical trials are not completed on dietary supplements and complementary therapies such as capsaicin.

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? The client's family should be included in meal preparation and decisions. Meat is only permitted for the evening meal. Clients of the Jewish faith do not allow the mixture of dairy and meat. Jewish clients do not eat fresh fruit.

Clients of the Jewish faith do not allow the mixture of dairy and meat. Clients of the Jewish faith do not allow the mixture of dairy and meat, and this should be respected by the nurse. Meat is permitted at any time of the day. There are not special dietary issues related to fruit. Client's families cannot be involved in meal preparations and decisions.

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? Assess the client for signs and symptoms of hypokalemia, and collaborate with the care team to have cardiac telemetry ordered. Assess the client's random glucose level, and administer antihyperglycemics as prescribed. Assess the client for Chvostek's sign or Trousseau's sign. Collaborate with the care team to have the client's prothrombin time and international normalized ratio (INR) assessed.

Collaborate with the care team to have the client's prothrombin time and international normalized ratio (INR) assessed. Ginseng is contraindicated with warfarin, which is commonly prescribed for the treatment of atrial fibrillation; an increased risk of hypercoagulation can occur. Chvostek's and Trousseau's signs are suggestive of hypocalcemia, which is unrelated to ginseng use. Similarly, blood glucose levels and potassium levels are not significantly affected.

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. Avoid making eye contact with the client. Arrange for the client to receive care from a nurse who is from a similar culture. Assess the client for potential culture-bound syndromes.

Consider the norms around nonverbal communication in the client's culture. Norms around verbal and nonverbal communication vary widely among cultures; the nurse should be aware of and accommodate these differences whenever possible. It is not normally necessary or possible for clients to receive care from nurses of a similar culture. Mimicking the client's avoidance of eye contact may not put the client at ease. Avoidance of eye contact is not suggestive of a more significant culture-bound syndrome.

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? Assess the specific meaning of incense burning for the client. Facilitate the ritual at the bedside because it is motivated by religious beliefs. Arrange a referral to the hospital's chaplain or spiritual care service. Dialogue with the client about alternative rituals or the possibility of performing the ritual outdoors.

Dialogue with the client about alternative rituals or the possibility of performing the ritual outdoors. A religious ritual that produces smoke would be categorically prohibited in a hospital setting. As a result, the nurse should explore reasonable alternatives with the client. The specific meaning or the ritual is of secondary concern. Similarly, a referral may be beneficial, but the primary concern is the client's specific request.

A client with a diagnosis of metastatic breast cancer asks the nurse, "Why has God done this to me? I need to see a minister and go back to church." What interventions would be most helpful to the client at this point in time? (Select all that apply.) Discuss feelings related to the illness. Address the use of spiritual resources. Teach the client about the dying process. Encourage communication about religious beliefs. Determine expectations for life-sustaining treatments.

Discuss feelings related to the illness. Address the use of spiritual resources. Encourage communication about religious beliefs. The nursing care interventions that would be most helpful to this client at the time are interventions that offer support related to the diagnosis of metastatic breast cancer. Therefore, the nurse will focus on discussing the client's feelings, communicating with the client about religious beliefs, and addressing available and useful spiritual resources. Later on in the treatment process, education on the dying process and expectations of treatment would be appropriate.

The emergency department nurse is admitting a client who does not speak English. The client is accompanied by the client's adult son, who does speak English. The client appears to be in pain, but the nurse is unable to assess the character or history of the client's pain because of the language barrier. How should the nurse best communicate with the client? Perform as many components of the assessment as possible, and arrange for an English-speaking family member to come to the hospital. Have a hospital interpreter come to the assessment; defer the assessment if none is available. Ask the client's son to describe the client's pain to the best of the son's ability. Enlist the help of a hospital interpreter; ask the client's son to translate if none is readily available.

Enlist the help of a hospital interpreter; ask the client's son to translate if none is readily available. Whenever possible, trained interpreters should be used to communicate with clients who do not speak English. If none is available (inlcuding telephone translation services), however, it may be necessary to have a family member translate as long as that family member is not a child. It would be unsafe to delay an emergency assessment pending the arrival of an interpreter.

In explaining an invasive diagnostic procedure to a client with English as a second language, the nurse recognizes that the client would be best educated if an interpreter was available. What is the best response by the nurse when a family member offers to serve as the interpreter? Ask if the client is agreeable with having the family member interpret the information. Address with the client that there is a video that can be used to explain the procedure. Explain to the client and family member that there are medical interpreters available. Inquire when an elder family member present can give permission for an interpreter.

Explain to the client and family member that there are medical interpreters available. It is best for the nurse to obtain an interpreter who is not a family member to insure the client's right to privacy. Asking the client if it is acceptable to use a family member as an interpreter places the client in a difficult position where the client is unable to say no. The use of a video is not the best educational method to use since the client may have questions that go unanswered. When an interpreter is required, there is no need to obtain permission from an elder family member to use this service.

Two days after the donation of the right lobe of the liver to a parent, a client tells the nurse, "I was pressured by my family to donate a piece of my liver." What is the nurse's priority intervention in this situation? Provide written documentation of the conversation to the ethics committee. Inform all the surgeons who harvested and transplanted the liver. Explore the client's statement to obtain additional, detailed information. Notify the supervisor to determine if a psychiatric evaluation is necessary.

Explore the client's statement to obtain additional, detailed information. This powerful statement by the client needs to be explored and the client requires support. This is the first step in an ethical analysis. The donor's advocate team needs to be informed. Only after collecting the information on this client situation and completing the steps of an ethical analysis can it be determined if a report should go to the hospital's ethics committee. A possible outcome based on the nurse's assessment may be to offer psychiatric support in the form of a consultation or therapy.

The nurse is struggling to effectively communicate with a client from a cultural background that is very different from the nurse's cultural background. Prior to discussing this situation with the nurse manager, what communication skills would be important for the nurse to consider as strategies for improving care? Select all that apply. Express willingness to learn from the client. Develop additional ways to engage the client. Acknowledge differences between self and client. Listen more attentively to understand the client. Recognize the meaning of actions and words to the client.

Express willingness to learn from the client. Develop additional ways to engage the client. Listen more attentively to understand the client. Recognize the meaning of actions and words to the client. To develop culturally competent communication skills, the nurse must integrate a willingness to learn from and about the client, to engage the client in both verbal and nonverbal communication during the care, and to actively listen and be attentive to the client. The recognition of the meaning that both actions and words have to the client can help build understanding. The acknowledgement of differences between the nurse and the client is not a strategy to use as it will not result in respect and tolerance of the client's cultural differences.

The obstetrical nurse is caring for a client who is three hours postpartum. The client tells the nurse that nearly a dozen family members will be soon arriving to visit her and her infant. The client assures the nurse that this is the norm in her culture. What is the nurse's best action? Encourage the client to assert that the visit would be emotionally and physically tiring. Facilitate the visit, unless it is ruled out medically or logistically. Communicate with a family member, and explain why having more than one visitor at a time is not permitted. Make contact with a family member, and explain the client's need for rest.

Facilitate the visit, unless it is ruled out medically or logistically. Unless there is a valid reason why this visit is an impossibility, the nurse should facilitate it. It would be inappropriate to have the client assert something that she does not truly believe. Policies concerning visitors vary by site, but none would limit visitors to only one at a time.

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. Be careful not to move the client's property except in an emergency. People with disabilities are often sensitive about their personal property. Sometimes improper handling of a wheelchair can cause damage to it.

It is important to ask the client before repositioning the wheelchair. For people with disabilities, their equipment, such as a wheelchair, is considered personal property and is regarded as an extension of the self. Therefore, the same courtesy that is extended to the person must be done with the equipment. Although the nursing assistant should be careful about moving a wheelchair and handling the equipment properly, these statements do not promote understanding of the situation that occurred. Suggesting that people with disabilities are sensitive about their personal property does not explain the situation and may promote negative feelings toward people with disabilities.

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? Provide background music of familiar songs. Think about ways to complete unfinished business. Perform actions that facilitate comfort measures. Know that being present with the person is important.

Know that being present with the person is important. The value of being present to a dying loved one is important, and it is often viewed as being more useful than keeping busy by doing things and having conversations. Providing background music may or may not be useful depending on the client's preference. The child will not be able to complete the client's unfinished business. Although comfort care is important, the nurse is most probably ensuring that this intervention is performed.

The nurse asks the parent of a terminally ill infant if the parent would like the child to be baptized. The parent becomes upset and asks to speak to the nurse-manager. What is the nurse-manager's best response? Ask the on-duty chaplain to talk to the parent. Apologize for the nurse's behavior and assign another nurse to this client. Let the parent express the parent's own spiritual beliefs and wishes. Explain that the nurse is only trying to determine the parent's wishes.

Let the parent express the parent's own spiritual beliefs and wishes. The best response is to allow the parent to express the feelings. The chaplain may or may not provide an appropriate response. Explaining and apologizing for another's behavior is not likely to diffuse the situation or help the parent.

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. Continue to reinforce the need for and benefit of transfusion. Request a consultation with the hospital chaplaincy department. Provide a range of literature to address their religious conflict.

Offer the client alternative treatment options to consider. In recognizing and respecting the client's religious beliefs and practices, the nurse should research and explore alternative treatment options to offer the client so that healing is not further compromised. It is fruitless to persist in discussing or providing information about a treatment that is being rejected due to deep religious feelings. Requesting a consultation with the chaplaincy department will also not dissuade the client, nor provide medical treatment options.

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? Reciprocate their anger and call the kitchen to complain. Recognize their request and respectfully take corrective action. Quickly remove the offending food and order a replacement. Apologize and reassure them that it won't happen again.

Recognize their request and respectfully take corrective action. The nurse must acknowledge that this apparently simple breach holds profoundly serious meaning to this family. It is important to acknowledge their request and respectfully take corrective action. These actions may require repeated interventions with the family, as well as the nurse investigating the events that contributed to the erroneous meal being delivered. This would include removing the offending food and obtaining an appropriate replacement for the child. Apologizing may be helpful, but reassuring them it won't happen again is inappropriate and may be seen as insincere at this point. It is inappropriate to reciprocate their anger and call the kitchen to complain.

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. Honor the partner's request because refusing the transfusion would be suicidal. Contact the hospital administrator and take protective custody of the client. See if the client has an advanced directive prior to making the decision.

Respect the client's right to refuse the transfusion. The right to refuse treatment is an ethical principle of respect for the autonomy of a competent individual. This individual must be informed of the risks and complications associated with his decision. A competent adult can refuse treatment even if the partner does not agree. The right to die involves initiating or withholding treatment for a client who is irreversibly comatose, vegetative, or suffering with end-stage terminal illness. Protective custody is invoked with a minor. A durable power of attorney for health care is utilized when a client is incapacitated and cannot speak.

A client is being seen in the emergency department and starts speaking in language not spoken by nursing staff. What is the nurse's first intervention? Communicate using hand gestures. Seek out a facility-approved translator. Call a local multicultural clinic for support. Find another staff member who speaks the client's language.

Seek out a facility-approved translator. When a client is seeking care from a facility, it is imperative that translation services are available for those who do not speak the area's dominant language. This ensures that the client understands procedures, medication, and care within the facility. Using sign language or hand gestures will not help the client understand the services. Finding another nurse is an option; however, that can disrupt care of others. Calling local multicultural sites such as clinics is not effective or reliable.

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? Baby oil can assist with smooth skin. Fish oil has antiviral properties. Antiperspirant will aid with vasoconstriction. Tea tree oil has antibacterial properties.

Tea tree oil has antibacterial properties. Tea tree oil is an alternative therapy that has antifungal and antibacterial uses. Clients use it to treat burns, insect bites, irritated skin, and acne. The nurse should review the prescriber's instructions with the client and also call the prescriber to report the tea tree oil application on the surgical site. Fish oil is an oral therapy used for treatment of coronary disease. Baby oil can make the skin smooth but does not make the skin of a surgical incision smooth. Antiperspirants decrease the secretion of moisture and not vasoconstriction.

The client is discussing the client's medication history with the nurse. During the discussion, the client pulls out a list of the prescribed medications, which include fish oil and St. John's Wort. What is the nurse's understanding of why these alternative therapies are used by the client? The client has a history of depression. The client has a history of coronary diseases. The client has a history of diabetes. The client has a history of digestive issues.

The client has a history of depression. The client has a history of depression. Fish oil and St. John's wort are alternative therapies to treat depression.

A nurse is conducting a teaching session with a client who is of the Hmong culture. The nurse asks the client a question, and the client responds by nodding the head. The nurse interprets this response as indicating which situation? The client understands the question. The client is implying no. The client is in agreement. The client is acknowledging that they are listening to the nurse's questions.

The client is acknowledging that they are listening to the nurse's questions. Dignity is protected ("saving face") by appearing obedient, which is a desirable trait. Nodding in agreement may mean "I am listening," not "I agree" or "I understand." They may nod "yes" when really meaning "no." "Saving face" (protecting the honor of the family and preventing shame) is very important. Interactions and situations that require frankness and objectiveness may be avoided because of fear that such situations can lead to "losing face."

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 concerned about the temperature in the room. The client is warm and wants to cool off. The client is cold and wants to warm up. The client is balancing the disease with cold foods.

The client is balancing the disease with cold foods. The client is using traditional Chinese medicine and balancing of the yin and yang. Diabetes is considered a hot disease, and the balance is finding foods that are cold. The client is not cold or warm, nor concerned about the temperature in the room.

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 loves nature and watching sunsets each evening. The client is demonstrating an active faith practice. The client is successfully communicating spiritual needs. The client is advocating to be able to meet religious needs. The client plans to wave goodbye as the family drives away.

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. The nurse should recognize the needs of a Muslim client in revealing a wish to perform a regular prayer schedule while in the hospital. The client is successfully communicating to meet these spiritual needs. The client is also advocating to meet the religious needs by asking which direction is west, which is associated with the prayer ritual. The client is not seeking information to ask about watching sunsets or waving goodbye to the family.

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 actions are most likely the result of elder abuse. The client's action may reflect cultural and familial norms. The client is likely emotionally and financially dependent on the son. The care team should explain North American cultural norms about decision making.

The client's action may reflect cultural and familial norms. Norms around decision making and the role of adult children vary by culture. Elder abuse is not an impossibility, but the client's actions are not necessarily rooted in this problem. Explaining North American norms is of no benefit to the client or the client's care. Deference does not necessarily indicate dependence.

The nurse has observed that a client who identifies as a Latter-day Saint (Mormon) has drunk the coffee that was on the breakfast tray. How should the nurse best interpret this observation? The client is likely from a Latter-Day Saints background but no longer adheres to the religion. The client's personal religious practices may differ from those of the larger religious group. The client has likely consumed the beverage because it was unfamiliar and not labeled. Alcohol is the only beverage that is prohibited in this religion.

The client's personal religious practices may differ from those of the larger religious group. When considering characteristics or behaviors of religions, it is important to know that there is often wide variation between individuals and among groups. Not every person who says that he or she is a member of The Church of Jesus Christ of Latter-day Saints (Mormon) will always forgo coffee, for example, even though the faith holds that consuming coffee is not acceptable. At the same time, it would presumptuous to conclude that the client no longer adheres to this religion.

The nurse is providing care for a client who is a recent immigrant. What principle should the nurse apply to the client's care? The client likely prefers the healthcare team to make decisions around care without involving the client. The client likely has a limited understanding of health and illness. The client may mistrust the nurse's motives. The client's preferences around touch and personal space may differ from the nurse's.

The client's preferences around touch and personal space may differ from the nurse's. Touch and personal space vary widely between cultures. It is simplistic to presume that because a person is from another culture they lack understanding of health and illness, or wishes the care team to make decisions without input. Differences in culture often lead to lapses in communication, but this is not the same as mistrust.

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 becoming acculturated to the new school. The student is experiencing cultural shock. The student is going through a socialization period. The student is developing a peer support system.

The student is experiencing cultural shock. Cultural shock involves feelings of helplessness and discomfort and a state of disorientation when an outsider attempts to comprehend or adapt to a new cultural situation. Peer groups usually develop based on the background, interests, and capabilities of its members. Developing peer cultures is part of the socialization process. Acculturation occurs when there's a blending of cultural or ethnic backgrounds. This process takes time to develop.

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? Make an effort to learn a language that is commonly spoken in the community. Ask clients from other ethnicities for suggestions on how to become more culturally aware. Thoughtfully reflect on the characteristics of their own culture. Ask several colleagues about the culture with which they most closely identify.

Thoughtfully reflect on the characteristics of their own culture. Cultural competence begins with self-awareness. This should precede efforts such as learning languages or inquiring about colleagues' cultures. The nurse should seek to better understand clients' cultures, but it would not be appropriate to ask clients for advice about becoming more culturally aware in general.

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? Ask the couple to explain this decision and religious implications to the healthcare provider. Work with the healthcare provider to locate a female healthcare provider for the procedure. Notify the nursing supervisor that there is a conflict that will require administrative attention. Explain that hospital policy requires the attending healthcare provider to continue the care.

Work with the healthcare provider to locate a female healthcare provider for the procedure. People of Muslim faith believe that female providers should be involved in the birthing process. Hospital policy does not require the male healthcare provider to continue the care if this is the case. Any client has the right to change providers for any reason without explanation. The supervisor does not need to get involved given the information available.

The supper meal tray this evening for clients who have a diet as tolerated consists of a beef patty with gravy, baked potatoe, steamed peas, and a mixed fruit cup for dessert. For which clients may this meal be inappropriate? Select all that apply. a client who has inquired about the availability of a Roman Catholic chaplain a newly admitted client who is self-declared as a Seventh Day Adventist a client whose religion was listed as "Hindu" on admission a client who was visited by a rabbi earlier in the day a client who has a copy of Koran on the bedside and who prays several times daily

a client whose religion was listed as "Hindu" on admission a newly admitted client who is self-declared as a Seventh Day Adventist Beef is not permitted within the dietary guidelines of Hinduism. Many (but not all) Seventh Day Adventists are vegetarians. A client with a copy of the Koran is very likely a Muslim, but Islam does not prohibit beef products. A client who was visited by a rabbi is likely Jewish; Judaism does not prohibit beef. Similarly, Roman Catholicism does not prohibit beef.

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. meditation. biofeedback. aromatherapy.

acupressure. The band on the wrist described by the client is an example of acupressure. Biofeedback involves connection to electrical sensors provide the person with information about the body so that the person can then focus actions to make small changes in the body to achieve the goal. Meditation involves deep thinking and reflection to focus the mind and body. Aromatherapy involves the use of essential oils to promote well-being

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. notify the physician to restrict the client's visitors. call security to escort the visitor out of the hospital. alert staff that this client is receiving illicit treatment.

advise the client how the client might receive adjunct services. The nurse can demonstrate respect for the client who seeks alternative treatment by discussing hospital protocol and how to properly request additional treatments while in the hospital. It is premature to call security to escort the client's visitor off the premises and premature to request that the physician restrict visitors. It is inappropriate to inform staff that the client is engaging in illicit treatment.

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: arrange for a sitter so the client is not left alone. allow privacy, but check on the client frequently. contact the health care provider for a psychiatric consult. monitor the client for respiratory difficulties.

allow privacy, but check on the client frequently. The nurse should acknowledge that the client is performing self-care for anxiety symptoms. The most respectful action is to allow privacy but to check on the client frequently. The client is likely chanting or reciting a mantra. There is no indication that the client is experiencing respiratory conflict. The client does not need a sitter or a psychiatric consult.

After unsuccessful CPR efforts, the nurse must prepare an Islamic client for the morgue. Which nursing action should the nurse take? doing nothing; the Burial Society will perform a ritual cleansing doing nothing; only the family and close friends may touch the body asking the client's family if they want to perform the ritualistic washing providing routine post-mortem care

asking the client's family if they want to perform the ritualistic washing Physical care, at death, for a person of the Islamic faith consists of ritualistic washing by the family, with the client's body positioned toward Mecca. This action would be a family choice. The Burial Society may perform ritual cleansing for clients of the Jewish faith. Hindu clients believe that only family and close friends should touch the body. Routine post-mortem care is appropriate for Christian clients.

A nurse is assessing the posterior lung fields for a client who is experiencing difficulty breathing. The nurse lifts off the shirt and notices red, circular areas along the mid-spine area. What type of therapy is this? bleeding cupping traditional Chinese medicine massage

cupping Cupping creates a vacuum in a small glass by burning the oxygen out of it and then placing the glass on the person's skin surface. Cupping draws blood and lymph to the body's surface that is under the cup and is used to treat lung congestion of clients. Bleeding is done with leeches. Massage is done by using pushing and pulling for stimulation of orthopedic and neurological conditions.

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? quality of communication with the client and family integration of spiritual sources of support for the client effective management of the client's physical discomfort consistent attention to the client's physical care needs

effective management of the client's physical discomfort Nursing actions that facilitate hope for a peaceful death are often focused on providing comfort care and pain relief. The family will be distressed and lose hope for a peaceful death if the client experiences intense, untreated pain. Having quality communication, integrating spiritual care, and careful monitoring of the client's physical needs are also important. The immediate issue is to prevent and address pain and suffering.

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 need to ask for permission before physically touching a client limited involvement of community members for assistance focus on being in tune with nature for health maintenance role of females in being the primary decision makers for the family

focus on being in tune with nature for health maintenance importance of the extended family in providing support need to ask for permission before physically touching a client In the Amish culture, the extended family and community play important roles in supporting the client. They have a strong extended family social structure, and caring for the community is a strong value. Family structure is patriarchal, with the husband often the family spokesperson and decision maker. The Amish believe in the importance of nature to maintain health and often use natural remedies as a major part of care. Because touch is discouraged, permission is needed before 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. ginger chamomile melatonin lavender peppermint

ginger lavender peppermint Substances such as lavender, ginger, and peppermint have been associated with reducing episodes of nausea associated with chemotherapy. Chamomile and melatonin would be useful to address difficulty sleeping.

A young, healthy client comes to the clinic and reports having two to three nosebleeds each week and bruising very easily. After taking an in-depth history, the nurse asks the client for a list of any alternative or complementary modalities (CAM) that she uses. Which of the CAM items may predispose the client to this bleeding problem? Select all that apply. ginger powder green tea extract valerian root garlic capsules grapeseed extract

ginger powder green tea extract garlic capsules grapeseed extract Ginger, green tea extract, garlic, and grapeseed extract can inhibit platelet aggregation and cause the client to experience abnormal bleeding such as bruising and nose bleeds. The combination of these supplements may cause an additive effect on the body. Valerian root is used to treat insomnia and is not known to have hematological effects on the body.

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? jojoba kava melatonin ginseng

ginseng Ginseng is used as an antihypertensive and lowers blood glucose. Kava is used for the treatment of anxiety and stress. Jojoba promotes hair growth and relief of skin problems. Melatonin aids in the treatment of insomnia.

The client with a terminal illness states to the nurse, "I am at the point where the treatment seems as bad to me as the illness." What topic of conversation would the nurse view as most important as they discuss the client's concerns? beliefs about the prognosis diagnostic progression of illness perceptions of illness burden success of symptom management

perceptions of illness burden When the client equates the treatment as being as difficult as the illness, the need to discuss the perceived benefits of treatment verses the burden of treatment becomes the essential conversation topic. The other topics related to prognosis, illness progression, and symptom management are secondary issues to address with the client.

A pregnant woman at 39 weeks' gestation comes to the labor and birth suite in early labor. The woman is a member of the local Muslim community. When developing the culturally appropriate plan of care for this client, which aspect would the nurse identify as the priority? ensuring adequate pain relief measures assigning staff members of either sex to provide care using the left hand to offer fluids to the client protecting the client's modesty

protecting the client's modesty Modesty is a key aspect when caring for a female client who practices the Muslim faith. Therefore, a priority for care would be to protect the woman's modesty as much as possible. Muslims view the right hand as clean and the left hand as unclean. The nurse should offer medications and fluid with the right hand. Although ensuring adequate pain relief measures would be important, this would not be the priority. In emergency situations or if there is no one available of the same sex, a caregiver of the opposite sex is allowed. Although touching is prohibited, healthcare providers of the same sex can touch clients to provide care when necessary.

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 the cultural position of the husband as the head of the house. demonstrating a lack of interest in the birth of the baby. reflecting of the couple's religious beliefs and practices. indicating the husband's anxiety related to the process of labor and birth.

reflecting of the couple's religious beliefs and practices. In the Orthodox Jewish faith, a lack of physical contact between the husband and wife during labor and birth is a religious practice. Additionally, the husband will stand in a place where the birth cannot be seen or a drape will be placed for the delivery so that he cannot view the birth. The husband's movement away from the wife does not demonstrate a lack of interest, the husband's anxiety, or the husband's role in the family as head of the household.

A client who practices the Mormon faith has had abdominal surgery several days ago. The client's bowel function has returned, and the client is now advanced to a full liquid diet. When working with the nutritional staff to ensure that the client's meal trays include the appropriate food choices for the client's prescribed diet, which suggestion would be most appropriate for the nurse to include? Select all that apply. cola sherbet strained cream of chicken soup coffee with cream sweetened iced tea cranberry juice

sherbet cranberry juice strained cream of chicken soup Based on the client's faith, the client is required to abstain from the ingestion of caffeinated products such as tea, coffee, and carbonated beverages such as colas. Items such as sherbet, fruit juices, including cranberry juice, and strained cream soups would be appropriate for the client's religious beliefs as well as adhere to the prescribed full liquid diet.

The nurse is planning care for a group of clients who requested the use of yoga. The client with which condition is not a candidate for yoga? arthritis spinal fusion anxiety diabetes

spinal fusion Yoga uses meditation, breathing, and movement. A client who had a spinal fusion has limited mobility and is not a candidate for yoga because of the positioning required. Healthcare provider-approved modifications will be necessary, at the least. All the other clients are good candidates for yoga.

A client who has just returned from a monthly visit home is admitted with an extremely prolonged bleeding time. The nurse observes the client to project a powerful odor of garlic on the breath, person, and clothing. What is the most important factor for the nurse to assess? the client's financial status the client's hygiene routine the client's dietary habits the client's housing standard

the client's dietary habits The nurse should acknowledge that routine consumption of excess amounts of garlic by some cultures can exacerbate increased bleeding and delayed coagulation. In this case, assessing the client's dietary habits would be appropriate. It is judgmental to assume that this client experiences difficulties with hygiene, poverty, or restricted access to water.

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. yoga. traditional Chinese medicine. herbal medicine.

therapeutic touch. Therapeutic touch uses energy fields that surround and penetrate the human body with the conscious intent to help or heal. Herbal medicine includes oral or topical supplements. Traditional Chinese medicine uses the balance of yin and yang.

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. it depends on which language, and how long the delay will be. an adult friend or family member must be located to translate. the child may not be allowed to translate for the parent's care.

these circumstances may allow the child to translate. The nurse must recognize that care of a non-urgent nature requires informed consent, necessitating education and understanding of the client or responsible person, who is of legal age. If the circumstances are of an urgent but not sensitive nature, the child may be allowed to provide basic translation on this occasion. The nurse should assess the emotional and intellectual capacity of the child in this instance and document this as well. The language in question and the duration of the delay in accessing a translator do not impact the decision to allow the child to translate. While desirable, this option can also be anticipated to involve delays in arriving at the rural area in a timely manner.

A client has received lunch. The client is served soup with crackers, an apple, and salad. The client uses the nurse call light and asks the nurse to bring a warm beverage. What alternative therapy is the client likely using? therapeutic touch traditional Chinese medicine yoga chiropractic therapy

traditional Chinese medicine Chinese medicine views health as a life in balance and uses the concept of yin and yang as a major influence. The client is balancing the meal with hot and cold items that are opposing yet complementary phenomena needed for dynamic equilibrium. Yoga is a discipline that focuses on muscles, posture, breathing, and consciousness. Therapeutic touch uses the energetic biofield of the client and recenters the energy of the client.