PNC 1: Legal, Ethics, Culture, Spirituality

The nurse is caring for a client on a medical-surgical unit. The client tells the nurse that the healthcare provider has refused to treat the client further if the client continues to be noncompliant with the healthcare provider's recommendations. Which is the priority nursing action in this situation? A) Take the issue to the hospital ethics committee. B) Advise the client to sue the healthcare provider. C) Have the client contact a consumer agency. D) Notify the healthcare provider of the client's complaints.

A) Acting as a client advocate and protecting the client's rights, the nurse should enlist the help of the hospital ethics committee. The nurse never advises a client to sue but assists the client to find help resolving the issue. A consumer agency is not appropriate because this is an ethical matter. The nurse should act on behalf of the client, and the best way to do that is by taking the issue to the hospital ethics committee, not to the healthcare provider.

A novice nurse is working in a busy emergency department of a hospital situated in a culturally diverse area of the city. Which should the nurse do when providing culturally competent care? A) Acquire the underlying background knowledge necessary that will provide these clients with the best possible healthcare. B) Treat everyone who comes to the emergency department seeking care as having the same needs. C) Assume that working in this emergency department will be the same as in other care contexts the nurse has encountered. D) Base the standard of care on the needs and attitudes of the dominant cultural group in the area.

A) As healthcare providers, it is imperative to recognize common prejudices. Prejudices are prejudgments about cultural groups or vulnerable populations that are unfavorable or false because they have been formed without the background knowledge and context upon which to form an accurate opinion. Healthcare providers must acquire this background knowledge to develop their cultural competence. The nurse cannot treat every client as having the same needs, assume that the emergency department does not present a unique context that must be understood on its own terms, or base his standard of care on what best serves a single cultural group, dominant or not.

The nurse is caring for a devout Muslim client who is near death. The nurse should be prepared for which request from the client related to religious beliefs? A) Turn the client's head or body toward Mecca. B) Have a spiritual leader perform the Anointing of the Sick. C) Read the client the Tibetan Book of the Dead. D) Perform a ritualistic bath for cleansing the body.

A) Muslims who are dying often want their body or head turned toward Mecca, and they are encouraged to say the prayer recognizing their loyalty to Allah. Roman Catholics may request having a spiritual leader perform the sacrament of Anointing of the Sick. Tibetan Buddhists may read the Tibetan Book of the Dead within 7 days after death, but not before death. Ritualistic bathing of the body is usually performed by some religions, including Muslims, after death, not before death.

A nurse is explaining the need to obtain laboratory tests on a client who has an infection and is of a cultural group different from the nurse's. During the interview, the client avoids eye contact and refrains from answering questions for long periods of time. Which does this behavior indicate to the nurse? A) In this client's culture, direct eye contact may show disrespect. B) The nurse should come back at a different time when the client is feeling more communicative. C) The nurse should have another nurse finish the interview who might be more culturally aware of this group's customs. D) Leave the room and come back after having learned more about this particular culture.

A) Nonverbal communication includes silence, touch, eye movement, facial expressions, and body posture. In some cultures, direct eye contact may indicate disrespect. In addition, some cultures are quite comfortable with long periods of silence. Before assigning meaning to nonverbal behavior, the nurse must consider the possibility that the behavior may have a different meaning for the client and family. The nurse should not leave to come back later or try to find another nurse to take over this client's care; nurses should be able to communicate with clients from a diversity of backgrounds

The nurse recognizes that a client is experiencing spiritual distress due to the need to receive a blood transfusion. The nurse should also identify the need to provide interventions for what other nursing diagnosis? A) Decisional Conflict B) Chronic Confusion C) Acute Pain D) Self Neglect

A) Some clients have religious beliefs that prevent them from receiving any blood products. If a client has a life-threatening condition that requires a blood transfusion, the client may have spiritual distress related to the conflict between religious beliefs and lifesaving medical treatments. This causes Decisional Conflict for the client. This conflict between beliefs and treatments would not likely cause Chronic Confusion, Acute Pain, or Self Neglect.

Prior to being discharged, a client tells the nurse, "I trust you and the rest of the medical team, and I think the prescribed treatment is going to work. I'm ready to embrace life, and I'm looking forward to celebrating the holiday season in a few months." This statement suggests that the client is experiencing which of the following? A) Spiritual well-being B) Denial C) Conflict D) Apprehension

A) The client speaks of trusting relationships, hope, and a feeling of being alive and ready to embrace what the future brings. This suggests the client is in a state of spiritual well-being. The client's statement is not suggestive of denial, apprehension, or conflict about the future.

A female client, from a male-dominated culture, is being discharged after a lengthy hospitalization. Which action by the nurse prior to providing discharge instructions is appropriate? A) Assess who the decision maker is in the family. B) Ensure that the healthcare provider gives the instructions. C) Make sure instructions are understood by the client. D) Ask the client when the best time for teaching would be.

A) The nurse needs to identify who has the "authority" to make decisions in a client's family. If the decision maker is someone other than the client, the nurse needs to include that individual in healthcare discussions. Nurses need an awareness of cultural variations of gender because they will be caring for diverse client needs. What might be considered sexism by one culture may not be in another. Regardless of who is present during the teaching, it is always necessary to make sure that the instructions are understood, but it is difficult to do that before instructions are given. Asking the client when the best time for teaching would be does not address the need for the decision maker of the family to be present. The nurse should not simply leave giving instructions to the healthcare provider.

The clinic nurse is caring for an infant during a routine wellness exam. The parents and infant immigrated to the United States 6 months ago. The mother explains that she believes that an herbal remedy is the best way to treat the infant's colic. Which action by the nurse is appropriate? A) Ask the mother what the ingredients are in the remedy. B) Give the mother an alternate remedy for colic. C) Explain how herbal ingredients may be harmful to the infant. D) Tell the mother not to use the remedy because there is no way to know what the ingredients' scientific effect may be.

A) To recognize cultural practices, the nurse must acknowledge that use of old and home remedies is part of caregiving practices. Asking the mother what ingredients are in the herbal remedy allows the nurse to best evaluate what the mother is using, and then a determination of the benefit or detriment to the infant can be made in a nonjudgmental manner. Telling the mother not to use the remedy, giving an alternative, or making a judgment that any herbal ingredient is harmful does not recognize this cultural practice and shows insensitivity on the part of the nurse.

The nurse is preparing to discharge a client from the hospital. Which actions by the client indicate that her religious needs were met during the hospitalization? Select all that apply. A) Requesting and attending religious services in the hospital chapel B) Thanking the nurse for contacting a priest to visit while hospitalized C) Asking nurse for additional supplies to change dressings while at home D) Refusing home care services because the client's daughter is a nurse and a Sunday school teacher E) Asking the nurse whom to call if problems occur after surgery

A, B Evidence that a client's religious needs were met while hospitalized would be the client thanking the nurse for contacting her priest and the client requesting and attending religious services in the hospital chapel. Asking for additional supplies to change dressings at home, asking whom to call if she has any problems at home, or telling the nurse that she will not need home care are unrelated to spiritual care.

The preceptor discusses the religions in which ritual baths are provided after the death of a client. Which individual should the preceptor identify as practicing this​ ritual? (Select all that​ apply.) A. Muslim B. Jewish C. Buddhist D. Baptist E. Lutheran

A, B Muslim and Jewish people practice ritual baths after death. Ritual baths are not practiced by​ Buddhists, Lutherans, or Christians.

Which questions are appropriate for the nurse to ask when assessing the spiritual beliefs of a client? Select all that apply. A) "How will being sick interfere with your religious practices?" B) "Would you like a visit from your spiritual counselor or the hospital chaplain?" C) "Are any particular religious practices important to you?" D) "How is your faith helpful to you?" E) "Because you indicated you are Catholic, I suppose you fast every Friday?"

A, B, C, D The question related to fasting on Friday is inappropriate because it assumes that a client follows all the practices of the client's stated religion. All other questions are appropriate for the nursing student to ask a client during an admission assessment while assessing spiritual and religious beliefs.

The nurse manager is planning a presentation for a group of nurses about culture and diversity. Which barrier to respecting a​ client's culture should the nurse manager include in the​ presentation? (Select all that​ apply.) A. Refusing to allow family members to be involved in managing illness and disease B. Refusal of Western healthcare providers to believe in mind-body connection C. Belief that illnesses are linked to scientific pathophysiology and not changes in energy D. Incorporating the​ client's beliefs into the plan of care E. Clients may not trust the current healthcare system and the providers

A, B, C, E Clients from other cultures may not trust the current healthcare system and providers because they believe in traditional healers. Current Western healthcare providers may not believe in the mind-body connection and turn to traditional science. Another barrier is refusing to allow the family to be involved in managing illness and disease. It is not a barrier when healthcare providers incorporate the​ client's beliefs into the plan of care.

A nurse is interviewing a client at a clinic near a shelter for the homeless. Understanding the lack of resources this client has available, which should the nurse assess during the intake phase of the health history? Select all that apply. A) Social support available B) Access to medication C) Access to nutritious meals D) Number of times married E) Any personal resources

A, B, C, E Homeless clients present unique and complex challenges. The nurse should inquire about any social support, personal resources, and access to prescribed medications and nutritious meals in order to plan care appropriately. The number of times the client has been married is irrelevant.

A nurse working on a medical-surgical unit wants to ensure care is provided within the standard of nursing care. Which actions by the nurse are appropriate? Select all that apply. A) Analyze the position description. B) Review and become familiar with the policy and procedure manual. C) Question the value of collaborating with other disciplines. D) Review applicable state nurse practice act and administrative rules. E) Adhere to national standards of practice and care.

A, B, D, E Nurses are expected to demonstrate competence within multiple areas of their professional role, including collaboration with the entire care team. The nurse's specific job description will contribute to defining the standard of care. Employers can limit but not expand the scope of practice, and the nurse will be held to functioning within the scope of employment. Agency policies and procedures serve in defining the standard of care. The applicable state nurse practice act and administrative rules form the basis of the standard of care to which each nurse is held. A primary source for defining the standard of care is the prevailing national nursing standards. Nurses who follow national standards of practice and standards of care will provide their clients with the best care possible and be far less likely to commit any unintentional act that may rise to the level of malpractice.

The nurse is performing a cultural assessment on an adult client. Which information should the nurse​ include? (Select all that​ apply.) A. The language spoken at home B. The cultural or religious influences in decision making C. Whether the client has insurance D. The kinds of food and drink the client prefers E. The​ client's region or country of origination

A, B, D, E Subjective data would be gathered by asking questions about cultural beliefs. Objective data would be gathered through observation of the client and the interactions between significant family members who might be present. Discovering the region or country the client originates from and lives in would give clues about the​ client's culture. It is important to know what language is spoken at home and whether the client understands English so that communication can be effective. Insurance is not necessarily a question that would come up during a cultural​ assessment, although socioeconomic status may affect healthcare delivery.

The nurse is preparing a presentation on health disparities in the United States. Which information is appropriate for the nurse to​ include? (Select all that​ apply.) A. African American women are at greater risk for heart disease than any other single population. B. Undocumented immigrants are more likely to have diseases such as HIV and tuberculosis than those with legal status. C. American Indians have a lower incidence of diabetes than any other race. D. Gay and lesbian individuals face greater discrimination in health care than transgender individuals. E. Muslim individuals are less likely to be engaged in seeking preventive health measures.

A, B, E Health disparities among certain populations are a concern in the United States. American Indians have a higher incidence of diabetes​ (33%) than any other race. Because Muslim individuals believe the status of their health is​ Allah's will, not in their​ control, they are less likely to take preventive health measures. African American women are at greater risk for heart disease than any other single population. Transgender individuals face greater discrimination in health care than do gay and lesbian individuals. Undocumented immigrants are more likely to have diseases such as HIV and tuberculosis than those with legal status.

The nurse is concerned about being sued for negligence when providing care. Which nursing actions may be grounds for negligence? Select all that apply. A) Client fell getting out of bed because the call light was not used. B) Client name band was checked prior to providing all medications. C) Client's morning medications were administered in the early afternoon. D) Client states not understanding activity restrictions and wound eviscerated. E) Client documentation did not include appearance of infiltrated IV site.

A, C, D, E Checking the client name band before providing medications is not an action that is negligent. However, providing medications beyond the prescribed time can be viewed as negligent care. One strategy to prevent instances of professional negligence is to ensure client safety. The client fell when getting out of bed because the call light was not used. Because there is no way of knowing if the client knew how to use the call light, the nurse should be concerned with this situation. Clear communication of directions, explanations, and providing effective client education regarding the client's healthcare requirements can help decrease the risk of bad outcomes, so the wound evisceration could be viewed as negligent care. Poor documentation about care, wounds, and intravenous sites could be viewed as negligent care.

Which client should the nurse recognize as often being exempt from the religious practice of​ fasting? (Select all that​ apply.) A.Nursing mother B.Adolescent C.Older adult D.Menstruating woman E.Marathon runner

A, D The clients who are often exempt from religious fasting are nursing mothers and menstruating women. Older​ adults, adolescents, and marathon runners are expected to adhere to the religious practice of fasting

The nurse is reviewing the medical records of a small urgent care clinic to identify clients who may be considered vulnerable. Which client should the nurse include as those who may be​ vulnerable? (Select all that​ apply.) A. A​ 32-year-old woman who lists the local shelter as her home address B. A​ 22-year-old woman who is crying and anxious due to fighting with her roommate C. A​ 17-year-old teenager enrolled in an afterschool​ boys' and​ girls' program D. An​ 82-year-old man living alone with no family nearby E. A​ 42-year-old man with a psychiatric history who lives in his car in a nearby park

A, D, E Vulnerable populations include older​ adults, children, people living in​ poverty, homeless​ people, and those who are in abusive​ relationships, are mentally​ ill, or chronically ill. An episode of anxiety or an altercation without a history of abuse is not considered evidence of belonging to a vulnerable population. A teenager in an afterschool program is not considered a member of a vulnerable population.

The nurse is planning care for a hospitalized client. Which activities should the nurse identify as appropriate to support the client's spiritual needs through presencing? Select all that apply. A) Being available to the client B) Sharing about a time when the nurse overcame a similar situation C) Reading a newspaper at the nurse's station D) Stating personal religious beliefs E) Listening to the client

A, E Features of presencing include being available to the client and listening. Stating personal religious beliefs, reading a newspaper, and sharing about a time when the nurse overcame a similar situation are not characteristics of presencing

A​ non-English-speaking immigrant mother seeks care at a local outpatient clinic in an area where many immigrants have settled. The mother is accompanied by​ 15-year-old child who speaks English. How should the nurse address the language​ barrier? A. Ask the local immigrant service organization to provide an interpreter. B. Use signs and gestures to communicate. C. Ask the child to act as translator. D. Conduct a physical assessment with no explanations

A. A representative of a local organization will understand the culture and may even have specific helpful knowledge of the​ family's background. Federal law requires provision of an interpreter. Asking a family member to act as translator may create confidentiality issues. Signs and gestures are inadequate for clear communication. An interpreter should be available to explain the physical assessment.​ However, the​ client's privacy should be​ protected, so the interpreter may not be present in the examining room at all times.

The nurse working in the memory care unit listens to the client talk about a career as an airline pilot. The nurse understands that allowing the client to tell life stories will provide which benefit to the​ client? A. Maintaining a sense of identity B. Slowing the loss of memory C. Preventing the client from acting out D. Maintaining verbal ability

A. Allowing the client to tell life stories assists the client in maintaining a sense of identity. Encouraging the client to share life stories does not contribute to maintaining verbal​ ability, slowing the loss of​ memory, or preventing the client from acting out.

The nurse is preparing a presentation on social differences for colleagues. Which statement should the nurse include in the​ presentation? A. "Subcultures can maintain heritage and identity through​ dress, foods​ eaten, and cultural​ festivities." B. "Practices regarding proximity to​ others, body​ movements, and touch are similar across​ groups." C. "Clients from​ present-oriented cultures are generally receptive to preventive healthcare​ measures." D. "Individuals with an external locus of control are more likely to take preventive healthcare measures than those with an internal locus of​ control."

A. Subcultures can maintain heritage and identity through​ dress, foods​ eaten, and cultural festivities. Practices regarding proximity to​ others, body​ movements, and touch differ among​ groups, such as when an​ individual's perception of personal space causes comfort or anxiety.​ Present-oriented cultures focus on the here and​ now, and individuals from these cultures may not be receptive to preventive healthcare measures. Those who follow an external locus of control are less likely to be engaged in preventive measures than those who follow an internal locus of​ control, because they do not see themselves as being in control of their health.

The nurse on the unit is providing care for several children. The nurse understands that which statement accurately describes their spiritual​ development? A. Development of spirituality parallels cognitive and psychosocial growth. B. Development of spirituality does not occur until school starts. C. Children's spiritual growth occurs when they perceive their world to be unsafe. D. Spirituality will only develop if the​ child's parents are religious.

A. The development of spirituality parallels the​ child's cognitive and psychosocial growth. Spirituality develops in infancy. It is not necessary for a child to have religious parents in order for spiritual growth to occur. The​ child's spiritual growth is not based on an unsafe world.

The nurse is an active member of an evangelical church and occasionally prays with clients. Which statement by the nurse indicates appropriate consideration prior to praying with a​ client? A. "I offer to pray with clients who are seeking​ prayer." B. "I pray only with clients who request me to do​ so." C. "I only pray with clients who are of the same​ faith." D. "I pray with clients who will listen to my religious​ beliefs."

A. The statement made by the nurse that offers appropriate consideration prior to praying with a client​ is, "I offer to pray with clients who are seeking​ prayer." The statements about praying only with clients who request​ it, praying only with clients who are of the same​ faith, and praying with clients who listen to the​ nurse's religious beliefs are inappropriate and do not offer the client therapeutic spiritual support.

A nurse is caring for an older adult client with terminal cancer. The client's family wants to continue treatment, but the client would like to discontinue treatment and go home. The nurse agrees to be present while the client tells the family. Which principle is the nurse supporting? A) Beneficence for the client B) Autonomy for the client C) Nonmaleficence for the client D) Justice for the client

B) Autonomy refers to the right to make one's own decisions. The nurse is supporting this principle by supporting the client in his decision. Nonmaleficence is the duty to "do no harm." Justice is often referred to as fairness. Beneficence means "doing good."

The nurse is caring for a 22-year-old client with Down syndrome. Because the client has an intellectual disability, he is under the legal care of his parents. The client needs medical treatment for aspiration pneumonia, but the parents are declining care because they have heard that aspiration pneumonia is often fatal in clients with chronic health conditions. In addition to ethics and advocacy, what other nursing concept must the nurse factor into care decisions made in this case? A) Informatics B) Development C) Mood and Affect D) Spirituality

B) Down syndrome causes intellectual disability, so the client's developmental stage needs to be taken into consideration when providing care, especially related to client teaching and advocating for the client whose rights appear to be in jeopardy. Informatics, mood and affect, and spirituality do not appear to play a role in this case.

The nurse is caring for a client from a different culture who had a myocardial infarction and is receiving atorvastatin (Lipitor). The nurse assesses the client's diet to be very high in fat. Which is the best plan by the nurse to improve the client's diet and reduce the risk that the client may need additional medications? A) Ask the client if he would rather have another nurse who is from the same culture speak to him about his dietary needs. B) With the client's permission, discuss the dietary requirements with whoever prepares meals for the family. C) Consult a dietitian to teach the client about low-fat diets. D) Give the client information specific to his culture related to low-fat diets.

B) Every culture has culture-specific diets; the nurse must include the individual in the family who does the meal preparation if a different diet is to be successful. Asking the client about having a nurse from the same culture speak to him is racist and implies that the nurse cannot understand the dietary needs of a client from another culture. At this point, a consult by dietary services is premature. Providing information is a good idea, but the nurse must also teach the client.

The nurse caring for an adult client from another country notices that the client consults with her mother on all healthcare decisions. What action by the nurse is the most culturally competent? A) Ask the client why the parent is being consulted for every decision. B) Accept the behavior of the client and family member. C) Ask the client's mother to leave the room to provide the client with more privacy. D) Confront the client's mother to state the importance of the client making her own decisions.

B) In a multicultural society, human differences are accepted and respected. The nurse should accept this behavior because it might be a cultural norm, or it may be the way this client prefers to approach decisions about healthcare. Either way, all other choices are inappropriate and do not consider the client's cultural, family, or personal values.

The nurse is caring for a client who is actively engaged in an organized religion. Based on this statement, the nurse knows that which of the following statements is most likely true? A) The client believes in the presence of only one god. B) The client knows other individuals from the same religion who may be available to offer emotional and spiritual support. C) The client lives by the moral code of the Ten Commandments. D) The client will require time set aside for prayer several times each day, and the nurse will need to work around this schedule.

B) Individuals who are actively engaged in a specific religion are usually part of a religious community. Members of this community are often called upon for emotional and spiritual support, especially during times of hardship or illness. Without knowing the client's specific religion, the nurse cannot assume that the client believes in the presence of only one god, that the client will need to set aside specific times each day for prayer, or that the client lives by the moral code of the Ten Commandments.

The nurse is caring for an 8-year-old client who has been in the hospital repeatedly due to complications from leukemia. The nurse understands that the family is very religious, and the client often speaks about God's care for her. Which age-appropriate nursing intervention should the nurse implement that can help the child express her spirituality? A) Help the child reminisce about fun experiences earlier in life. B) Provide the child with tools to draw and color pictures. C) Provide the child with tools to produce a music video. D) Support parent-child bonding to encourage attachment.

B) Nurses can support the spiritual well-being of the child by age-appropriate activities that allow nonverbal expression of faith, including drawing, coloring, painting, play, or music, depending on the child's interests or energy level. Producing a music video is more appropriate for adolescent clients. Supporting parent-child bonding is more appropriate for infants. Reminiscing about the past is more appropriate for older adults.

Which action demonstrates correct reporting of suspected child abuse? A) The nurse includes the entirety of the client's medical record. B) The nurse compiles a report with all pertinent information that is factually true. C) The nurse recommends that the organization report the abuse to state authorities. D) The nurse reports only information the client has authorized for release.

B) Reports should be complete and accurate and should be made according to the policy of the organization for which the nurse works. In addition to reporting the abuse within the organizational framework, the nurse should personally report the abuse to the proper authorities. When abuse is reported, all pertinent information in the client's medical record (not simply the entire record) is required by law to be disclosed to the reporting agency. As such, reporting abuse or suspected abuse represents an exception to client confidentiality rules.

A nurse is volunteering time in a local free clinic that provides care to the underinsured population. By volunteering time to work in the clinic, this nurse is demonstrating which professional value? A) Human dignity B) Social justice C) Integrity D) Autonomy

B) Social justice is upholding fairness on a social scale. This value is demonstrated in professional practice when the nurse works to ensure equal treatment under the law and equal access to quality healthcare. Human dignity is respect for the worth and uniqueness of individuals and populations. Autonomy is respecting the client's right to make decisions about their healthcare. Integrity is acting in accordance with an appropriate code of ethics and accepted standards of practice.

The nurse is caring for a terminally ill client who practices Catholicism. The client states to the​ nurse, "Can you please notify the​ priest? I would like to turn my illness over to​ God." Based on the​ client's statement, which ritual should the nurse anticipate will be​ performed? A. Confirmation B. Anointing of the sick C. Baptism D. Communion

B. Based on the​ client's statement, the nurse can anticipate that the priest will perform the healing ritual of anointing the sick. It is important for the nurse to have an understanding of the​ client's religious beliefs in order to ensure that interventions are offered and performed in a timely manner.​ Baptism, communion, and confirmation are not rituals of the very ill.

Which statement accurately describes the purpose of the American Nurse's Association's Code of Ethics for Nurses? A) It serves as a statement of nurses' personal values and standards. B) It serves as the profession's nonnegotiable ethical standard. C) It serves as an announcement of nurses' commitment to the profession. D) It serves as a standard protocol for performing nursing procedures.

B) The ANA Code of Ethics for Nurses serves as a statement of nurses' ethical obligations and duties (not their personal values and standards), as the profession's nonnegotiable ethical standard, and as the nursing profession's statement of commitment to society (not the nurse's commitment to the profession). Nurses should refer to the ANA Code of Ethics for Nurses to direct how they perform their duties in daily practice, but it does not provide standard protocols for performing nursing procedures.

The nurse is caring for a client in spiritual distress. The client has met with the hospital chaplain but did not find it beneficial. The nurse recognizes that outside assistance from the client's own spiritual advisor may be helpful. What should the nurse do before making an appointment with the advisor? A) Consult with the primary care provider to find an available counselor. B) Ask the client's permission to contact the counselor. C) Call the hospital chaplain to come speak with the client. D) Advocate with the primary care provider to offer spiritual care to the client.

B) The client's permission is needed before seeking an outside counselor in order to protect the client's right to confidentiality. Therefore, the nurse should ask the client's permission before contacting the counselor. The nurse does not need to consult with the primary care provider to find an available counselor, nor should the nurse ask the primary care provider to offer spiritual care to the client. Although the nurse could call the hospital chaplain to come speak with the client, this is not required before scheduling an appointment with an outside counselor.

The nurse is caring for a client in the intensive care unit (ICU) who was in a motor vehicle crash. The healthcare provider asks the nurse to extubate the client because there is no communication between the brain and body due to a cervical fracture. The family agrees with the decision of the healthcare provider, but the nurse is uncomfortable pulling the tube. Which is the reason the nurse is experiencing difficulty with this task? A) An ethical conflict B) Personal values C) Legal issues D) Cultural values

B) The nurse is distressed because of personal values, which are in conflict with causing the client's death. The decision is within ethical principles. Cultural values are not in evidence in this instance. Extubating this client would not be a legal decision.

Every year, the nurse attends a nursing conference and takes several continuing education courses to help maintain licensure. Which section of the ICN Code of Ethics does this uphold? A) Nurses and people B) Nurses and practice C) Nurses and the profession D) Nurses and co-workers

B) The nurses and practice section of the ICN Code of Ethics states that nurses carry the professional responsibility and accountability for nursing practice and for maintaining competence by continual learning. The other sections of the ICN Code of Ethics do not address continuing education for nurses.

Which treatment program would be most appropriate for homeless clients whose type 1 diabetes requires daily insulin injections? A) Home healthcare B) Outpatient clinic C) Partial hospitalization programs D) Inpatient hospital-based care

B) The outpatient clinic would provide the care the client requires in the most cost-effective manner. There is no indication for inpatient or partial hospitalization at this time. Because the client is homeless, home healthcare would not be the best option in this situation.

The family members of a critically ill client tell the nurse, "We believe in the power of prayer. Prayer connects us all and makes us stronger. We will continue to pray that our loved one recovers." This statement suggests that the family is demonstrating which of the following characteristics? A) Good family support system B) Spiritual well-being C) Denial D) Spiritual distress

B) Through their statement, the family members express the belief that they are connected by a higher power. They also say they draw strength from this belief. This is evidence of spiritual well-being, not spiritual distress. The family may or may not be denying the client's health status. Although this statement indicates that the family turns to a higher power for support, it does not reveal anything about the family's overall support system.

A nurse educator is talking to a student about how to deal with an ethical dilemma in practice. Which does the nurse educator explain to the student as important regarding actions during an ethical dilemma? A) Examining all conflicts in the situation B) Investigating all aspects of the situation C) Relying on nursing judgment D) Making a decision based on the policy of the agency

B) To avoid making a premature decision, the nurse plans to investigate all aspects of the dilemma before deciding. Overconfidence can lead to poor decision making. Reading the agency policy regarding the matter addresses only one aspect of the situation. Examining the conflicts surrounding the issue is only one aspect of the situation to consider.

The nurse is assessing a client's spirituality. Which of the following findings would suggest that the client experiences spirituality as a source of strength? Select all that apply. A) The client uses the telephone to inform family members of an unwanted diagnosis. B) The client reads spiritual material every evening. C) The client asks to watch a religious service on television. D) The client says she has no desire to meet with a chaplain. E) The client tells the nurse she is convinced she will be punished in the afterlife.

B, C Regularly reading spiritual material and asking to watch a religious service on television are actions that suggest the client views spirituality as a source of strength. In contrast, focusing on possible punishment in the afterlife would suggest that the client is experiencing spiritual distress. Lack of interest in meeting with a chaplain might indicate spiritual distress, or it might indicate that the client either places little emphasis on spirituality or feels that his or her spirituality is a private matter. Discussing an unwanted diagnosis on the phone is unrelated to spirituality.

The nurse observes a healthcare provider discussing an operative procedure with a client and determines that informed consent was achieved. Which information was included in the informed consent process? Select all that apply. A) The provider's disapproval if the surgery is not performed B) The health problem that requires surgery C) The purpose of the surgery D) The expectations of the surgery E) Outcome if surgery is not performed

B, C, D, E For informed consent to be achieved, the client should receive the following information: the diagnosis or condition that requires treatment, purposes of the treatment, what the client can expect to feel and experience, intended benefits of the treatment, risks, and what could occur if the surgery is not performed or if alternatives to the treatment are chosen. To give informed consent voluntarily, the client must not be coerced in any manner. If the client provides consent due to fear of disapproval by a healthcare provider, such consent is not considered to be voluntary. Coercion of any kind invalidates the consent.

A nurse working in an assisted living facility is preparing an educational program regarding ageism for the colleagues on the unit. Which statements reflect ageism? Select all that apply. A) "If the client is competent to make decisions, I should not go to other members of the family for care decisions." B) "The elderly are just lazy, and that is why they need help with activities of daily living." C) "All elderly people are sickly." D) "Addressing an elderly client as 'Honey' or 'Sweetie' is disrespectful." E) "The elderly are less likely to recover from illness."

B, C, E Ageism is the term used to describe the deep and profound prejudice in American society against older adults. The beliefs that elderly people are sickly, less likely to recover from illness, and lazy are all examples of ageism. The nurse should always address the client by name and involve the client in care decisions if the client is competent to decide.

A client is receiving care in the hospital for life-threatening injuries sustained in a motor vehicle crash and is taken immediately to surgery. There is no family available to provide consent; however, the client's medical record is available and reviewed by the nurse. Which treatments are inappropriate in this situation? Select all that apply. A) Emergency surgery B) Treatment that was previously refused C) Treatment that violates religious beliefs D) Medications to treat the injury E) Experimental medications for a research study

B, C, E In most states, the law assumes an individual's consent to medical treatment when the person is in imminent danger of loss of life or limb and unable to give informed consent. In other words, the emergency doctrine assumes that the individual would reasonably consent to treatment if able to do so. This doctrine serves as a guiding principle that permits healthcare providers to perform potentially life-saving procedures under circumstances that make it impossible or impractical to obtain consent. Treatment that was previously refused or violates the client's documented religious beliefs is not appropriate. Experimental medications that are being initiated in conjunction with a research study are also not appropriate.

Which aspect of organizational governance should reflect adherence to cultural competence standards within a healthcare​ facility? (Select all that​ apply.) A. Translation services B. Organizational practice implementation C. Mission statement D. Staff training E. Policies and procedures

B, C, E Organizational​ mission, policies and​ procedures, and practice implementation should support cultural competence. Translation services and staff training are not parts of organizational governance.

The nurse is providing care to a client who has just received a diagnosis of cancer. Which findings would suggest that the client is experiencing spiritual distress? Select all that apply. A) Client is observed crying with children. B) Client tells the nurse that he feels hopeless. C) Client discusses possible outcomes with healthcare provider. D) Client turns off a religious show on the TV and stares out the window. E) Client is talking quietly with spouse.

B, D Spiritual distress may be characterized by expressions of a deficit in meaning, purpose, hope, forgiveness, or intimacy with the divine, or by anger or a lack of interest about previously spiritually nurturing persons or resources. Telling the nurse he feels hopeless and turning off a religious TV show indicates spiritual distress. The other actions are normal responses to a cancer diagnosis.

The nurse is performing a holistic assessment of a client. Which observations indicate that the client is experiencing spiritual distress? Select all that apply. A) The client is sitting in a chair before breakfast reading the Bible. B) The client states he has lost his faith in God since he's gotten ill. C) The client is watching a religious program on the television. D) The client is crying, pacing, and mumbling about God being angry with him. E) The client is overheard arguing with clergy about the existence of God.

B, D, E The client who states a loss of faith in God after getting ill, the client who is crying, pacing and mumbling about God being angry with him, and the client who is overheard arguing with clergy about the existence of God may all be experiencing spiritual distress. The client who is observed sitting in a chair before breakfast reading the Bible or who is watching a religious program on the television is demonstrating a behavior of spiritual health.

The nurse is caring for a client who is newly diagnosed with diabetes. Which spiritual therapy should the nurse incorporate into the plan of care to assist the client in improving overall health and​ well-being? A. Expressive artwork B. Mindfulness and meditation C. Dignity therapy D. Awe therapy

B. Mindfulness and meditation can be used as prayer and as a nonreligious lifestyle strategy for improving health and​ well-being. Awe is associated with greater​ prosociality, generosity, and ethical decision making. Awe may activate​ spiritual/religious feelings. Dignity therapy is effective for improving spiritual and emotional outcomes for clients at the end of life. Expressive artwork is a means for​ self-expression and meaning making and is used for individuals with mental health and​ disabilities, older​ adults, and individuals who have experienced trauma or displacement.

The nurse recognizes that which religion asks its members to fast during daylight hours for a month during a period of special​ observance? A. Buddhism B. Islam C. Christianity D. Judaism

B. Muslims practice fasting during daylight hours during the month of Ramadan. Fasting for a month during daylight hours is not a practice in​ Judaism, Buddhism, or Christianity.

The nurse is observing a newly admitted client to assist in obtaining information for the spiritual assessment. Which clinical observation is most applicable to the spiritual​ assessment? A. Mealtime B. Behavior C. Language D. Diet

B. The clinical observation that is most applicable to the spiritual assessment is behavior. The performance of behaviors such as prayer or reading of religious literature is reflective of spirituality.​ Language, diet, and mealtimes are not necessarily reflective of spirituality.

The nurse is caring for an adult client in the clinic. The nurse identifies that which concepts are most applicable to the spiritual growth of the​ adult? A. Identity and​ well-being B. Meaning and connectedness C. Loving and forgiving D. Prayer and religion

B. The nurse identifies that meaning and connectedness are the concepts that are most applicable to the spiritual growth of the adult.​ Loving, forgiving,​ prayer, religion,​ identity, and​ well-being are not concepts that are most applicable to the spiritual growth of the adult.

The nurse is caring for a hospitalized preschool child. In which spiritual developmental phase should the nurse anticipate the child to​ be? A. Undifferentiated faith B. Intuitive-projective faith C. Conjunctive faith D. Mythic-literal faith

B. The​ child's spiritual developmental phase is intuitive-projective faith. This phase is​ fantasy-filled and imitative. In this​ phase, the child can be permanently influenced by​ examples, moods,​ actions, and stories of the visible faith. This phase occurs between 3 and 7 years of age. Conjunctive​ faith, mythic-literal ​faith, and undifferentiated faith are phases of spiritual development that occur during other developmental phases of life.

The nurse should understand that spiritual beliefs and practices are assessed for each client for which primary ​reason? A. It assists the nurse in identifying which chaplain to notify. B. The presence of spiritual distress may interfere with coping​ and/or healing. C. It assists in gathering statistical religious demographics. D. Clients of the same religion can share a semiprivate room.

B. When a client enters the healthcare​ system, a nurse can screen for the presence of any spiritual distress likely to interfere with healing. Nurses understand that spiritual assessment can inform interventions that foster hope and incorporate a​ client's spirituality as a resource for motivating client change and improving client outcomes. The primary purpose of the assessment is not to gather religious demographic​ data, identify which chaplain to​ notify, or assign clients who share the same spiritual beliefs a semiprivate room.

A student nurse administers a medication to the wrong client while the instructor is with another student. Which statement by the instructor is most appropriate in this situation? A) "You have placed the nursing student program in danger." B) "You may be sued by the hospital for the extra care cost to the client." C) "You are expected to practice like a licensed nurse." D) "You have set a bad example for the other students."

C) A nursing student is held to the standard of conduct of an experienced, licensed professional nurse. Students are required to know the standards and to follow them. Hospitals do not generally sue nurses to recover money for extended care due to an error. It is not likely that the teaching program is in danger, as people do make mistakes and hospitals do rely on nursing schools to help provide care to clients. It is not likely that the other students are apt to follow the example of a student who fails to follow policy

The nurse is reviewing the discharge instructions for administration of home medications with an older adult client. In considering the normal changes experienced with aging when developing a teaching plan for this client, what type of bias should the nurse be careful to avoid? A) Relativism B) Fundamentalism C) Ageism D) Multiculturalism

C) Ageism is discrimination against older adults, which the nurse should guard against when developing a teaching plan for this client to ensure that no part of it depends on biases about older adults. Relativism and fundamentalism are ethical philosophies. Multiculturalism is many cultures existing in a society in which no culture dominates.

A client was recently diagnosed with alcoholic liver cirrhosis. During a regular checkup, the client tells the nurse, "This is God's punishment for all those parties I went to when I was younger." The nurse should recognize that this religious view could have a negative effect on what other nursing concept? A) Addiction B) Legal Issues C) Stress and Coping D) Digestion

C) Clients can use religion as either a positive or a negative coping strategy. Negative expressions of religious coping include statements like "God is punishing me." If the client is addicted to alcohol, the diagnosis and religious belief may stimulate the client to give up alcohol, which would not be a negative effect. There are no legal issues present due to this client's statement. This religious view is unlikely to affect the client's digestive processes, although the disease itself may reduce metabolism associated with digestion.

The nurse is providing care to a Catholic client who describes herself as "extremely devout." Which treatment option is most likely to cause spiritual distress for this client? A) Blood transfusion for anemia B) Specialized cardiac diet C) Elective termination of pregnancy D) A below-the-knee amputation

C) Elective termination of pregnancy, or abortion, is the treatment most likely to cause a devout Catholic client spiritual distress. Blood transfusion, specialized cardiac diet, and below-the-knee amputation are less likely to cause this client spiritual distress because they are not prohibited by Catholic teaching.

The nurse is caring for a client who just had abdominal surgery. The client's nonverbal cues indicate pain, but the client denies the need for the pain medication prescribed by the healthcare provider. The nurse recognizes that this client is from a culture that feels it is inappropriate to complain about pain. Which action by the nurse is appropriate? A) Seek out a family member to convince the client to take the medication. B) Consult with the healthcare provider about providing pain medication without the client's knowledge. C) Offer the pain medication to the client again, stating that providing comfort is the nurse's most important responsibility. D) Allow the client to suffer in silence.

C) Members of some cultures will typically not complain of pain or physical problems because they are taught self-restraint and the priority of the group over individual needs. Many people from these cultures will consider refusal of something offered as a gesture of courtesy. The nurse should take this into account when offering the pain medication to the client in a culturally sensitive way. Seeking out the intervention of a family member of the client, trying to administer the medication without the client's knowledge or simply allowing the client to suffer in silence are not appropriate actions.

The nurse notices that a client, who is from another country, appears uncomfortable when the nurse asks to look at the client's abdominal incision from a recent surgery. Which nursing action is the most culturally competent? A) Close the client's curtain to maintain privacy. B) Ask the client to explain why she is uncomfortable. C) Explain the reason for the intervention using lay terms. D) Wait until the next assessment time to observe the incision.

C) The most culturally competent intervention is to explain to the client the reason for the intervention using lay terms. The nurse should close the client's curtain to maintain privacy for all clients; this is not necessarily just a culturally competent action. Asking the client why she is uncomfortable is confronting the client and is not culturally competent. Waiting until the next assessment time to observe the incision is inappropriate, as this can lead to missing important assessment findings regarding the state of the client's incision.

The nurse is providing care to a client diagnosed with type 2 diabetes mellitus. The client wishes to take Communion but must fast for 1 hour prior to receiving it. Which action by the nurse is most appropriate? A) Contact the healthcare provider to suggest an alternative form of nutrition because the client is refusing to eat or drink. B) Provide the client with breakfast and morning medication and encourage the client to eat and take Communion some other time. C) Find out when the hospital clergy will be distributing Communion and adjust the client's medications and breakfast accordingly. D) Suggest that because the client is hospitalized, eating and drinking will not affect the Communion.

C) The nurse should follow the client's expressed wishes regarding spiritual care and should not pressure them to relinquish any of their beliefs or practices. To support the client's spiritual needs, the nurse should find out when Communion will be distributed and adjust the medications and breakfast accordingly. The nurse should not suggest that eating and drinking will not affect Communion. The nurse should not ignore the client's needs by providing medication and breakfast. The nurse should also not contact the healthcare provider to suggest alternative forms of nutrition, because the client is not refusing to eat or drink but wants to delay eating and drinking until after Communion.

When receiving nursing care, the client states, "I drink a small glass of warm water mixed with the juice of one lemon every morning because it helps to heal my body." Which action by the nurse is appropriate when providing care to this client? A) Tell the client that cold water is better metabolized by the body. B) Instruct the client that lemon juice is really a dose of vitamin C that helps with healing. C) Provide the warm water and juice of a lemon. D) Suggest the client delay the water and lemon until after morning medications.

C) The nurse should follow the client's expressed wishes regarding spiritual care. To support the client's beliefs about healing, the nurse should provide the client with the warm water and lemon juice. The nurse should not instruct the client about the benefits of lemon juice being vitamin C. The nurse should also not suggest that cold water be used instead. Asking the client to delay drinking the water and lemon juice will not support the client's spiritual needs.

The nurse is providing care to several clients. Which clients are most likely to request a vegetarian diet due to religious beliefs? Select all that apply. A) A Catholic client B) A Jewish client C) A Hindu client D) An Episcopalian client E) A Seventh-Day Adventist client

C, E Of the individuals listed, the Hindu and Seventh-Day Adventist clients are most likely to be vegetarian because of their religious beliefs. The Jewish, Episcopalian, and Catholic clients may opt to abstain from certain types of food, but these clients are not likely to be vegetarian because of their religious beliefs.

A client who is scheduled for surgery wants to continue to wear a religious medallion. Which actions by the nurse support the client's religious needs? Select all that apply. A) Keep the medallion on the client but remove it once anesthesia is provided. B) Ask the client if wearing a medallion is going to ensure a successful surgery. C) Document that the medallion is being worn by the client. D) Suggest the client not wear the medallion because it will most likely be lost. E) Explain that the medallion can be safety pinned to the client's gown.

C, E The nurse should explain that the medallion can be safety pinned to the client's gown. This approach would ensure compliance with the client's religious needs as well as safety for any surgical intervention planned for the client. The nurse should also document that the medallion is being worn by the client. The nurse should not remove the medallion after anesthesia is provided. The nurse should not tell the client that the medallion will be lost if worn or confront the client by asking if the medallion is going to ensure successful surgery.

The nurse is caring for an adolescent client in the hospital. The nurse understands that which statement reflects the spiritual growth of​ adolescents? A. Spiritual growth is reflected in living a purposeful life. B. Spiritual growth is reflected in maintaining loving relationships. C. Spiritual growth is reflected in their unique identity. D. Spiritual growth is reflected in the practice of religious ritual.

C. Adolescents​ are, by​ nature, in the process of learning to differentiate themselves from their​ parents, forming their own unique​ identity, and thinking independently and critically. The nurse understands that the​ adolescent's spiritual growth is reflected in the​ adolescent's unique identity. The spiritual development of the older adult is reflected in living a purposeful​ life, practicing religious coping strategies such as​ prayer, and maintaining loving relationships.

The nurse is researching cultures and diversity in health care. Which cultural characteristic that affects health care should the nurse classify as an environmental​ control? A. Skin color B. Emphasis on the past C. Preventive medicine D. Personal boundaries

C. Preventive medicine is an environmental​ control, because those who follow an internal locus of control will be motivated to eat​ healthy, exercise, and make use of other wellness measures. Skin color is a biological factor. Personal boundaries are space​ factors, and emphasis on the past is a time orientation.

The nurse working the weekend shift has received a report on several clients. Based on the​ clients' religious​ preferences, for which client does the nurse anticipate arranging for the chaplain to provide Holy​ Communion? A. Hindu B. Buddhist C. Roman Catholic D. Orthodox Jew

C. The nurse can anticipate arranging for the chaplain to provide Holy Communion to the client who is Roman Catholic. Roman Catholics are especially dutiful in receiving Holy Communion. Receiving Holy Communion is not a religious practice of the​ Hindu, Buddhist, or Orthodox Jew.

The nurse belongs to a Christian denomination that considers homosexuality sinful.​ However, while working with a lesbian​ client, the nurse maintains an​ open, interpersonal rapport with the client while providing​ consistent, effective care. Which term best describes the​ nurse's behavior? A. Assimilation B. Stereotyping C. Cultural humility D. Enculturation

C. The nurse is practicing cultural​ humility, which is the realization that a client needs​ care, not judgment. Assimilation is the process of adapting to and integrating characteristics of the dominant culture as​ one's own. Stereotyping is an overgeneralization of group characteristics that reinforces societal biases and distorts individual characteristics.​ Enculturation, or cultural​ transmission, is exemplified by a process that children use to learn cultural characteristics from adults.

The nurse is caring for a hospitalized young adult. The nurse recognizes that the client is most likely in which phase of​ spirituality? A. Intuitive-projective faith B. Conjunctive faith C. Individuative-reflective faith D. Undifferentiated faith

C. The nurse recognizes that the young adult is most likely in the spiritual phase of individuative-reflective ​faith, which is characterized by the development of a​ self-identity and worldview that are differentiated from those of others. Conjunctive​ faith, undifferentiated​ faith, and intuitive-projective faith occur during other developmental phases of life.

The preceptor is monitoring a graduate​ nurse's assessment of a male client who recently immigrated to the United States from China. Which assessment activity by the graduate nurse indicates the need for​ follow-up regarding culturally competent​ care? A. Determine if the client has any daily spiritual practices. B. Ask the client about food preferences or food preparation needs. C. Inquire if the client speaks any English. D. Discourage use of acupuncture or cupping for pain relief

C. The provision of culturally competent care begins with incorporating culture into the initial nursing assessment. It is appropriate for the nurse to ask the client about his proficiency with English to ensure that they communicate effectively about treatment. The nurse should inquire about religious or cultural practices at specific times of day or during the week and plan care accordingly. The nurse should also ask about​ (not discourage) use of traditional healing practices such as herbal supplements or mind-body practices​ (e.g., cupping,​ acupuncture). Administering culturally competent care also involves inquiring about cultural practices related to food preparation and preferences.

A 16-year-old client has requested that she be examined and receive counseling without her parents being present. Which response demonstrates a correct response to this request? A) The nurse asks the client's parents if this is okay with them. B) The nurse agrees but still informs the parents immediately of everything they did not witness. C) The nurse strongly urges the client to reconsider this request to receive the best possible care. D) The nurse agrees that the client has the right to make this request but suggests that the parents still be present and involved.

D) Adolescent clients may wish to be examined or receive counseling separate from their parents. The nurse should make every effort to honor this request, though doing so may lead to confrontation with the parents. Understanding state statutes and organizational policy related to adolescent confidentially is essential when situations such as this arise. When providing confidential care to adolescents, the nurse should encourage adolescents to consider involving parents or guardians in their decision making. The nurse should make it clear that this is a suggestion and not a requirement for receiving care. The nurse should not clear this request with the parents, involve the parents anyway, or make it sound as though competent care depends on the adolescent reconsidering her request.

A nurse is admitting a client to the oncology unit. During the admission assessment, when the nurse asks the client about religious preference, the client states, "I am an atheist." The nurse should recognize that the client holds which belief? A) The client believes that there is one God. B) The client believes that there is more than one god. C) The client believes that the existence of God has not been proven. D) The client does not believe in any god.

D) An atheist is an individual who does not believe in any god. Monotheism is the belief in the existence of one God. Polytheism is the belief in more than one god. An agnostic is an individual who doubts the existence of God or a supreme being or who believes that the existence of God has not been proven.

The nurse administers morphine to a client after surgery to help manage pain even though morphine has a risk of creating dependence and addiction. What ethical principle does the nurse apply in this situation when planning care? A) Veracity B) Justice C) Autonomy D) Beneficence

D) Beneficence requires that the actions one takes should promote good. This includes giving treatments that have some risks when the nurse and others involved in client care have determined that the benefits outweigh the risks. Autonomy is the right to self-determination. Justice means treating all clients fairly. Veracity is the principle of always telling the truth.

While hospitalized, a client learns that a close friend has died suddenly. The client is crying and asking, "Why, God?" The nurse should correctly identify that the client is demonstrating which type of spiritual distress? A) Physiologic B) Psychologic C) Treatment-related D) Situational

D) Factors that may be associated with or contribute to an individual's spiritual distress include situational concerns, physiologic problems, and treatment-related concerns. Situational factors include the death or illness of a significant other, inability to practice one's spiritual rituals, or feelings of embarrassment when practicing them. Physiologic problems include having a medical diagnosis of a terminal or debilitating disease. Treatment-related factors include recommendation for treatment, surgery, dietary restrictions, or isolation. Psychologic is not a factor that contributes to spiritual distress.

The nurse is evaluating the following goal: Client will select low-fat foods from a list by the end of the month. The client, who has different beliefs about food, has not been able to achieve this goal. Which action by the nurse is appropriate? A) Extend the time frame and give the client a longer period to achieve the goal. B) Select a different goal. C) Make sure that the client understands the importance of the goal. D) Modify the plan of care to be consistent with the client's beliefs regarding food.

D) If the outcomes are not achieved for a client with different beliefs, the nurse should be especially careful to consider whether the client's belief system has been adequately included as an influencing factor and modify the plan of care to be consistent with the client's belief regarding food. Extending the time frame, selecting a different goal, or checking how the client understands the importance of the goal may not be as helpful as looking at the cultural practices-including dietary ones-of the client.

Which acculturation behavior will the nurse observe in a client who has emigrated from another country to the United States? A) The client buys all needed products from the local store owned by people from the client's country. B) The client lives in a neighborhood that is populated predominantly with people from the client's country. C) The client speaks his native language only. D) The client attends church in the neighboring community to meet new people.

D) Individuals experience acculturation when they begin to adapt or borrow habits of the new culture. The client who attends church in the neighboring community to meet new people is displaying acculturation. The other behaviors are examples of a client who may feel comfortable only in the client's culture.

A general term used for a variety of conditions in which an individual is born with a reproductive or sexual anatomy that does not seem to fit the typical definitions of female or male is A) homosexual. B) transgender. C) genderqueer. D) intersex.

D) Intersex is a general term used for a variety of conditions in which an individual is born with a reproductive or sexual anatomy that does not seem to fit the typical definitions of female or male. Homosexuality is a sexual preference for members of the same sex. Transgendered individuals do not identify with the gender assigned to their bodies. Genderqueer individuals don't identify with male or female exclusively but with both categories.

The novice nurse working in an inner-city hospital that serves a diverse client population states, "I want to learn everything possible about all of the clients." Which response by the seasoned nurse is appropriate? A) "I will give you a great book that describes all of the critical factors." B) "You should always be nonjudgmental." C) "This will come with time as you get to know clients and then encounter problems." D) "You need to first understand who you are."

D) It is a priority for the nurse to develop an awareness of his or her own perceptions, prejudices, and stereotypes regarding the client populations that are served. Reading about culture and remaining nonjudgmental are strategies that can be incorporated after engaging in a self-awareness inventory. Although experience working with diverse clients will help, it will be more meaningful after engaging in a self-awareness inventory.

A nurse is working at a healthcare clinic serving the needs of an inner-city population that is predominantly made up of minority people groups. A neighbor says the nurse must be brave because most of "those" people have guns and are in gangs. Which response by the nurse is appropriate? A) "It's very difficult for me when you discriminate like that." B) "It's okay because I'm not a gang member, so I will be okay." C) "Hey, it's a job like any other job. All jobs have problems." D) "That's an unfortunate stereotype. Can we talk about the reality?"

D) It is the nurse's role to promote the act of bridging, linking, or mediating between groups of people from different cultural systems to reduce conflict or produce change. Calling the neighbor's comment discriminatory may increase conflict. Rationalizing or failing to confront the neighbor's perceptions does not promote cultural brokering.

The nurse places a client in a treatment room of the emergency department for treatment of abdominal pain and vaginal bleeding. The spouse, speaking for the client, asks that only a female provider examine his wife for the pelvic exam. The nurse recognizes that the client is from a culture that prohibits men from examining women. Which is the most culturally appropriate statement by the nurse? A) "Your spouse will be covered with a sheet, so it will not matter whether the examiner is male or female." B) "The male and female providers both respect privacy." C) "The request is unreasonable and cannot be honored." D) "Every attempt will be made to honor your request."

D) Many cultures have religious beliefs that prohibit men from examining women and women from examining men. To provide culturally appropriate care, the nurse must recognize this as a legitimate request and make every attempt to honor this request. Although both male and female staff have professional and ethical responsibilities to respect a client's privacy, the nurse must still make efforts to meet the request of the client. The response of covering the client or stating the request is unreasonable shows insensitivity to the client's cultural need.

The nurse is developing a plan of care for a devout Muslim client. Which intervention should the nurse anticipate being a priority for this client? A) The client will be able to participate in observing Sabbath. B) The client will be able to participate in daily prayer with a rosary. C) The client will be able to participate in reading the Torah. D) The client will be able to participate in prayer at specific times without interruption.

D) Nurses working with Muslim clients should be aware that many Muslims pray five times a day, and when developing the plan of care they should take prayer times into consideration if this is important to the client. Observing the Sabbath is common to Christianity and Judaism. Daily prayer with a rosary is common to Catholicism. Reading the Torah is specific to Judaism.

The nurse is caring for an older adult client with advanced dementia. The family often mentions that the client was very spiritual earlier in life and loved to sing. What could the nurse suggest to the family to help support the client's religious needs? A) They should help the client reminisce about spiritual events early in life. B) They should encourage the client to compose lyrics or write music to a new spiritual song. C) They should sing some of their favorite songs to the client. D) They should bring in a recording of some of the client's favorite spiritual songs for him to listen to.

D) One way that clients with dementia can worship is through various art forms, including music. This is an especially appropriate option for this client, given his history of spirituality and a love of singing. Letting the client listen to some favorite of his spiritual songs will give him an opportunity to enjoy an enriching spiritual experience without being pressured to participate, generate new ideas, or remember events from the past

The client is admitted to the hospital following a miscarriage, and she is septic. The healthcare provider orders antibiotics, which the client refuses, stating, "I don't deserve them. I lost my baby because I had sex outside of marriage." Which is the appropriate response by the nurse? A) "I'll notify your healthcare provider about your decision." B) "Do you think you should be punished because you had a miscarriage?" C) "I think you need to do what is best for you." D) "You have a serious infection and really need the medication."

D) Telling the client she needs the medication is providing the best care possible. Telling the client she needs to do what is best is inappropriate; the nurse knows she needs the medication. Calling the healthcare provider is inappropriate; the nurse knows the client needs the medication. Asking the client if she thinks she should be punished is inappropriate; she is septic and needs the medication.

While helping a client with the evening meal, the nurse observes the client close his eyes, bow his head, and murmur words of thanks and praise. What should this behavior suggest to the nurse? A) The client did not want the nurse to leave. B) The client was asking that the meal be better than the last. C) The client is confused. D) The client was praying before eating.

D) The client's behavior of bowing the head, closing the eyes, and murmuring words of thanks and praise are indications that the client was praying. The client was not demonstrating confusion. The nurse has no way of knowing if the client was asking that the meal be better than the last. The client was not delaying the nurse so that she did not leave.

A nurse enters a client's room to assess why the alarm on an IV infusion has sounded. As the nurse checks the IV equipment, the client says he would like someone to pray with. How should the nurse address the client's spiritual needs while providing necessary IV care? A) The nurse should focus her attention solely on the infusion, because it is more important at this time than the client's prayer request. B) The nurse should nod in response to the client's request while taking care of the infusion. C) While taking care of the infusion, the nurse should offer to call a clergy member. D) After assessing that the alarm is not an emergency, the nurse should offer to pray with the client.

D) The nurse can best address this client's spiritual needs by being fully present with the patient and not being distracted by other tasks such as assessing the IV infusion. Although the nurse's first priority is to assess that the alarm is not an emergency, she can then stop and be fully present by listening to the client's request and offering to pray with the client. The other options do not indicate that the nurse is fully present with the client.

A nurse is caring for a client who was recently diagnosed with a terminal illness. Which statement made by the client would indicate to the nurse that the client is in spiritual distress? A) "I am not sure why this is happening but I believe God has a plan for me." B) "I wish I did not have cancer but I believe that it is happening for a reason." C) "My children don't go to church and they are having a difficult time dealing with my diagnosis." D) "People tell me things happen for a reason, but why is God doing this to me?"

D) The statement "But why is God doing this to me?" is reflective of spiritual distress. The client is not demonstrating being able to find a purpose and is also demonstrating a disconnect between herself and her higher spirit. The other answers do not indicate spiritual distress of the client.

During a sexual history, the client states, "I have always felt like a man trapped in a woman's body." The nurse should recognize that the client may identify as what? A) Bisexual B) Heterosexual C) Homosexual D) Transgender

D) The term transgender refers to individuals who do not identify with the gender assigned to their body. For example, an individual who identifies as transgender may have typical female anatomy but feel like a male and seek to become male by presenting as male and taking hormones or electing to have sex reassignment surgeries. This client's statement relates to gender identification, not to the sexuality of the client.

A client requests that surgery be delayed for several days until after a period of Holy Days has concluded. Which action by the nurse supports this client's request? A) Remind the client that one's health is more important than following Holy Days. B) Provide the client with alternative forms of treatment to replace having surgery. C) Suggest the client think about whether having the surgery is the right decision, as the client is willing to delay it now. D) Communicate the client's request to the surgeon.

D) To support the client's need to avoid surgery during Holy Days, the nurse should communicate the client's request to the surgeon. The nurse should not remind the client that health is more important than following Holy Days or suggest that the client consider not having surgery. The nurse should also not provide the client with alternative forms of treatment to replace having surgery, as this is outside the nurse's scope of practice.

While assessing a client's spiritual needs, the nurse asks, "What spiritual beliefs are important to you?" This question represents which step of the FICA assessment model? A) Community B) Address C) Implication D) Faith

D) Within the FICA assessment model for spirituality, faith is assessed by asking the question "What spiritual beliefs are important to you?" Implication is assessed by asking the client, "How is your faith affecting the way you cope?" Community is assessed by asking, "Is there is a community of like-minded believers with which you routinely meet?" Address is assessed by asking the client, "How can the healthcare team support your spiritual needs?"

A client is abstaining from meat and dairy products during Lent and refuses to select these items when making meal choices. Which actions by the nurse support the client's nutritional and religious needs? Select all that apply. A) Ask the healthcare provider to discuss the impact of the restricted diet on the client's health. B) Provide soy milk products as supplements. C) Add protein powder supplements to the client's water pitcher. D) Ask the client what foods are typically consumed during this period of time. E) Consult with a dietitian for food choices to meet the client's needs.

D, E The best interventions would be for the nurse to consult with a dietitian for food choices to meet the client's health and religious needs and ask the client what foods are typically consumed during this period of time. The nurse should not provide soy milk products as supplements because the client may not like them. The nurse should not ask the physician to talk about the restricted diet with the client. The nurse should also not provide protein powder supplements in the client's water pitcher.

Which is a core belief about health in​ non-Western cultures? A. Health is the absence of disease. B. Health is the strength to do anything you want. C. Health is an attribute of youth. D. Health is a state of harmony that encompasses​ mind, body, and spirit.

D. Non-Western cultures view health as a harmonious state. Western society sees health as the absence of disease. Other views of health are more individual.

The nurse is caring for a client who is newly diagnosed with a terminal disease. The client begins sobbing and​ states, "I know God is punishing​ me." Which immediate action by the nurse provides the most spiritual​ support? A. Notifying the chaplain B. Asking if the client would like to pray C. Asking if the client would like to speak with the healthcare provider D. Sitting quietly with the client

D. The immediate action that will provide the most spiritual support to the client is to sit quietly with the client. Presencing is often the best and sometimes the only intervention to support a client who is experiencing circumstances that medical interventions cannot address. When a client is​ helpless, powerless, and​ vulnerable, a​ nurse's presencing can be most beneficial. There will be later opportunities to offer chaplain​ services, prayer, and for the client to speak with the healthcare provider.

Which is the most appropriate time for the nurse to assess the spirituality of a​ client? A. After the psychosocial and physical assessment B. Following the psychosocial assessment C. Following introductions D. Prior to a physical assessment

D. The most appropriate time for the nurse to assess the spirituality of a client is prior to a physical assessment. The client may practice a religion in which physical touch and modesty are of significant concern. A rapport must be established prior to asking the client about spiritual practices. Spiritual assessment is integrated into the psychosocial assessment.

Which should the nurse include when caring for a client of a different​ culture? A. Enforce use of specialty practitioners. B. Instruct client to take ordered medications. C. Enforce use of Western healthcare practices. D. Be nonjudgmental in healthcare beliefs.

D. The nurse should be nonjudgmental in healthcare beliefs for all clients and include their beliefs into the plan of care. The nurse should never enforce Western health care or any healthcare practices on any client. The nurse should not enforce the use of specialty practitioners if the client does not believe in this practice. The nurse would instruct the client to take the medications​ prescribed, but this is unrelated to the​ client's culture.

The nurse is caring for a client who is terminally ill. Which type of spiritual therapy should the nurse integrate into the​ client's plan of​ care? A. Gratitude B. Prayer writing C. Expressive artwork D. Dignity therapy

D. The nurse will incorporate dignity therapy into the​ client's care plan. Dignity therapy is effective for improving spiritual and emotional outcomes for clients at the end of life. Gratitude is associated with​ prosociality, emotional​ well-being, and other positive outcomes. Writing about negative life events is known to improve emotional and physical​ well-being. Expressive artwork is used in acute and community care settings with​ children, adolescents, individuals with mental health and​ disabilities, older​ adults, and individuals who have experienced trauma or displacement.

The nurse is admitting a client who practices Hinduism. The client informs the nurse of the​ client's adherence to a strict diet that is consistent with the​ client's religious beliefs. Based on the information shared by the​ client, which hospital menu should the nurse provide for the​ client? A. Kosher B. Gluten-free C. Vegan D. Vegetarian

D. The nurse will provide the client a vegetarian menu.​ Vegan, Kosher, and​ gluten-free menus are not relevant to the​ client's religious practices.

A nurse is working with a number of clients at a free clinic. Which client population is at the highest risk for low levels of healthcare? A) Undocumented immigrants B) Men who have protected sex with men C) Men who have sex with women D) Teenagers

The term "vulnerable population" refers to groups of people in our culture who are at greater risk for diseases and reduced life span due to lack of resources and exposure to more risk factors. People may be made vulnerable by immigration status. Men or teenagers as a group are not more likely to be at risk for lower levels of healthcare.