CH 5: Cultural Diversity

A 45-year-old client who is hospitalized for the first time in the client's life is experiencing culture shock, not understanding what is going on with the client's body or in the hospital. Place the stages of culture shock listed below in the order in which the client will most likely experience them. a Honeymoon b Disenchantment c Effective function d Beginning resolution

1. Honeymoon 2. Disenchantment 3. Beginning resolution 4. Effective function Explanation: Culture shock is a stress syndrome that normally progresses through a series of recognizable stages (honeymoon, disenchantment, beginning resolution, and effective function) to its resolution.

All of the following are factors to consider when caring for clients with limited income. Which ones is the most important? A) Basic human needs may go unmet B) Limited access to reliable transportation C) Decreased access to health care services D) Risk for increased incidence of disease

A) Basic human needs may go unmet Explanation: Poverty prevents many people from consistently meeting their basic human needs. Limited means of transportation, decreased access to health care services, and an increased incidence of diseases are also influenced by limited income, but meeting one's basic human needs is the most important factor.

The nurse is admitting a client from China to the med-surge unit with a diagnosis of cancer. While doing the client's assessments, the client speaks of her naturalistic beliefs related to health care and the importance of the yin/yang theory. Based on her cancer diagnoses, the idea that cancer is considered a cold illness in the culture, and her yin/yang beliefs, which meals will the patient most likely order for lunch? A) Chicken noodle soup with crackers, fruit crisp, and hot tea B) Turkey sandwich, small tossed salad, and iced tea C) Chef's salad, bread, and water D) Fruit smoothie and granola bar

A) Chicken noodle soup with crackers, fruit crisp, and hot tea Explanation: In some Asian cultures, good health is thought to be achieved through the proper balance of yin (feminine, negative, dark, and cold) and yang (masculine, positive, light, warm). Hot foods are eaten when a person has a cold illness, such as cancer, a headache, and stomach cramps. Based on this info, the pt would likely select chicken noodle soup with crackers, fruit crisp, and hot tea, as these are hot foods. The other options are cold foods and would more likely be eaten when a patient has a hot illness.

Despite the presence of a large number of elderly residents of Asian heritage, a long-term care facility has not integrated the Asian concepts of hot and cold into meal planning. Which of the following should the nurses at the facility recognize this as an example of? A) Cultural blindness B) Stereotyping C) Cultural assimilation D) Cultural imposition

A) Cultural blindness Explanation: Cultural blindness is characterized by ignoring cultural differences or considerations and proceeding as if they do not exist. This phenomenon may underlie the failure to incorporate cultural considerations into dietary choices. Stereotyping assumes homogeneity of members of other cultures. Cultural assimilation involves the replacement of values with those of a dominant culture. Cultural imposition presumes that everyone should conform to a majority belief system.

A nurse walks by a client's room and observes a Shaman performing a healing ritual for the client. The nurse then remarks to a coworkers that the ritual is a waste of time and disruptive to the other clients on the floor. What feelings is this nurse displaying? A) Culture conflict B) Cultural blindness C) Stereotyping D) Cultural Shock

A) Culture conflict Explanation: Culture conflict occurs when people become aware of cultural differences, feel threatened, and respond by ridiculing the beliefs and traditions of others to make themselves feel more secure about their own values. Cultural blindness occurs when one ignores differences and proceeds as though they do not exist. Stereotyping is the assumption that all members of a culture, ethic group, or race act alike. Culture shock refers to the feelings a person experiences when placed in a different culture that is perceived as strange.

Personal space and distance is a cultural perspective that can impact nurse-client interactions. What is the best way for the nurse to interact physically with a client who has a different cultural perspective on space and distance? A) Know the client's cultural personal space preferences. B) Realize that sitting close to the client is an indication of warmth and caring. C) Sit three to six feet away from the patient in an attempt to not offend. D) Remember not to intrude into the personal space of the elderly.

A) Know the client's cultural personal space preferences. Explanation: When providing nursing care that involves physical contact, you should know the client's cultural personal space preferences. Sitting close to, or too far away from, the patient may be interpreted as offensive. Age is not necessarily a deciding factor in regards to a person's cultural practices.

The nurse is obtaining a health history from a patient of Puerto Rican descent. Which of the following is most likely to be a health problem that has a cultural connection for this patient? A) Lactose enzyme deficiency B) Tuberculosis C) Sickle cell anemia D) Suicide

A) Lactose enzyme deficiency Explanation: Common health problems that may affect the Puerto Rican population include lactose enzyme deficiency and parasite diseases. TB is a common health problem for the Native American population. Sickle cell anemia predominantly affects the African American population, and suicide is common for the Native American and white middle-class population.

A nursing instructor has assigned a student to care for a client of Asian descent. The instructor reminds the student that personal space considerations vary among culture. What personal space preferences are important for the student to consider when caring for this client? A) People of Asian descent prefer some distance between themselves and others. B) People of Asian descent commonly stand close to one another when talking. C) People of Asian descent touch one another when sitting next to a familiar person. D) People of Asian descent prefer direct eye contact when communicating.

A) People of Asian descent prefer some distance between themselves and others. Explanation: Individuals of Asian descent are more comfortable with some distance between themselves and others. Direct eye contact may be considered impolite or aggressive within the Asian culture, and they may tend to avoid direct eye contact and avert their eyes while speaking with others.

When providing care on an Indian reservation, the nurse has prioritized assessments for diabetes and fetal alcohol syndrome when working with residents of the reservation. Show should this nurse's practice be best understood? A) The nurse is correct in assessing for health problems that have a higher incidence and prevalence among this population. B) The nurse is stereotyping American Indians as leading unhealthy lifestyles and abusing alcohol. C) The nurse is performing cultural imposition of the majority American culture, and the accompanying beliefs around diabetes and alcohol use. D) The nurse should seek specific permission from each client before proceeding with these assessments.

A) The nurse is correct in assessing for health problems that have a higher incidence and prevalence among this population. Explanation: Because diabetes and fetal alcohol syndrome are known to have a higher incidence and prevalence among American Indians, Nurse K. is justified in reflecting this objective reality during health assessment. This action is rooted in epidemiology, not the inaccurate generalizations of stereotyping. Because the consequences of both problems are significant and objective, Nurse K. is not guilty of cultural imposition and specific permission for these assessments is not likely necessary.

When providing nursing care to an African American individual, which of the following cultural factors should the nurse consider? A) Values and beliefs are often present oriented. B) Families are usually patriarchal. C) They possess weak religious affiliations. D) Families are highly competitive.

A) Values and beliefs are often present oriented. Explanation: Cultural factors that should be considered when providing care to the African American family include the recognition that the family is usually matriarchal, values and beliefs are present oriented, there is strong family unity and cooperation, and families are frequently highly religious and highly respect the African American clergy.

A male nurse is preparing to take the vital signs of a female patient. Which ethnic group would consider this improper? A) Native American B) Arab Muslim C) White D) African American

B) Arab Muslim Explanation: The Islamic religion does not allow the use of health care professionals of the opposite gender unless it is impossible to locate one of the same gender. Native Americans, Caucasians, and African Americans do not necessarily share this sentiment.

An Asian American male client is operated on for gallstones. On the postoperative night, the nurse finds that the client is not sleeping and is tossing and turning. When asked about analgesics, the client expresses that he does not have pain. What nursing action is most appropriate? A) Believing that the client has no pain B) Assessing for non-verbal expressions of pain C) Inspecting the incision site for any abnormality D) Asking the client if he is feeling hungry

B) Assessing for non-verbal expressions of pain Explanation: The nurse should be aware that in Asian American culture, men tend to control their emotions and expressions of physical discomfort. Keeping this in mind, the nurse should assess the client for non-verbal expressions of pain. The nurse should not believe the client when he says that he does not have pain because, after surgery, pain is likely to occur. The nurse may inspect the incision site, but it is not an appropriate action. Asking the client if he is hungry may be irrelevant.

A Mexican immigrant who migrated to the United States and lives in a Spanish-speaking community with other relatives is taken to the ER following a fall at work. He is admitted to the hospital for observation. The nurse is aware that this client is at risk for: A) Cultural assimilation B) Cultural shock C) Cultural imposition D) Cultural blindness

B) Cultural shock Explanation: Culture shock refers to the feelings a person experiences when placed in a different culture perceived as strange. Culture shock may result in psychological discomfort or disturbances, as the patterns of behavior a person found acceptable and effective in his or her own culture may not be adequate or even acceptable in the new one. The person may then feel foolish, fearful, incompetent, inadequate, or humiliated.

A client who has difficulty sleeping expresses to the nurse that watching television may help him relax and get sleep. The nurse disregards the client's concern and suggests drinking warm milk before going to bed. Which cultural characteristic is the nurse demonstrating? A) Stereotype B) Ethnocentrism C) Racism D) Relativity

B) Ethnocentrism Explanation: The nurse disregarding the client's concern is an example of ethnocentrism. Ethnocentric people view one's own culture as the only correct standard by which to view people of other cultures. Stereotypes are preconceived and untested beliefs about people. Racism uses skin color as the primary indication of social value. Understanding the cultures relate differently to the same given situation is called relativity.

The nurse caring for a Native American client plans care understanding that one belief of Native American healing practices is which of the following? A) Modern life facilitates healing agents. B) Healing takes time. C) Balancing yin and yang is important. D) Energy flow through meridians throughout the body.

B) Healing takes time. Explanation: Native American healing practices are grounded in their cultural views. One concept, identified in a study, is that healing takes time.

A nurse is caring for a client after internal fixation of a compound fracture in the tibia. The nurse finds that the client has not had his dinner, seems restless, and is tossing on the bed. Keeping in mind that the client is Latino, what is the most appropriate response by the nurse? A) Are you having pain in your leg? B) Tell me what you are feeling. C) Do you need pain medication? D) Are you feeling all right?

B) Tell me what you are feeling. Explanation: The nurse should ask the client what he is feeling. Asking open-ended questions would encourage the client to verbalize his pain. Latino men may not demonstrate their feelings or readily discuss their symptoms because they may interpret doing so as being less than manly. Closed-ended questions like Are you having pain?; Do you need pain medication?; and Are you feeling all right? may block communication and the client may not express his feelings.

A nurse in a large metropolitan city enjoys working in a health clinic that primarily serves Hispanic clients. What does this statement imply about the nurse? A) The nurse's knowledge and skills are not adequate to care for clients with acute illnesses. B) The nurse respects and values providing culturally competent care. C) The nurse is attempting to overcome cultural blindness. D) This employment makes the nurse feel superior to a minority group of people.

B) The nurse respects and values providing culturally competent care. Explanation: The nurse who recognized and respects cultural sensitivity, avoids cultural imposition and ethnocentrism, and provides nursing care that accepts the significance of cultural factors in health and illness.

A 40-year-old nurse is taking a health history from a Hispanic man aged 20 years. The nurse notes that he looks down at the floor when he answers questions. What should the nurse understand about this behavior? A) The client is embarrassed by the questions. B) This is culturally appropriate behavior. c) The client dislikes the nurse. D) The client does not understand what is being asked.

B) This is culturally appropriate behavior. Explanation: Eye contact is one of the most culturally variable forms of communication. Although Americans emphasize eye contact while speaking, Hispanics look downward in deference to age, gender, social position, economic status, and authority.

What is the term that describes the inability of a person to recognize his/her own values, beliefs, and practices as well as those of others, because of strong ethnocentric tendencies? A) acculturation B) cultural blindness C) cultural imposition D) Stereotyping

B) cultural blindness Explanation: Cultural blindness occurs when one ignores differences and proceeds as though they do not exist, resulting in bias and stereotyping. Acculturation is the process by which members of a culture adapt or learn how to take on the behaviors of another group. Cultural imposition is the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture. Stereotyping is when one assumes that all members of a culture, ethnic group, or race act alike.

A nurse engages in professional rituals as a means to standardize practice and ensure efficiency. In doing so, the nurse integrates understanding of which of the following as a characteristic? A) Preconceived and untested belief about people B) Viewing one's own culture as the only correct standard C) Common and observable expressions of culture D) Belief system held to varying degrees as absolute truth.

C) Common and observable expressions of culture Explanation: Rituals are common and observable expressions of culture. A preconceived and untested belief about people is called a stereotype. Viewing one's own culture as the only correct standard is ethnocentrism. A belief system held to varying degrees as absolute truth is referred to as culture.

The nurse is providing care for a Cambodian client. The nurse says, "You have to get up and walk whether you want to or not." What is this statement an example of? A) Culture shock B) Stereotyping C) Cultural imposition D) Cultural competence

C) Cultural imposition Explanation: Cultural imposition is the tendency for health care personnel to impose their beliefs, practices, and values on people of other cultures because they believe their ideas are superior. When health care professionals assume they have the right to make decisions for clients, the clients often respond by becoming passive, angry, or resistant to treatment.

The nurse is providing home care for a client who traditionally drinks herbal tea to treat an illness. How should the nurse respond to a request for the herbal tea? A) We do not allow our clients to drink herbal tea. B) Why in the world would you want to drink that stuff? C) Let me check with the doctor to make sure it is okay to drink the tea with your medicines. D) I have to fill out a lot of forms that you will have to sign before I can do that.

C) Let me check with the doctor to make sure it is okay to drink the tea with your medicines. Explanation: Herbs are a common method of treatment in many cultures. If a client traditionally drinks an herbal tea to alleviate symptoms of an illness, there is no reason why both the herbal tea and the prescribed medications cannot be used as long as the tea is safe to drink and does not interfere with, or exaggerate, the action of the medications. Asking why the patient would want to drink "that stuff" is demeaning to the patient. Answer d is incorrect because there is no paperwork necessary.

The nurse is admitting a new client to the unit. The nurse notes that this client would need an alternate meal choice when the menu specified pork for a meal. What cultural group would require an alternative meal choice? A) Christian B) Protestant C) Muslim D) Mormon

C) Muslim Explanation: Many Muslim people abstain from eating pork.

When the South Asian client arrives 25 minutes late to her appointment at the clinic, the nurse recognizes this as a sign of which of the following? A) Disrespect B) Laziness C) Respect D) Superiority

C) Respect Explanation: In some South Asian cultures, being late is considered a sign of respect. It may be useful to note this in the client's file and take it into account when scheduling future appointments.

An older adult of Chinese ancestry refuses to eat at the nursing home, stating, "I'm just not hungry." What factors should the staff assess for this problem? A) The woman does not like to eat with other residents of the home. B) The woman is using this as a means of going home. C) The food served may not be culturally appropriate. D) The food served may violate religious beliefs.

C) The food served may not be culturally appropriate. Explanation: Residents in long-term care settings often do not have much choice of foods. As a result, they may not be able to select cultural food preferences. When assessing the cause of depressed appetite in clients, the nurse should determine whether the problem may be related to culture.

A nurse in the hospital is caring for a Native American male. What person is most important to include in the care of the client? A) Family B) Physician C) Tribal medicine man D) Physical therapy aide

C) Tribal medicine man Explanation: Observance of rituals in times of stress and uncertainty helps to restore a sense of control, competence, and familiarity; to that extent, these rituals are a desirable adjunct to nursing care.

The nurse is caring for a Mexican American who is Catholic. The nurse wishes to learn more about the culture by consulting a key informant. Which of the following religious practitioners would be most knowledgable about the beliefs held by individuals of Mexican ethnicity? A) a church mother B) a voodoo priest C) a curanders D) a peyote leader

C) a curanders Explanation: For Mexican Americans who are Roman Catholic, the priest and the curandera (a secular folk healer) may be useful informants.

A father, mother, grandmother, and three school-aged children have immigrated to the United States from Thailand. Which member(s) of the family are likely to learn to speak English more rapidly? A) Unemployed father B) Stay-at-home mother C) Grandmother D) Children

D) Children Explanation: When people from another part of the world move to the US, they may speak their own language fluently but have difficulty speaking English. This is especially true for women, older adults, and those who are unemployed. Children usually assimilate more rapidly and learn the language more quickly because they go to school each day and make new friends in the dominant culture.

A nurse is caring for an elderly woman from a far eastern culture. How does the nurse demonstrate awareness of culturally competent care? A) Maintaining eye contact at all times. B) Trying to speak louder than usual. C) Using touch when communicating. D) Establishing effective communication.

D) Establishing effective communication. Explanation: Establishment of an environment of culturally competent care and respect begins with effective communication, which occurs not only through words, but also through body language and other cures, such as voice, tone, and loudness. Maintaining eye contact at all times is incorrect because not all cultures are comfortable with eye contact; speaking louder is incorrect because the issue is a communication problem, not a hearing problem; not all cultures are comfortable with touch so this would block communication.

An Anglo-American client reports to the primary health care facility with symptoms of fever, cough, and running nose. While interviewing the client, which of the following points should the nurse keep in mind? A) Do not probe into emotional issues. B) Do not ask very personal questions C) Sit at the other corner of the room D) Maintain eye contact while talking.

D) Maintain eye contact while talking. Explanation: While interviewing an Anglo-American client, the nurse should maintain eye contact, because it indicates openness and sincerity. Anglo-Americans freely express positive and negative feelings; therefore, the nurse may probe into emotional issues. Anglo-American culture is an open culture, and members of this culture don't mind providing personal information. Also, Anglo-Americans are not threatened by closeness, so the nurse may not have to sit in another corner of the room.

Most nurses have been taught to maintain direct eye contact when communicating with clients. Some cultural groups would not value direct eye contact with the nurse. Which cultural group would consider direct eye contact impolite? A) Americans B) British C) Canadians D) Native Americans

D) Native Americans Explanation: Eye contact is also a culturally determined behavior. Although most nurses have been taught to maintain eye contact when speaking with patients, some people from certain cultural backgrounds may interpret this behavior differently. For example, some Asians, Native Americans, Indo-Chinese, Arabs, and Appalachians may consider direct eye contact impolite or aggressive, and they may avert their eyes when talking with nurses and others whom they perceive to be in positions of authority.

A nurse is caring for a client from Taiwan who constantly requests pain medication. What should the nurse consider when assessing the client's pain? A) Most people react to pain the same way B) Pain in adults is less intense than pain in children. C) The client has a low pain tolerance. D) Pain is what the client says it is.

D) Pain is what the client says it is. Explanation: Pain is what the client says it is, and nursing care should always be individualized. The nurse respects the client's right to respond to pain in whatever manner is culturally and individually appropriate and never stereotypes a client's perceptions or responses to pain. Pain tolerance is subjective; again, the client's pain is what she says it is.

The client in a rehabilitation unit is having a difficult time adjusting to the scheduled activities on the unit, as well as being dependent on others for meals and medications. Which word best describes what the patient is experiencing? A) Anxiety B) Disparity C) Resolution D) Shock

D) Shock Explanation: The acute experience of not comprehending the culture in which one is situated is called culture shock. This is often experienced by a client who suddenly finds himself or herself in the subculture of a hospital or health care agency.

When a labor and delivery nurse tells a coworker that an Asian client probably did not want any pain medication because "Asian women typically are stoic." the nurse is expressing a belief known as what? A) Stigma B) Ethnic slur C) Bias D) Stereotype

D) Stereotype Explanation: Stereotypes are preconceived and untested beliefs about people. Ethnic slurs refers to a statement made about another according to their ethnicity; stigma refers to social disapproval; bias refers to an inability to view someone or something without being objective.

A home health care nurse is visiting a client 60 years of age. During the intial visit, the client's husband answers all of the questions. What would the nurse assess based on this behavior? A) The client does not want the nurse to visit. B) The husband does not trust his wife to answer the questions. C) The client is not able to answer the questions. D) The husband is the dominant member of the family.

D) The husband is the dominant member of the family. Explanation: To provide culturally competent care, the nurse must take into consideration the role of the family member who makes most decisions. To disregard this fact or to proceed with nursing care that is not approved by this person can result in conflict or disregard for what is being taught.

The focal point of nursing in the nurse-client interaction. What must nurses consider when conducting the necessary assessment of their clients and significant others? A) their health disparities B) their societal beliefs C) the subgroup they belong to D) their own cultural orientation

D) their own cultural orientation Explanation: Because the nurse-client relationship is the focal point of nursing, nurses should consider their own cultural orientation when conducting assessments of pts and their families and friends. Although nursing as a whole is actively recruiting more diverse members, many nurses are members of, and have the same value systems as, the dominant middle-class structure in the United States.

The nurse is educating a client of Chinese descent regarding the reduction and elimination of lactose in the diet. Which statement(s) made by the client indicates that the education was effective? Select all that apply. a) "I should replace 2% milk with lactose-free milk." b) "I can use foods that use milk solids since those are not milk products." c) "When I drink coffee or tea, I should use a non-dairy creamer instead of milk or cream." d) "I can use kosher parve foods because they are prepared without milk." e) "If I drink milk, I should drink one large glass a day and none at any other time."

a) "I should replace 2% milk with lactose-free milk." c) "When I drink coffee or tea, I should use a non-dairy creamer instead of milk or cream." d) "I can use kosher parve foods because they are prepared without milk." Explanation: The nurse determines that the client understands and can apply the education provided when the client states the intention to substitute milk for non-dairy coffee creamer, substitute milk for a lactose-free milk product, and use kosher parve (kosher neutral) products, which are not made with milk products. The statement about drinking a large glass of milk once daily instead of several times a day indicates the client requires further education, because the client should avoid milk or only drink small amounts. Dry milk solids contain milk and should be avoided; examples include some bread, cereals, puddings, gravy mixes, caramels, or chocolate.

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

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

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

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

A nurse is providing care to a client from a culture different from the nurse's own. The nurse is having difficulty relating to the client. What intervention by the nurse is most appropriate? a) Ask the client how the client wants to be treated based on the client's values and beliefs. b) Look up the client's culture online and try to figure out methods to relate. c) Ask another nurse to take over the client's care. d) Consult the Office of Minority Health Resource Center to help in the provision of care.

a) Ask the client how the client wants to be treated based on the client's values and beliefs. Explanation: The best way to provide culturally appropriate care is to ask the client what the client values and believes and how the client would like to be treated. Asking another nurse to take over care will not help identify the cultural care needs. Researching the client's culture online and consulting the Minority Health Resource Center may be helpful as a learning experience later, but they do not help immediately in the provision of care. Also, remember that information about any culture is general and must be individualized.

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

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

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

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

A nurse is conducting a cultural assessment of a client. Which person would the nurse identify as the expert? a) Client b) Nurse c) Health care provider d) Older family member

a) Client Explanation: When gathering cultural information, the interviewee is the expert. Other family members may provide information about the culture, but the client is the expert. The nurse and health care provider are responsible for obtaining information related to the culture.

A client is admitted with end-stage pancreatic cancer and is experiencing extreme pain. The client asks the nurse whether an acupuncturist can come to the hospital to help manage the pain. The nurse states, "You won't need acupuncture. We have pain medications." Which characteristic has the nurse displayed? a) Cultural imposition b) Stereotyping c) Cultural conflict d) Culture shock

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

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

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

A nurse is providing care to a medically compromised client with limited ability to speak the dominant language. To obtain information about the client's culture, who would be appropriate for the nurse to use as a key informant? Select all that apply. a) Family b) Interpreters c) Friends d) Client's religious contact e) Staff

a) Family b) Interpreters c) Friends d) Client's religious contact Explanation: For most clients with limited ability to speak the dominant language, the most useful key informants in the hospital or clinic situation may be trained interpreters who are bilingual and bicultural, or family and friends. The role of religious figures in health, including as key informant, is important because people often interpret life-death and health-illness issues in terms of their cultural heritage or religious beliefs. The staff would be an inappropriate choice as a key informant.

An unlicensed assistive personnel (UAP) has made a disparaging comment about a client from another culture, stating that the client's hygiene practices are "oddComplet". When questioned by the nurse, it becomes clear that this characterization stems from differences between the client's culture and the UAP's culture. What is the nurse's best response? a) Initiate a dialogue with the UAP about the potential harms of ethnocentrism b) Report the statement to the client in the interests of transparency and accountability c) Complete an incident report describing the UAP's racist behavior d) Document the fact that the UAP must not be assigned care of this client

a) Initiate a dialogue with the UAP about the potential harms of ethnocentrism Explanation: Viewing one's own culture as the point of reference to all others is ethnocentrism. The UAP's statement provides a teachable moment for the nurse and would not be considered egregious to the extent that an incident report, documentation or removal from care is necessary.

Which nursing action displays linguistic competence? a) Learning pertinent words and phrases in the client's language b) Speaking loudly to a client who does not speak the dominant language c) Asking a family member to interpret for a client who does not speak the dominant language d) Repeating statements to a client who speaks only a language different from the nurse

a) Learning pertinent words and phrases in the client's language Explanation: Linguistic competence is best displayed by learning pertinent words or phrases in the client's language. Speaking loudly and repeating words do not solve the communication barrier or show an effective response to a linguistic need. Asking the client's family to interpret is discouraged because it is often unreliable and leads to confusion for the client and the nurse.

Which behaviors demonstrated by the client would the nurse consider reflections of the client's pride in ethnicity? Select all that apply. a) Listening to folk music and dance b) Crying when given a diagnosis of cancer c) Requesting assistance when transferring from bed to chair d) Requesting native cuisine e) Asking to wear unique clothing

a) Listening to folk music and dance d) Requesting native cuisine e) Asking to wear unique clothing

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

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

A parent informs the nurse that immunizations are against the parent's cultural and religious beliefs and the parent does not want the child to receive immunizations. The nurse proceeds to inform the parent that the child will be consistently ill and will not be allowed to start school unless immunized. The nurse also informs the parent that the nurse had all of the nurse's own children vaccinated. The nurse's behavior an example of: a) cultural imposition. b) cultural blindness. c) cultural conflict. d) stereotyping.

a) cultural imposition. Explanation: The nurse's behavior is an example of cultural imposition, defined as the tendency to impose one's cultural beliefs, practices, and values on a person from a different culture. Stereotyping is when one assumes that all members of a culture, ethnic group, or race act alike. Cultural blindness occurs when one ignores differences and proceeds as though they do not exist. Cultural conflict occurs when people become aware of cultural differences, feel threatened, and respond by ridiculing the beliefs and traditions of others to make themselves feel more secure in their own values.

A nurse is working with a culturally diverse group of clients. The nurse understands that cultural norms: a) require an individualized approach by the nurse. b) allow nurses to predict a client's response. c) can be generalized to anyone of that culture. d) are fairly consistent across cultural groups.

a) require an individualized approach by the nurse. Explanation: Knowing a cultural norm does not enable one to predict a person's response. Generalizing about cultural norms in contemporary societies is inappropriate because people belong to more than one subcultural group and are influenced uniquely by multiple and diverse groups. Exceptions to cultural norms always exist. Therefore the nurse needs to approach each person as an individual.

A nurse caring for culturally diverse patients in a health care provider's office is aware that patients of certain cultures are more prone to specific disease states than the general population. Which patients would the nurse screen for diabetes mellitus based on the patient's race? Select all that apply. a. A Native American patient b. An African-American patient c. An Alaska Native d. An Asian patient e. A White patient f. A Hispanic patient

a. A Native American patient c. An Alaska Native e. A White patient f. A Hispanic patient Explanation: Native Americans, Alaska Natives, Hispanics, and Whites are more prone to developing diabetes mellitus. African Americans are prone to hypertension, stroke, sickle cell anemia, lactose intolerance, and keloids. Asians are prone to hypertension, liver cancer, thalassemia, and lactose intolerance.

In order to provide culturally competent care, nurses must be alert to factors inhibiting sensitivity to diversity in the health care system. Which nursing actions are examples of cultural imposition? Select all that apply. a. A hospital nurse tells a nurse's aide that patients should not be given a choice whether or not to shower or bathe daily. b. A nurse treats all patients the same whether or not they come from a different culture. c. A nurse tells another nurse that Jewish diet restrictions are just a way for them to get a special tray of their favorite foods. d. A Catholic nurse insists that a patient diagnosed with terminal bladder cancer see the chaplain in residence. e. A nurse directs interview questions to an older adult's daughter even though the patient is capable of answering them. f. A nurse refuses to care for a married gay man who is HIV positive because she is against same-sex marriage.

a. A hospital nurse tells a nurse's aide that patients should not be given a choice whether or not to shower or bathe daily. d. A Catholic nurse insists that a patient diagnosed with terminal bladder cancer see the chaplain in residence. Explanation: Cultural imposition occurs when a hospital nurse tells a nurse's aide that patients should not be given a choice whether or not to shower or bathe daily, and when a Catholic nurse insists that a patient diagnosed with terminal bladder cancer see the chaplain in residence. Cultural blindness occurs when a nurse treats all patients the same whether or not they come from a different culture. Culture conflict occurs when a nurse ridicules a patient by telling another nurse that Jewish diet restrictions are just a way for Jewish patients to get a special tray of their favorite foods. When a nurse refuses to respect an older adult's ability to speak for himself or herself, or if the nurse refuses to treat a patient based on that patient's sexual orientation, the nurse is engaging in stereotyping.

The nurse practitioner sees patients in a community clinic that is located in a predominately White neighborhood. After performing assessments on the majority of the patients visiting the clinic, the nurse notes that many of the minority groups living within the neighborhood have lost the cultural characteristics that made them different. What is the term for this process? a. Cultural assimilation b. Cultural imposition c. Culture shock d. Ethnocentrism

a. Cultural assimilation Explanation: When minority groups live within a dominant group, many members lose the cultural characteristics that once made them different in a process called assimilation. Cultural imposition occurs when one person believes that everyone should conform to his or her own belief system. Culture shock occurs when a person is placed in a different culture perceived as strange, and ethnocentrism is the belief that the ideas, beliefs, and practices of one's own cultural group are best, superior, or most preferred to those of other groups.

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

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

The nurse is caring for a client who is admitted for hypertension (HTN). The nurse notes that the client has not been eating the food provided, and family members have brought in homemade food. What would be the best response by the nurse? a) "You should consider eating the food provided, which is healthier." b) "Can you tell me what foods you prefer to eat and what your family is bringing you?" c) "It is ok to eat what your family brought you, as long as we see what it is." d) "Do you understand the specific diet for your HTN?"

b) "Can you tell me what foods you prefer to eat and what your family is bringing you?" Explanation: The nurse should attempt to provide culturally sensitive food; however, the nurse should assess what foods the client wants to eat. The nurse should educate the client on food preferences that are also appropriate to the disease-specific dietary restrictions. Even though the diet may be healthier, the nurse should first assess the client's preferences. The nurse should verify the client's understanding of the diet but should avoid closed-ended questions such as asking if the client understands the specific diet for HTN.

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

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

The nurse is collecting the health history of a client and notes the client is apprehensive in answering questions. The client states, "My spiritual healer will be here soon." What is the best response by the nurse? a) "These questions need to be answered so we can provide you with the best care." b) "We can wait until your spiritual healer arrives and work together to answer these questions." c) "I can wait until your spiritual healer arrives, but you are the only one who can answer these questions." d) "I will leave the questionnaire here. Please fill it out when your spiritual healer arrives."

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

Which behavior by the nurse is stereotyping? a) Openly ridiculing the practice of acupuncture b) Avoiding older adult clients because their care is time consuming c) Explaining to others that Western medicine is always superior d) Grouping care assignments to allow ample time to care for complex clients

b) Avoiding older adult clients because their care is time consuming Explanation: Avoiding older adult clients because their care is time consuming is stereotyping. This is a mistaken belief and an overgeneralization. Some older adult clients are very healthy. Ridiculing acupuncture is cultural conflict. Assuming that Western medicine is superior is ethnocentrism. Grouping care assignments to allow ample time to provide care is an appropriate strategy in time management.

The emergency department nurse is caring for a client injured in a motor vehicle collision. The client recently immigrated to the country. The nurse should implement interventions aimed at addressing which issue? a) Ageism b) Culture shock c) Ethnocentrism d) Generalization

b) Culture shock Explanation: Culture shock is bewilderment over behavior that is culturally atypical for the client. The client who recently immigrated from another country would experience culture shock over being in a new culture, including a new culture of health care in the new country of residence. Ethnocentrism is the belief that one's culture is better than other cultures. Generalization is the belief that a person shares cultural characteristics with others from a similar background. Ageism is a negative belief that older adults are physically and cognitively impaired.

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

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

Which area is typically included in a cultural assessment? a) Employment status b) Food preferences c) Ethics d) Marital status

b) Food preferences Explanation: Dietary tolerance is associated with both cultural food preferences and biologic variation. A client's marital status and employment status are aspects of demographic information recorded in the client's health record but would not be pertinent, in and of themselves, to a cultural assessment. Ethics would not be typically covered in a cultural assessment, although one's religious affiliation might be.

A nurse is providing care to a client who is from a different culture. Which aspect about culture would be most important for the nurse to integrate into the client's care? a) Individuals learn culture in a purposeful manner. b) Not all members of the same culture act and think alike. c) Culture is relatively static and unchanging. d) Individuals can easily describe their culture.

b) Not all members of the same culture act and think alike. Explanation: Culture is shared unequally by its members; that is, not all members of the same culture act and think alike. Culture is also dynamic and changes as people come into contact with new beliefs and ideas. Some learning of culture is purposeful and some is absorbed without awareness. Much of culture is implicit, a combination of habit and assumptions about the world, such that habits are enacted without reflection in the daily course of living. This makes culture difficult for members to describe.

A family has immigrated and settled in a neighborhood that primarily speaks their native language. The nurse caring for this family recognizes that which family member will likely require the greatest amount of time to learn the dominant language? a) The 12-year-old son in the family who attends public school b) The 45-year-old mother in the family who does not work outside the home c) The 18-year-old daughter in the family who works at a restaurant in a neighboring town d) The 58-year-old father in the family who works in a nearby factory

b) The 45-year-old mother in the family who does not work outside the home Explanation: The 45-year-old mother will have the greatest challenge in learning the dominant language due to not working outside the home and living in a community that speaks the native language. Children usually assimilate more rapidly and learn the language of the dominant culture quickly because they leave home each day to go to school, making new friends in the dominant culture. Wage earners also tend to learn a new language more quickly through the work setting. Language acquisition is tied to necessity and assimilation, rather than to the degree of difficulty.

A nurse convinces a client who is a Jehovah's Witness that receiving blood products is more important than the legalistic components of religion. What client reaction may be expected following this mandated change? a) The client states, "Why isn't blood administration forced on all who need that treatment?" b) The client states, "I feel like I abandoned my religion." c) The client states, "I can't get over my feelings of legalism as a Jehovah's Witness." d) The client states, "I am glad that nurse told me what to do."

b) The client states, "I feel like I abandoned my religion." Explanation: When clients are forced to participate in care that conflicts with their values, feelings of guilt and abandonment are likely. These feelings may deepen and threaten the client's well-being. The other answer choices are not related to mandated change.

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

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

A nurse is caring for a client with bacterial pneumonia and a temperature of 104°F (40.0°C). Yesterday, the client's temperature was 102°F (38.9°C). The health care provider on call prescribes cool compresses for the client to help lower the fever. The client insists that the nurse bring warm blankets because they will help the client to recover more quickly. The nurse recognizes that the client's request is an example of: a) ethnocentrism. b) cultural ritual. c) cultural competence. d) cultural stereotyping.

b) cultural ritual. Explanation: Clients and families often express rituals, or practices habitually repeated in certain contexts, during times of stress, such as during an acute hospitalization. Keeping the body covered and warm is a home remedy used by many cultures to help heal the body. As in this example, cultural rituals may conflict with Western medical beliefs. Cultural competence is an approach to health care in which one is aware of one's one cultural beliefs and biases and understands the effects that a client's culture has on the client's health care. Stereotyping involves applying a preconceived and untested generalization to a whole group of people. Ethnocentrism is the belief that one's culture is superior to another.

Persistent gaps between the health status of minorities and non-minorities are defined as: a) cultural relativity. b) health disparities. c) ethnocentrism. d) racism.

b) health disparities. Explanation: Despite continued advances in health care and technology, racial and ethnic minorities continue to have higher rates of disease, disability, and premature death than non-minorities. These differences are known as health disparities. Racism is the belief that one's race is superior to another. Ethnocentrism is the belief that one's culture is superior to another. Cultural relativity is the belief that an understanding of a person's behavior depends, at least in part, on an understanding of that person's cultural context.

The nurse is admitting a new client who is a member of the Navajo Nation. Which action should the nurse consider while conducting the interview? a) include the shaman in the assessment process b) write notes after the interview c) ask which family member should also be included d) allow client to view notes after interview

b) write notes after the interview Explanation: Native American/First Nations traditionally preserved heritage through oral rather than written history. Clients who are members of these nations may be suspicious of nurses who write down what they say. If possible, the nurse should write notes after, rather than during, the interview. It would be inappropriate to let the client review the nursing notes after the interview, to include a shaman during the assessment, or to inquire which family member also needs to be consulted in this process.

A young Hispanic mother comes to the local clinic because her baby is sick. She speaks only Spanish and the nurse speaks only English. What is the appropriate nursing intervention? a. Use short words and talk more loudly. b. Ask an interpreter for help. c. Explain why care can't be provided. d. Provide instructions in writing.

b. Ask an interpreter for help. Explanation: The nurse should ask an interpreter for help. Many facilities have a qualified interpreter who understands the health care system and can reliably provide assistance. Using short words, talking loudly, and providing instructions in writing will not help the nurse communicate with this patient. Explaining why care can't be provided is not an acceptable choice because the nurse is required to provide care; also, since the patient doesn't speak English, she won't understand what the nurse is saying.

A nurse is using the ESFT model to understand a patient's conception of a diagnosis of chronic obstructive pulmonary disease (COPD). Which interview question would be MOST appropriate to assess the E aspect of this model—Explanatory model of health and illness? a. How do you get your medications? b. How does having COPD affect your lifestyle? c. Are you concerned about the side effects of your medications? d. Can you describe how you will take your medications?

b. How does having COPD affect your lifestyle? Explanation: The ESFT model guides providers in understanding a patient's explanatory model (a patient's conception of her or his illness), social and environmental factors, and fears and concerns, and also guides providers in contracting for therapeutic approaches. Asking the questions: "How does having COPD affect your lifestyle?" explores the explanatory model, "How do you get your medications?" refers to the social and environmental factor, "Are you concerned about the side effects of your medications?" addresses fears and concerns, and "Can you describe how you will take your medications?" involves therapeutic contracting.

A student nurse is not looking forward to clinical rotation on a geriatric unit, stating "How can I get them to move faster? They always seem so slow!" How should the instructor respond? a) "I will show you several different techniques which you can use while providing care to these older clients." b) "Perhaps you should review the information in our textbook for some techniques you can use." c) "Be careful of the negative attitude in your approach. How fast an individual moves will depend on physical ability not necessarily age." d) "You will get to learn how to best plan your care utilizing the slower response from older clients."

c) "Be careful of the negative attitude in your approach. How fast an individual moves will depend on physical ability not necessarily age." Explanation: Ageism is a form of negative stereotypical thinking about older adults. This can include thinking all older adults are physically and cognitively impaired, have lack of interest in sex, or are burdensome to families and society. The instructor should first help the student recognize the stereotypical attitude and then provide tips on how to best address this attitude and not how to change the client's actions.

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

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

The nurse is taking a client history. With which client is direct eye contact appropriate? a) 60-year-old woman of Arab descent b) 44-year-old woman of Asian descent c) 32-year-old white woman d) 55-year-old Native American/First Nations woman

c) 32-year-old white woman Explanation: White Westerners generally make and maintain eye contact throughout communication. Although it may be natural for whites to look directly at a person while speaking, that is not always true of people from other cultures. It may offend clients of Asian descent or Native Americans/First Nations clients, who are likely to believe that lingering eye contact is an invasion of privacy or a sign of disrespect. Clients with Arab heritage may misinterpret direct eye contact as sexually suggestive.

What is the priority assessment for the nurse when developing a plan of care for a client living in poverty? a) Access to financial assistance b) Access to health insurance c) Access to care d) Access to affordable housing

c) Access to care Explanation: Poverty has long been a barrier to adequate health care. If clients cannot access health care, it does not matter if they have affordable housing, health insurance, or financial assistance. It is not possible to create a plan of care with client involvement without adequate support and access to care.

Which behavior by the nurse demonstrates cultural blindness? a) Administering pain medication when a client shows nonverbal indicators of pain b) Explaining to the client that using acupuncture to treat labor pain is ridiculous c) Administering antibiotics to a child whose parents do not believe in Western medicine d) Convincing a client that Western medicine is more effective than alternative therapy

c) Administering antibiotics to a child whose parents do not believe in Western medicine Explanation: Cultural blindness occurs when one ignores differences and proceeds as though they do no exist. Administering antibiotics to a child when the parents do not believe in Western medicine is an example of cultural blindness. Convincing a client that Western medicine is most effective is cultural imposition. Dismissing acupuncture as ridiculous is inappropriate and an example of cultural conflict. Administering pain medication when a client shows nonverbal pain indicators is not an example of cultural blindness.

A family recently immigrated to a new country. The parent reports that the adolescent is showing signs of fear, has vague reports of stomach pain, and feels humiliated by peers because of their culture. What is the priority assessment for the nurse? a) Cultural assimilation b) Cultural blindness c) Culture shock d) Cultural imposition

c) Culture shock Explanation: The client is experiencing symptoms associated with culture shock. Culture shock occurs when a person is immersed in a different culture that is perceived as strange. The person may feel foolish, fearful, incompetent, or humiliated, and these feelings can lead to frustration and anxiety. Cultural assimilation is when one begins to assume some characteristics of a culture outside of one's own. Cultural blindness occurs when cultural differences are ignored. Cultural imposition occurs when one pushes his or her beliefs onto another person.

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

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

A client's spouse has asked that the client be cared for exclusively by female nurses. How should the nurse incorporate this request into the care plan? a) Assess the couple's rationale for making the request b) Determine whether the request is based on a valid reason or cultural preference c) Document the request and make all reasonable efforts to honor it d) Document the request as a knowledge deficit and address the couple's educational needs

c) Document the request and make all reasonable efforts to honor it Explanation: Although cultural assessment in a tactful and respectful manner is likely appropriate in this situation, the care team's guiding principle and obligation should be to accommodate and respect the couple's request. It would be inappropriate for the care team to attempt to convince the couple to change their minds or assume that it is a personal preference. The nurse would not teach the couple that male nurses on the unit are empathetic, as having female nurses is the client's preference.

A nurse is working in a clinic that serves a community with a high population of immigrants. Which nursing assessment is the priority? a) Blood pressure assessment b) Blood sugar assessment c) Language assessment d) Spiritual assessment

c) Language assessment Explanation: Although all of the assessments are appropriate, the priority assessment is communication. If clients do not speak the dominant language, it may be necessary to obtain an interpreter to provide culturally appropriate care.

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

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

The nurse is providing discharge teaching for a client who is from a different culture. The nurse notes that the client will look away from the nurse and does not maintain eye contact. What would be the most appropriate action by the nurse, with regard to culturally competent care? a) Tell the client that it is important to pay attention to the teaching and ask if the client would like an interpreter. b) Continue with teaching and leave written instructions for the client to review. c) Utilize a key informant and continue with the teaching, verifying the client's understanding through open-ended questions. d) Change positions to promote eye contact with the client, asking open-ended questions to ensure understanding.

c) Utilize a key informant and continue with the teaching, verifying the client's understanding through open-ended questions. Explanation: Eye contact is a culturally variable nonverbal behavior. In some cultures, direct eye contact when speaking with others may be considered impolite or aggressive and clients may avert their eyes during the conversation. Therefore, utilizing a key informant or interpreter will help with interpreting nonverbal behavior and ensure teaching is completely translated and understood. Telling the client that it is important to listen implies that the client is not paying attention to the teaching. Changing positions to maintain eye contact is not culturally competent care and may make the client uncomfortable. Leaving the instructions for the client to review is not appropriate, as the nurse should finish the teaching and use teach-back to evaluate the learning.

A client who immigrated from another country informs the nurse of dietary requests. The nurse responds to the special dietary needs by stating, "You are now living here, and you should try to start eating those foods common to our diet." This inappropriate response is an example of: a) cultural diversity. b) cultural assimilation. c) cultural imposition. d) cultural blindness.

c) cultural imposition. Explanation: The nurse's response is an example of cultural imposition, which is defined as the belief that everyone should conform to the majority belief system. Cultural blindness is the result of ignoring differences and proceeding as though they do not exist. In this situation, the nurse did not ignore the request but inappropriately responded to it. Cultural diversity is defined as a diverse group in society, with varying racial classifications and national origins, religious affiliations, languages, physical sizes, genders, sexual orientations, ages, disabilities, socioeconomic statuses, occupational statuses, and geographic locations. Cultural assimilation occurs when members of a minority group live within a dominant group and lose the cultural characteristics that make them different.

When reviewing the chart of an older adult client, the nurse notes that the client identifies as Japanese. The nurse realizes the client is referring to which ancestral and cultural factor? a) values b) race c) ethnicity d) ethnocentrism

c) ethnicity Explanation: Ethnicity refers to a common bond of kinship with country of origin, for this client Japan. Race refers to biologic differences, for this client Asian. Ethnocentrism is the belief that one's personal heritage is superior to others. Values are beliefs and attitudes that are important to a person. The scenario does not provide details to determine if the client expresses ethnocentrism nor any personal values.

A woman has moved from the east coast to the west coast. She is a single parent of four children who is having difficulty finding employment due to a lack of a car and primarily speaking an uncommon language for the area. Which factor is a barrier to health care? a) female gender b) multiple children c) primary language other than the dominant one d) cultural differences

c) primary language other than the dominant one Explanation: The client speaking a language that is uncommon for the area as one's primary language is a barrier to health care. Being from a different culture, female, or the parent of multiple children does not create a barrier to care.

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

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

The nurse admits a client to the critical care unit to rule out a myocardial infarction. The client has several family members in the waiting room. Which nursing action is most appropriate? a) Allow all the visitors into the room. b) Insist that only one family member can be in the room at a time. c) Explain to the family that too many visitors will tire the client. d) Assess the client's beliefs about family support during hospitalization.

d) Assess the client's beliefs about family support during hospitalization. Explanation: Asking the client about the client's beliefs exemplifies that the nurse recognizes the importance of respecting differences rather than imposing standards. If the client believes family support is significant to health and recovery, the nurse should respect the client's beliefs and allow the visitors into the room.

When describing the concept of ethnicity, which statement would be most appropriate to use? a) Culture involves self-consciousness while ethnicity does not. b) Ethnicity is an alternative term that implies the same ideas as culture. c) Ethnicity is a present-oriented form of identity. d) Ethnicity allows people to define themselves and others to define them.

d) Ethnicity allows people to define themselves and others to define them. Explanation: Ethnicity is a cluster of ways for people to define themselves and be defined by others. It involves the selection of certain shared cultural characteristics, such as symbols of a common group origin, history, or descent. Ethnicity is not culture. Ethnic identity is distinguished from culture in that ethnic identity is self-conscious about select symbolic elements that are taken as the emblem of group social identity. Ethnicity or ethnic identity refers to a self-conscious, past-oriented form of identity based on a notion of shared cultural (and perhaps ancestral) heritage, as well as current position within the larger society.

A client tells the nurse that the only thing that helps the client sleep is a glass of warm milk. The nurse caring for the client insists that this cultural practice is a myth and tries to convince the client that reading a book would be better. What is the nurse demonstrating? a) Stereotyping b) Culture shock c) Cultural pervasiveness d) Ethnocentrism

d) Ethnocentrism Explanation: Sometimes healthcare providers assume that their cultural belief (whether of the healthcare culture of or their own personal culture) is better than their clients' cultural beliefs. This is a form of ethnocentrism. Cultural pervasiveness refers to learning a set of behaviors within a particular culture. Culture shock is the feelings a person experiences when placed in a different culture. Stereotyping refers to preconceived and untested beliefs about people.

The nurse is caring for a client who perceives time differently. What action should the nurse take for this client? a) Perform interventions at random times during shift. b) Set all interventions to be done at specific times. c) Have the client set all times for the interventions. d) Maintain flexibility when the client requests interventions at specific times.

d) Maintain flexibility when the client requests interventions at specific times. Explanation: People view time differently. Social time can reflect attitudes regarding punctuality that vary among cultures. The nurse should maintain a flexible attitude and adapt the time of interventions to the client's needs and requests. It is not realistic to have the client set all the times for the interventions or to have the interventions at a specific time or interventions at random times during the shift.

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

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

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

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

The younger nurses on a unit, who seem to adapt easily to the new technology presented, are perceived as threatening by two nurses who have worked on the unit for years. The older nurses begin to ridicule the younger nurses, saying, "You might be able to work a computer, but we know how to provide real care." How should the charge nurse respond? a) The charge nurse should understand that this is stereotyping in the form of racism and intervene immediately. b) The charge nurse should recognize that this is cultural imposition and the younger nurses are forcing new technology on the older nurses. c) The charge nurse should demonstrate cultural blindness and pretend that the issue does not exist. d) The charge nurse should discuss the concept of cultural conflict and help both parties see their respective value to the unit.

d) The charge nurse should discuss the concept of cultural conflict and help both parties see their respective value to the unit. Explanation: The scenario presents a classic example of cultural conflict. The older nurses feel threatened by those who are technologically savvy and try to prove their value so that they feel more secure. Both parties have value, and the charge nurse can use knowledge of diversity to help bring cohesion to the unit.

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

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

The nurse is using an interpreter to communicate with a client who speaks a different language. What would be the best way to choose an interpreter for this client? a) The interpreter should speak in a loud voice. b) The interpreter should conduct the conversation quickly to avoid misinterpretation. c) The interpreter should always make direct eye contact. d) The interpreter should understand the health care system.

d) The interpreter should understand the health care system. Explanation: Obviously, nurses cannot become fluent in all languages, but certain strategies for fostering effective cross-cultural communication are necessary when providing care for clients who are not fluent in the dominant language. Cultural needs should be considered when choosing an interpreter; however, it is also important to use an interpreter who understands the health care system. In choosing an interpreter, the nurse should not select one who speaks in a loud voice, conducts the conversation quickly, or always makes direct eye contact. Direct eye contact is regarded differently among cultures.

The community health nurse is assessing a home-bound client. The client expresses their own past-oriented ancestral heritage and family rituals. The nurse recognizes that the client is expressing: a) ethnocentrism. b) a subculture. c) assimilation. d) ethnic identity.

d) ethnic identity. Explanation: Ethnicity or ethnic identity refers to a self-conscious, past-oriented form of identity based on a notion of shared cultural (and perhaps ancestral) heritage and current position in larger society. Assimilation refers to new customs and attitudes that are acquired through contact and communication among persons of a particular culture and subculture refers to a group of people within a culture who have ideas and beliefs that are different from the rest of that society. Ethnocentrism is the practice of seeing one's own culture as the highest standard.

A preconceived and untested belief about an individual or group of individuals is: a) racism. b) culturally competent care. c) cultural relativity. d) stereotyping.

d) stereotyping. Explanation: Stereotypes are exaggerated descriptors of character or behavior that are commonly reiterated in mass media, idiomatic expressions, and folklore. Racism is believing that one's race is superior to another. Culturally competent care is care that involves an awareness of one's own cultural beliefs and biases and an understanding of how a client's culture affects the client's health care. Culture relativity is the belief that an understanding of a person's behavior depends, at least in part, on an understanding of that person's cultural context.

A nurse is caring for patients of diverse cultures in a community health care facility. Which characteristics of cultural diversity that exist in the United States should the nurse consider when planning culturally competent care? Select all that apply. a. The United States has become less inclusive of same-sex couples. b. Cultural diversity is limited to people of varying cultures and races. c. Cultural diversity is separate and distinct from health and illness. d. People may be members of multiple cultural groups at one time. e. Culture guides what is acceptable behavior for people in a specific group. f. Cultural practices may evolve over time but mainly remain constant.

d. People may be members of multiple cultural groups at one time. e. Culture guides what is acceptable behavior for people in a specific group. f. Cultural practices may evolve over time but mainly remain constant. Explanation: A person may be a member of multiple cultural, ethnic, and racial groups at one time. Culture guides what is acceptable behavior for people in a specific group. Cultural practices and beliefs may evolve over time, but they mainly remain constant as long as they satisfy a group's needs. The United States has become more (not less) inclusive of same-sex couples. The definition of cultural diversity includes, but is not limited to, people of varying cultures, racial and ethnic origin, religion, language, physical size, biological sex, sexual orientation, age, disability, socioeconomic status, occupational status, and geographic location. Cultural diversity, including culture, ethnicity, and race, is an integral component of both health and illness.

A nurse states, "That patient is 78 years old—too old to learn how to change a dressing." What is the nurse demonstrating? a. Cultural imposition b. Clustering c. Cultural competency d. Stereotyping

d. Stereotyping Explanation: Stereotyping is assuming that all members of a group are alike. This is not an example of cultural competence nor is the nurse imposing her culture on the patient. Clustering is not an applicable concept.