chapter 5

A nurse is conducting an ethnographic interview with a client. Which step would the nurse do first?

Ask an open-ended, general question

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?

Ethnocentrism

While caring for a client from a culture different from the nurse's, the nurse inadvertently offends the client. What is the best action by the nurse?

Learn from the mistake and do not repeat it.

What cultural considerations might the nurse expect of those living in poverty? Select all that apply.

Low levels of self-respect and feelings of worthlessness are common. Family structures are often unstable and abusive. Living conditions are often crowded, with several families living together. Large numbers in the culture need government assistance.

The nurse is caring for a client who perceives time differently. What action should the nurse take for this client?

Maintain flexibility when the client requests interventions at specific times.

Nurses are responsible for delivering culturally competent care for all clients. Culturally competent care does not account for:

client's height.

Which nursing intervention reflects culturally appropriate care when addressing a client?

"Good morning, Mr. Smith. I am your nurse, John."

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?

"Be careful of the negative attitude in your approach. How fast an individual moves will depend on physical ability not necessarily age."

The nurse is caring for a client who is postoperative 24 hours from an appendectomy. The client is hesitant to get out of bed. How should the nurse respond?

"Can you describe what you are feeling when you try to move?"

The clinic nurse is obtaining demographic data from a client. The client states, "Why do you need to know what my ethnicity is?" How should the nurse respond?

"Collecting this information allows us to develop a personalized plan of care to meet your needs."

The nurse has just attended a seminar on concepts of cultural diversity. Which statement made by the nurse would require further education?

"Culture cannot be influenced, and you are born with your culture."

Which statement about diversity is true?

"Diversity demonstrates differences among groups of people."

A nurse who usually works on the surgical unit is asked to float to the oncology unit because of staffing needs. Which statement by the nurse indicates the possibility of the nurse experiencing culture shock?

"I am very stressed now because I do not understand how things work on this unit."

While performing the initial assessment of an infant, the nurse notes a soiled string of yarn around the infant's neck. Which response from the nurse would facilitate culturally competent care?

"I see you have a string tied to your child's neck. Can you explain why you do this?"

Which statement by the nurse is a culturally appropriate reaction to a client's perception of pain?

"If a client needs to yell in pain, that is his or her right."

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?

"It is important to monitor my blood pressure."

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?

"We can wait until your spiritual healer arrives and work together to answer these questions."

A new client comes to the primary care clinic and asks for help treating head lice. The interview reveals that the client lives with nine other people in a one-bedroom apartment. Which statement by the client is nurse's priority concern?

"We do not have running water."

The nurse cares for a client who is a member of a different culture from the nurse's. Which question is most important for the nurse to ask to assess the client's beliefs about treatment?

"What are your expectations about being in the hospital?"

A client is admitted to the health care facility with hypoglycemia. After the client is stable, the nurse discovers that the client has not taken the prescribed medicines. The client believes that eating saffron will keep blood sugar under control. What is the most appropriate response by the nurse?

"What would you think about taking the medicines, too, and benefitting from both?"

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.

"When I drink coffee or tea, I should use a non-dairy creamer instead of milk or cream." "I can use kosher parve foods because they are prepared without milk." "I should replace 2% milk with lactose-free milk."

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?

"Would you feel more comfortable with your family with you?"

The nurse is caring for a client who practices Catholicism and was newly diagnosed with cancer. The client states, "God is punishing me for my past sins." How should the nurse respond?

"You sound upset. Would like you to talk about it?"

When providing culturally competent care to clients, a nurse understands that cultural competence involves which characteristics? Select all that apply.

A process that requires life-long learning A commitment to promoting health equity Knowledge of influences on the clients' beliefs Awareness of one's own influences on responses

What is the priority assessment for the nurse when developing a plan of care for a client living in poverty?

Access to care

Which behavior by the nurse demonstrates cultural blindness?

Administering antibiotics to a child whose parents do not believe in Western medicine

The community health nurse is developing a workshop for a group of Native American/First Nation clients. Which topic should the nurse teach?

Alcohol use disorder

Which scenarios are examples of a culturally appropriate nursing intervention? Select all that apply.

Asking the client's grandmother, who is the head of the family, to be involved in the plan of care Asking for cultural assistance from clergy at the client's request Allowing the client to eat food from home that is consistent with the client's dietary plan Asking sincerely for the client to explain religious rituals

The nurse admits a client to the critical care unit to rule out a myocardial infarction. The client has several family members in the waiting room. Which nursing action is most appropriate?

Assess the client's beliefs about family support during hospitalization.

A 12-year-old black client has experienced significant blood loss and may require a blood transfusion. The client's mother, father, and sisters are currently present at the bedside in the emergency department. How should the nurse direct questions and education about the client's condition and treatment?

Assess who is the dominant member of the family and then address that person.

When completing a transcultural assessment of communication, which assessment by the nurse is most appropriate?

Assessment of eye contact, personal space, and social taboos

Which scenario is an example of cultural competence in nursing?

Attending a conference for cultural diversity

Which behavior by the nurse is stereotyping?

Avoiding older adult clients because their care is time consuming

A nurse is working to develop cultural competence. Which activities would be appropriate for the nurse to engage in when exploring the nurse's own cultural awareness? Select all that apply.

Critical reflection Feedback from colleagues Self-assessment

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?

Cultural imposition

Which term is most appropriate for describing a healthcare practitioner who is respectful of the healthcare traditions of other cultures?

Culturally sensitive Culturally sensitive is defined as being respectful of other diverse cultures. Culturally impositive is the tendency for healthcare practitioners to impose their beliefs, practices, and values on people of other cultures. Culturally appropriate and culturally competent refer to the holistic care given by healthcare practitioners.

Which examples are considered acceptable cultural norms in health care? Select all that apply

Defining diabetes mellitus as a metabolic disorder characterized by elevated blood sugar Encouraging adult women to conduct self-breast exams once a month Documenting pain with every client assessment Following a specific regimen for cardiac rehab

Which examples are considered acceptable cultural norms in health care? Select all that apply.

Defining diabetes mellitus as a metabolic disorder characterized by elevated blood sugar Encouraging adult women to conduct self-breast exams once a month Documenting pain with every client assessment Following a specific regimen for cardiac rehab

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.

Determine in which language the client communicates effectively. Review facility policy on communication with clients who do not speak the dominant language. Schedule a certified interpreter when collecting client health history.

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?

Discuss with the client the need for assistance during ambulation.

A client is experiencing culture shock. Which findings would the nurse likely assess? Select all that apply.

Disorientation Stress

The client is admitted to the hospital with a ruptured ovarian cyst. The client has expressed that it is very important that the spouse be present to receive all medical information. Using the concepts of culturally competent care, which is the best response?

Document the client's request in the nursing care plan.

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?

Document the request and make all reasonable efforts to honor it

When describing the concept of ethnicity, which statement would be most appropriate to use?

Ethnicity allows people to define themselves and others to define them.

How is culture learned by each new generation?

Formal and informal experiences

Which concepts are considered cultural norms of the health care system? Select all that apply.

Frequent use of jargon and documentation Professional deference to pecking order Use of a problem-solving methodology

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.

Honeymoon Disenchantment Beginning resolution Effective function

The use of one's culture as a cultural standard is known as:

ethnocentrism.

Which teaching statement best exemplifies cultural competence in relation to time for the American culture?

It is important to be on time for your health care appointment.

Which aspects of nursing make it recognizable as a subculture? Select all that apply.

Manner of dress Language used Rituals

A nurse is assessing a client's culture. Which aspect would be the easiest for the nurse to recognize?

Material

A nurse is conducting a seminar for a group of nurses about the cultural competency in nursing. When describing culture, which terms would be appropriate for the nurse to use? Select all that apply.

Pervasive Ritualistic Holistic Recognizable

A client refuses to allow any healthcare worker of Asian descent to provide care. This client is demonstrating what practice?

Racism

Which behaviors demonstrated by the client would the nurse consider reflections of the client's pride in ethnicity? Select all that apply.

Requesting native cuisine Listening to folk music and dance Asking to wear unique clothing

The nurse is caring for a client admitted with an upper respiratory infection. The client tells the nurse about following the holistic belief of hot/cold. Which food items should the nurse provide to the client based on this information?

Soup, hot tea, and toast The client believes in the hot/cold theory of disease, so the client needs to treat cold diseases with hot food and hot diseases with cold food. The most appropriate choice would be the soup, hot tea, and toast. The other options are all cold foods, which the client would not use to treat a cold disease such as an upper respiratory infection.

The nurse is caring for a client whose language skills are very limited in the dominant language, and an interpreter has been obtained. The interpreter appears to be telling the client more than the nurse is saying and possibly providing an opinion or medical advice. Which action is appropriate for the nurse to take?

Speak privately with the interpreter and instruct them to only provide language interpretation.

A nurse is working with an interpreter to communicate with a client who speaks very little of the nurse's language. Which actions would be appropriate for the nurse to take? Select all that apply.

Speak to the client rather than the interpreter. Use simple sentences to convey the verbal message. Rephrase a question using different words if the answer is inappropriate.

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

Stereotyping

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?

Stereotyping

The nurse caring for several clients on a surgical unit notes that one of the clients is Muslim. The nurse decides to remove all pork from the client's meal tray prior to delivering it to the room. What best describes the nurse's action?

Stereotyping

A nurse receives a report for a client who is going to surgery in the morning. The nurse is informed that the client is Jehovah's Witness. What education is needed for this particular client?

The client needs to have a discussion with the health care team about blood product preferences

A client is seeking care at the local clinic. The nurse is completing a cultural assessment. Which scenario would demonstrate cultural assimilation?

The client's child learned the dominant language as a second language.

A client reports to the primary health care facility for routine physical examination after cardiac rehabilitation following myocardial infarction. How should the nurse conduct the interview?

The nurse should avoid using medical terminology.

Which nursing actions are appropriate when collecting a health history for a client whose primary language differs from the dominant language? Select all that apply.

Use the facility telephonic interpreting system. Have a bilingual nurse assist with the health history. Request assistance from a certified interpreter.

An adolescent informs the nurse at the clinic, "I do not know what is happening to me, my skin is turning very white in spots all over my hands." The nurse assesses hypopigmented areas on the hands and documents the finding. Following evaluation by the health care provider, what education will the nurse provide to the client?

Using a pigmented cream will help to even the skin tones. The adolescent is experiencing hypopigmentation, which is called vitiligo and can affect clients of any ethnic group. Vitiligo may be embarrassing for the person affected. A pigmented cream can be used to cover the area and make the skin tones more evenly blended. There are no physical symptoms such as stinging, and the disorder is not caused by sun exposure. The condition may affect different areas of the body and is not necessarily confined to the present area.

The nurse is performing an assessment for a Native American/First Nations client who is hesitant to answer questions related to psychosocial history. What action by the nurse will facilitate communication between the nurse and the client?

Wait to write down notes or put the information in the computer until after the interview, if possible.

Which population group should the nurse routinely screen for heart disease?

White

The nurse working on a medical unit always performs hand hygiene between contact with each client. In addition to being understood as an infection control measure, this practice can be understood as:

a ritual.

The nurse is caring for an older adult client who has been hesitant to seek health care. Which action(s) by the nurse would develop a trusting nurse-client relationship? Select all that apply.

addressing the client by title and last name following through with requests by the client respecting the client's privacy

The nurse is teaching a family, who has recently learned a family member has a lactase deficiency, how to make healthier dietary choices to ensure the family member obtains enough calcium in their diet. The nurse determines the teaching was successful when they choose which menu as the best choice?

baked salmon patty, steamed spinach, sweet potato, salad with romaine lettuce, hard-boiled egg slices, carrots, celery, cucumber, and vinegar vinaigrette dressing, apple slices, ice tea

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:

cultural imposition.

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:

cultural imposition.

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

cultural ritual.

When an American client states, "I only want an American doctor," the client is expressing:

ethnocentrism.

Healthcare facilities that sponsor health promotion activities only in affluent areas are considered:

culturally blind.

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?

ethnicity

The nurse is caring for a client from China and assisting the client with the lunch tray. Which item on the tray should the nurse question the client about being able to ingest?

milk

A 35-year-old client was admitted to the hospital following an automobile accident with a fractured leg. Which action should the nurse prioritize after learning this client's family is of Italian descent?

monitor hemoglobin and hematocrit for possible anemia

A nurse caring for clients of different cultures in a hospital setting attempts to make eye contact with clients when performing the initial assessment. What assumption might the nurse make based on common cultural practices?

A Muslim-Arab woman refuses to make eye contact with her male nurse. Assumption: She is being modest.

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?

Culture shock

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?

Ask the client how the client wants to be treated based on the client's values and beliefs.

The nurse is caring for a terminally ill client who immigrated from Mexico. Which nursing intervention regarding spiritual care is appropriate?

Ask the client if a spiritual leader is desired.

Which scenarios are examples of cultural competence? Select all that apply.

Attending a cultural diversity lecture series in the community Making arrangement for an acupuncturist to come to the hospital and provide pain relief for the client Having a one-on-one conversation with a client regarding prayer needs and practices Performing a self-assessment of one's own personal biases

A nurse caring for clients in a culturally diverse neighborhood knows that culture affects the nurse's interactions with the client. Which are characteristics of culture? Select all that apply.

Culture guides what is acceptable behavior for people in a specific group. Cultural practices and beliefs mainly remain constant as long as they satisfy a group's needs. Culture influences the way people of a group view themselves, have expectations, and behave.

A nurse is reading a journal article about culturally competent nursing care. The article begins discussing culture and its unique characteristics. Which characteristics would the nurse expect to be identified? Select all that apply.

Culture may evolve over time. Culture makes sense to its members. Culture is shared through communication.

A family recently immigrated to a new country. The parent reports that the teenager is showing signs of fear, has vague reports of stomach pain, and feels humiliated by peers because of their culture. What is the priority assessment for the nurse?

Culture shock

A nurse is caring for a postoperative client after knee arthroplasty. The nurse plans to help the client ambulate but is aware that the client may feel threatened by physical closeness because the client is from a culture that tends to prefer more personal space when interacting with others. Using the principles of culturally competent care, what would be the most appropriate nursing action?

Explain the purpose and need for assistance during ambulation.

Which disorders might a nurse screen for in a black client, based on race? Select all that apply.

Keloid formations Lactase deficiency Sickle cell anemia

A nurse is part of an orientation team for a group of newly hired nurses. The nurse is to prepare a presentation for the group about different cultural groups common to the facility. As part of the presentation, the nurse is planning to describe how culture is communicated to provide a foundation for culturally competent care. Which methods of communication would the nurse include? Select all that apply.

Language Behavior Symbols

A nurse is working with a local community group to address health disparities in the area. Which concepts would be important for the group to address when planning to correct health disparities? Select all that apply.

Minority Disadvantaged Less powerful

A Native American/First Nations client comes to a new clinic. The client has been to multiple clinics. The client uses peyote as part of the client's religion. Past care providers have dismissed the client's health concerns as being imaginary. What is the priority nursing diagnosis?

Powerlessness related to the inability to make health care providers understand the client's symptoms

The nurse is caring for two clients with the same ethnic background. The nurse notices some differences between the two in the religious practices and the slang used for communicating. What is most likely the etiology of these differences?

ethnicity Ethnicity or ethnic identity refers to the differences among a group who share the same cultural and/or ancestral heritage. Cultural norms are the actions that are expected by others within the culture. Cultural relativity refers to the differences between cultures in the meaning of various behaviors. Ethnocentrism is the belief that one's own practices are the only correct practices.

The nurse is admitting a client who practices the Jewish faith to the acute care unit and calls the dietary department to order a kosher dietary tray without consulting the client about food preferences. Which behavior is the nurse demonstrating when performing this action?

generalization

The spouse of a client asks the nurse whether the spouse may bring in a cream from home to apply to the client's skin. The spouse says, "Whenever anyone gets sick, we always use this cream." The nurse interprets this as:

ritual.

A 65-year-old Asian American female has been brought to the emergency department accompanied by her spouse with a fractured femur. The health care provider has prescribed a Foley catheter be inserted. Which action(s) should the male nurse, who has been assigned to the provide care to this client, prioritize to best care for this overly anxious client? Select all that apply

explain the situation to the client request the client's permission to insert the Foley catheter allow the spouse to stay in the room during the insertion

A staff nurse meets with the charge nurse and is reporting that all the new nurses are leaving messes on the unit. The staff nurse states, "These youngsters think they can waltz in here and get our jobs." What is this nurse demonstrating?

Cultural conflict

A client has recently immigrated and is exhibiting symptoms of culture shock. The client reports feeling unaccepted in the new culture. The client states, "I can't do anything right here." What is the priority nursing diagnosis?

Situational low self-esteem related to culture shock and feelings of fear and incompetence

A parent brings a newborn into the clinic for a 3-month wellness visit and when assessing the back, the nurse observes a dark blue area on the lower back resembling ecchymosis that does not elicit a pain response when pressure is applied. What action should the nurse take to address this finding?

documenting the finding as a "Mongolian spot" he nurse has observed a Mongolian spot, which is hyperpigmentation commonly seen in darkly pigmented infants and children usually located on the lower back, abdomen, thighs, shoulders, or arms. This is caused by the migration of melanocytes into the fetal epidermis, and the spots usually fade by age 5 years. The nurse should document the finding as a normal assessment finding and continue with the assessment. This is not a sign of child abuse and child protective services would not be brought into the situation. An injury in a 3-month-old is unlikely in the area of the lower back and if injury was expected, it would elicit a pain response from the infant. Spina bifida occulta is the only form of spina bifida that does not have an obvious sign and may only appear as a dimple or a tuft of hair, not a dark blue area.

A nurse is demonstrating ethnocentrism. Which statement would reflect this concept?

"My Russian heritage is superior to all others."

A nurse has recently completed a seminar on cultural diversity. Which statement regarding development of cultural knowledge indicates a need for additional teaching?

"The more curious the nurse is about the client's culture, the more the client will want to share."