Exam 5
What does the open double quote"Aclose double quote" stand for in the LEARN model of cultural competence? A. Assert B. Acknowledge C. Affirm D. Accept
A. Assert ***B. Acknowledge C. Affirm D. Accept Acknowledge and discuss the differences and similarities between the perceptions of the client and that of the health care team. Assert, affirm, and accept are not steps in the LEARN model.
Which group is diagnosed with AIDS at a rate that is more than ten times that of Caucasians? A. Pacific Islanders B. Asian Americans C. African Americans D. Hispanics
A. Pacific Islanders B. Asian Americans ***C. African Americans D. Hispanics African Americans have a rate of AIDS infection that is ten times that of Caucasians. Hispanics have a rate three times the Caucasian rate of AIDS infection. Asian Americans and Pacific Islanders do not have higher rates of AIDS.
The nurse is using an interpreter to discuss the care plan with a client of another culture. What form of communication is the nurse using to communicate with the client? A. Silence B. Touch C. Eye contact D. Verbal
A. Silence B. Touch C. Eye contact ***D. Verbal Verbal communication is an important tool to use when exchanging information about the plan of care. Using an interpreter is an example of using appropriate verbal communication to ensure that the client understands the information. Silence, touch, and eye contact are forms of nonverbal communication.
Which are examples of nonverbal communication? (Select all that apply.) A. Sitting forward in a chair B. Crossed arms C. Yelling D. Blushing E. Lack of eye contact
***A. Sitting forward in a chair ***B. Crossed arms C. Yelling ***D. Blushing ***E. Lack of eye contact Blushing, lack of eye contact, crossed arms, and sitting forward in a chair are all forms of nonverbal communication. Yelling is verbal.
The nurse is doing an assessment addressing the interaction of members of the family. Which level of family cohesion describes a family where family members cannot develop a separate identity? A. Disengaged B. Separated C. Connected D. Enmeshed
A. Disengaged B. Separated C. Connected ***D. Enmeshed Members of an enmeshed family cannot develop a separate identity. Separated and connected family cohesion is thought to offer optimal family competency in Western developed societies. Disengaged families are like a group of strangers who happen to live together.
Which cultural phenomenon that affects health care is classified as an environmental control? A. Skin color B. Emphasis on the past C. Faith healing D. Personal boundaries
A. Skin color B. Emphasis on the past ***C. Faith healing D. Personal boundaries Faith healing is an environmental control. Skin color is a biologic factor. Emphasis on the past is a time orientation. Personal boundaries are space factors.
A nursing instructor is discussing the concept of cultural diversity with a group of nursing students. While discussing broad groups, the instructor realizes she needs to reinforce teaching this concept when her students give which example? A. An example of diversity is the customs of a community. B. A project discussing health care diversity in the inner city versus the suburbs of a major city. C. A subgroup of diversity could include education, or occupation. D. The sexual orientation of a group of college sophomores participating in a birth control study.
***A. An example of diversity is the customs of a community. B. A project discussing health care diversity in the inner city versus the suburbs of a major city. C. A subgroup of diversity could include education, or occupation. D. The sexual orientation of a group of college sophomores participating in a birth control study. The customs of a community are considered part of the culture. Diversity refers to the quality of being different. Characteristics that distinguish broad groups from one another. Examples include age, race, gender, sexual orientation, and religion. Subgroups of diversity include socioeconomic status, education, occupation, interests, marital status, or rural versus urban living situations.
A nurse is reviewing the medical records of a small urgent care clinic. The nurse has been asked to identify clients who may be considered vulnerable. Which clients will the nurse include as those who may be vulnerable? (Select all that apply.) A. An 82-year-old man living alone with no family nearby B. A 17-year-old in an afterschool boys' and girls' program C. A 32-year-old woman who lists the local shelter as her home address D. A 22-year-old woman who is crying and anxious because she is fighting with her roommate E. A 42-year-old man with a history of psychiatric illnesses who lives in his car in a nearby park
***A. An 82-year-old man living alone with no family nearby B. A 17-year-old in an afterschool boys' and girls' program ***C. A 32-year-old woman who lists the local shelter as her home address D. A 22-year-old woman who is crying and anxious because she is fighting with her roommate ***E. A 42-year-old man with a history of psychiatric illnesses who lives in his car in a nearby park Vulnerable populations include the elderly, children, people living in poverty, homeless people, and those who are in abusive relationships, are mentally ill, or chronically ill. An episode of anxiety or an altercation without a history of abuse is not considered evidence of belonging to a vulnerable population. A teenager in an afterschool program is not considered a member of a vulnerable population.
Chen Yong, a 23-year-old Chinese student, goes to the local Chinatown clinic when he hurts his leg playing soccer. He is told that the doctor is not available and he will have to return the following day for treatment. What health care disparity does this incident illustrate? A. Asians have reported problems with receiving timely health care. B. Asians are unlikely to have health insurance. C. Asians do not want to use Western medical services. D. Asians prefer to use acupuncture and herbs for treatment.
***A. Asians have reported problems with receiving timely health care. B. Asians are unlikely to have health insurance. C. Asians do not want to use Western medical services. D. Asians prefer to use acupuncture and herbs for treatment. Asians were 1.5 times as likely as Caucasians to report that they sometimes or never get care for illnesses or injury as soon as they wanted to. Although some Asians may select traditional Chinese medicine in certain situations, that is not a concern in this situation. Health care coverage is not the problem in Chen Yong's case.
The nurse is assessing the health status of an adult client. Which aspects of culture will the nurse consider when assessing this client? (Select all that apply.) A. Customs are part of the culture of a client. B. Culture is defined by nonphysical traits. C. A client's culture is determined by race. D. Values are a part of culture. E. Beliefs are a part of culture.
***A. Customs are part of the culture of a client. ***B. Culture is defined by nonphysical traits. C. A client's culture is determined by race. ***D. Values are a part of culture. ***E. Beliefs are a part of culture. The culture that encompasses a client's way of life is based on nonphysical traits. The values and beliefs a client holds are part of culture and can influence health care. Customs can influence a client's attitude toward health. Race refers to physical and genetic heritage and is directly related to such physical traits a client may have as skin color, but it is not related to a client's culture.
The nurse is caring for a 5-year-old client diagnosed with cancer. Which factors affecting a family's ability to cope should the nurse consider when planning care (Select all that apply.) A. Financial resources of the family B. Strength of the family structure C. Ability to seek services D. Number of dependents living at home E. Country of origin of the family
***A. Financial resources of the family ***B. Strength of the family structure ***C. Ability to seek services D. Number of dependents living at home E. Country of origin of the family A child's illness or hospitalization can create stressful events for the child and family. The family's ability to cope depends on the strength of the family structure, its ability to successfully seek services, its support system, and available resources. The country of origin of the family does not directly affect the ability to cope with a child's illness. The number of dependents living at home and family size do not directly affect the family's ability to cope with a child's illness.
The nurse is caring for a 32-year-old client, a partner in a gay marriage, who has just given birth. What does the nurse understand about this family that will affect the plan of care? A. Frustrations about infant care are normal. B. Children in lesbian families are at higher risk for poor health. C. Families have coping strategies. D. The home environment is less supportive and healthy.
***A. Frustrations about infant care are normal. B. Children in lesbian families are at higher risk for poor health. C. Families have coping strategies. D. The home environment is less supportive and healthy. As part of the nursing interventions, the nurse will facilitate the integration of the infant by helping these parents recognize that frustrations about infant care are normal, and encouraging bonding with and care for the infant by both parents. Homosexual adults form gay and lesbian families with goals of caring and commitment, the same as heterosexual couples do. Children in gay and lesbian families have been found to have the same advantages and expectations for development, adjustment and health as children in heterosexual families. Gay and lesbian parents can effectively provide supportive and healthy environments for their children. All families have coping strategies that help them deal with stress and change, which should be encouraged.
The nurse is to provide an assessment for a client of Asian descent and his family. What would the nurse need to understand related to the client and his family's worldview? (Select all that apply.) A. Health care beliefs B. Values C. Health care practices D. Language E. Educational level
***A. Health care beliefs ***B. Values ***C. Health care practices ***D. Language E. Educational level Health care beliefs, language, and values are part of a culture's worldview and can influence a client's acceptance of and cooperation with the treatment plan. If the client does not speak the same language as the nurse and the health care provider, an interpreter will be required. Health care practices may differ from what the nurse plans and can include alternative practices that may interfere with the treatment plan. Although not part of the worldview or culture, the client's level of education will be considered when planning teaching for the client.
Which are aspects of organizational governance that should reflect adherence to cultural competence standards? (Select all that apply.) A. Mission statement B. Staff training C. Organizational practice implementation D. Policies and procedures E. Translation services
***A. Mission statement B. Staff training ***C. Organizational practice implementation ***D. Policies and procedures E. Translation services Organizational mission, policies and procedures, and practice implementation should support cultural competence. Translation services and staff training are not part of organizational governance.
Which is the definition of the term multiculturalism? A. Multiculturalism describes a society in which many subcultures coexist. B. Multiculturalism describes shared values, beliefs, attitudes, and customs in a community of people. C. Multiculturalism is the process of adapting to local customs. D. Multiculturalism describes the quality of being unlike or different.
***A. Multiculturalism describes a society in which many subcultures coexist. B. Multiculturalism describes shared values, beliefs, attitudes, and customs in a community of people. C. Multiculturalism is the process of adapting to local customs. D. Multiculturalism describes the quality of being unlike or different. Multiculturalism refers to many cultures existing together. Culture describes shared values and customs. Diversity describes the quality of being unlike or different. Assimilation is the process of adapting to local customs.
The nurse is planning care of a 10-year-old child with an asthma exacerbation whose parents are currently unemployed. Which interventions are the best for the nurse to pursue for this family? (Select all that apply.) A. Reassuring the family of the potential benefits of pursuing the nurse's collaborative interventions B. Identification of areas of knowledge deficiency in cultural competence C. Referral to community wellness clinics D. Avoidance of assumptions or judgments E. Referral to social services experts
***A. Reassuring the family of the potential benefits of pursuing the nurse's collaborative interventions B. Identification of areas of knowledge deficiency in cultural competence ***C. Referral to community wellness clinics D. Avoidance of assumptions or judgments ***E. Referral to social services experts Nurses often need to collaborate with other professionals to help clients regain or maintain health. The nurse's collaborators may include social services experts, community free wellness clinics, food banks, and other community organizations that can meet the family's needs. The nurse teaches the family the value of these resources to their child's and family's health and encourages them to follow through on securing support. Identification of areas of knowledge deficiency in cultural competence and avoiding assumptions or judgments about clients are part of the nurse's own professional development and practice, not a nursing intervention for a client.
Which are factors that shape family development? (Select all that apply.) A. Sibling relationships B. Parenting style C. Family-centered care D. Resiliency E. Boundaries
***A. Sibling relationships ***B. Parenting style C. Family-centered care ***D. Resiliency ***E. Boundaries Factors that shape family development are parent-child interaction, family size, sibling relationships, boundaries, family cohesion, resiliency, family coping mechanisms, emotional availability, family flexibility, family communication patterns, parenting style, and genetic considerations and nonmodifiable risk factors. Family-centered care is the partnership between nurses and families when planning care.
The nurse observes the client in prayer with family members. Which cultural phenomenon would the nurse recognize is occurring? A. Social organization B. Personal space C. Time orientation D. Environmental control
***A. Social organization B. Personal space C. Time orientation D. Environmental control Religious beliefs are part of what may identify the social organization of the culture of a family unit. Although the family members might be close to each other, focus is not on personal space, which refers to the comfortable or appropriate distance for interaction with other people. Time orientation differs among cultures, with some putting more value on the past and present; Anglo-American culture places more emphasis on the future. However, the focus during this client's prayer is not on time. The family is displaying social organization and not controlling the environment around them.
When developing a family plan of care for a pediatric client with a chronic health condition, which areas require an in-depth assessment of all family members? (Select all that apply.) A. Socioeconomic status B. Religious preferences C. Medication schedules D. Culture and social practices E. Education level
***A. Socioeconomic status ***B. Religious preferences C. Medication schedules ***D. Culture and social practices E. Education level A family plan of care requires in-depth assessment of all family members, including their health history, socioeconomic status, religion, culture, nutrition, and social habits and practices. Medication schedules and education/intelligence levels do not need to be assessed unless the nurse becomes aware of a problem in this area.
The nurse is performing a cultural assessment on an adult client. What type of information would be used to complete the cultural assessment? (Select all that apply.) A. The language spoken in the home B. Whether the client has insurance C. The client's region or country of residence D. The kinds of food and drink the client prefers E. The cultural or religious influences in decision making
***A. The language spoken in the home B. Whether the client has insurance ***C. The client's region or country of residence ***D. The kinds of food and drink the client prefers ***E. The cultural or religious influences in decision making Subjective data would be gathered by asking questions about cultural beliefs. Objective data would be gathered through observation of the client and the interactions between significant family members who might be present. Discovering the region or country the client originates from and lives in would give clues about the client's culture. It is important to know what language is spoken in the home and whether the client understands English so that communication can be effective. Insurance is not necessarily a question that would come up during a cultural assessment, although socioeconomic status may affect health care delivery.
The nursing students are meeting for a post conference following their shift on a medical floor. One of the students is reviewing a client's cultural background. Which statement by the student illustrates the concept of cultural humility? A. The nurse's expression of sensitivity to the differences between her client's culture and her own. B. The nurse's discussion of her cultural superiority over her client's culture. C. The nurse's explanation to her client that his religious beliefs lack scientific validity when discussing his diagnosis D. The nurse's example of her authoritative stance when teaching her client which diet is best for his diagnosis.
***A. The nurse's expression of sensitivity to the differences between her client's culture and her own. B. The nurse's discussion of her cultural superiority over her client's culture. C. The nurse's explanation to her client that his religious beliefs lack scientific validity when discussing his diagnosis D. The nurse's example of her authoritative stance when teaching her client which diet is best for his diagnosis. Cultural humility is displayed when a nurse recognizes that his or her personal cultural values are not superior to the cultural values of another person. The nurse is not demonstrating cultural humility when he or she is claiming cultural superiority over another person. Taking an authoritative stance to influence a client against dietary choices does not reflect cultural humility. Abusing the power of the nurse's position against the client's religion is not using cultural humility. Cultural humility is demonstrated when the nurse is sensitive to the differences in his or her client's culture, even though the nurse's personal values are not the same as the client's.
The nurse is assessing a client of a different culture who has different religious beliefs. Which statements or questions by the nurse would demonstrate cultural competence when assessing the client? (Select all that apply.) A. "How do you feel about taking medications or blood products if they are prescribed?" B. "I understand that you may not believe in receiving human blood products; is that correct?" C. "I apologize for keeping you so long. Would you like some privacy for prayer before continuing the exam?" D. "May I ask what your partner might think about this plan of care?" E. "I cannot continue with this assessment if you are not willing to be compliant with my plan of care."
***A. "How do you feel about taking medications or blood products if they are prescribed?" ***B. "I understand that you may not believe in receiving human blood products; is that correct?" ***C. "I apologize for keeping you so long. Would you like some privacy for prayer before continuing the exam?" ***D. "May I ask what your partner might think about this plan of care?" E. "I cannot continue with this assessment if you are not willing to be compliant with my plan of care." The nurse can show knowledge of a client's culture by asking appropriate questions that are not demeaning or rude. Asking how the client feels about taking medications opens the conversation to what cultural or religious beliefs might interfere with the medical care of the client. Attitudes of acceptance and recognition would help to build rapport with the client. An accepting attitude does not mean the nurse agrees with the client but that the nurse is willing to accept what the client believes, and work it into the plan of care. Communication is an important skill for a nurse when assessing and caring for a client with a different culture to ensure proper care. Asking about family support opens the conversation so the client feels comfortable speaking about family objections. A nurse who does not demonstrate cultural competence would hinder the health care being provided to the client and may hinder the client's compliance. Refusing to work a plan of care around a client's cultural beliefs is unethical and not beneficial to the client.
The nurse is teaching a 16-year-old unmarried client who has given birth. What is most important for the nurse to include when discussing care with the client and her extended family? A. "This infant is at risk for health and social problems." B. "It would be better for the child if the mother could marry the father." C. "Family members should become active in bonding with the infant." D. "This infant will strengthen your family ties."
A. "This infant is at risk for health and social problems." B. "It would be better for the child if the mother could marry the father." ***C. "Family members should become active in bonding with the infant." D. "This infant will strengthen your family ties." The nurse's instruction is that family members should become active in caring for, interacting with, and bonding with the infant. Children in adolescent families are at greater risk for health and social problems; however, this infant is currently a part of the mother's family. Parents in these families may be forced to stop their formal education and are more likely to be physically, developmentally, and financially unprepared to care for a child. The nurse understands this and encourages the extended family to provide support for the mother and infant in order to promote health. The nurse provides culturally competent care that includes promoting family competence and health, and being nonjudgmental, regardless of the type of family the client has. Integrating a new infant into any family comes with stressors. A family that is resilient can adapt and transform in response to stress.
The nurse is caring for a 10-year-old client with diabetes. The parents of the client do not speak English. How should the nurse best teach the client and family about home care? A. A sibling that speaks fluent English should translate. B. The client should translate. C. An agency translator should be used. D. The nurse should provide written instruction in the family's language.
A. A sibling that speaks fluent English should translate. B. The client should translate. ***C. An agency translator should be used. D. The nurse should provide written instruction in the family's language. Language barriers prevent therapeutic communication that is necessary to providing culturally competent care. It is not uncommon for children to be asked to interpret for the family; however, this exposes them to information they may not understand or know how to communicate. The preferred method for teaching home care is the hospital/agency translator. Information written in the family's language might be useful, after verbal instruction is given.
The nurse educator is presenting an in-service to staff nurses regarding the spiritual health of clients admitted to the unit. Which role of the nurse will the educator include in the presentation? A. Asking the client's family for permission before disclosing the client's prognosis B. Declining to discuss spirituality directly out of respect for differing beliefs C. Assisting the client in recalling past experiences in which he or she drew upon hope while in crisis D. Introducing clients to the chaplain, who can assist them in finding religious belief
A. Asking the client's family for permission before disclosing the client's prognosis B. Declining to discuss spirituality directly out of respect for differing beliefs ***C. Assisting the client in recalling past experiences in which he or she drew upon hope while in crisis D. Introducing clients to the chaplain, who can assist them in finding religious belief Spiritual health is the state of wellness encompassing personal fulfillment as well as the fulfillment of life with others. The nurse can support the client's spirituality by assisting the client to recall times when he or she experienced hope. Spirituality is not the same as religious beliefs. The nurse can assist the client in developing spirituality without involving religious practices. The client should be the focus of care and information. It is important to include the family and any source of support, but the focus is the client. The role of the nurse is to support the client's experience of spirituality, not promote religious belief. The chaplain can provide support to the client in the development of his or her personal spiritual development.
Which action by the nurse would indicate further education is necessary for the nursing care to be effective and culturally sensitive? A. Becomes knowledgeable about cultures served B. Becomes an effective communicator C. Puts own personal beliefs aside D. Acknowledges the numerous variations of family structures
A. Becomes knowledgeable about cultures served B. Becomes an effective communicator ***C. Puts own personal beliefs aside D. Acknowledges the numerous variations of family structures To become a culturally competent nurse, you must have the knowledge and skill to take care of families from different cultures. You should find out more about your clients' cultures, be a good communicator, acknowledge the numerous variations in family structure, and become aware of your own cultural beliefs so that you can anticipate possible misunderstandings. However, you do not have to put your own personal beliefs aside completely, but rather your beliefs should not affect the care that you provide.
Which interventions may be most appropriate when divorce alters a family structure? (Select all that apply.) A. Being alert to signs of intense grief reactions B. Considering the nature of the loss C. Providing information about counseling and support groups D. Educating about the importance of health maintenance and nutrition E. Advising about healthy coping mechanisms for stress
A. Being alert to signs of intense grief reactions B. Considering the nature of the loss ***C. Providing information about counseling and support groups ***D. Educating about the importance of health maintenance and nutrition ***E. Advising about healthy coping mechanisms for stress Family-focused interventions that are appropriate when divorce alters the family are providing information, advising about healthy coping mechanisms, and educating about the importance of health maintenance and nutrition. The nurse's being alert to signs of grief and considering what the loss means to the family are part of the nurse's assessment, not interventions.
A nursing student is doing an internship in an inner-city free clinic. As part of the curriculum the nursing student is expected to give a presentation on health care disparities in the United States. Which statistics are appropriate for the student to include in the presentation to classmates? (Select all that apply.) A. Caucasians populations have a worsening health disparity in colorectal cancer mortality than Hispanic or African American populations. B. Asian individuals are more likely not to seek care for an illness or injury. C. African Americans have a higher rate of new AIDS cases than Caucasians. D. Asian adults over the age of 65 are more likely than Caucasians not to be immunized against pneumonia. E. Caucasians were more likely to report poor health care communication than the Hispanic population.
A. Caucasians populations have a worsening health disparity in colorectal cancer mortality than Hispanic or African American populations. ***B. Asian individuals are more likely not to seek care for an illness or injury. ***C. African Americans have a higher rate of new AIDS cases than Caucasians. ***D. Asian adults over the age of 65 are more likely than Caucasians not to be immunized against pneumonia. E. Caucasians were more likely to report poor health care communication than the Hispanic population. Health disparities among non-Caucasian populations are a concern in the United States. According to the 2010 National Health Disparities report, African Americans have a rate of AIDS that is ten times greater than Caucasians. Asian adults were 50% more likely than Caucasians not to be vaccinated for pneumonia. Asians were 1.5 times more likely not to get care for an illness or injury. African American populations have worsening colorectal cancer mortality from 2000dash-2006 than Caucasians. Hispanics are 1.7 times more likely to report poor communication with their health care provider than Caucasians.
A nurse is caring for a 5-year-old client from an intergenerational family with 75-year-old grandparents who have provided care since the parents went to prison. Which factor, affecting the families' ability to cope with a young child, should the nurse consider when planning care? A. Decision making that is dispersed throughout the family system B. Family concerns that focus on maintaining functioning C. Family roles that are assigned by age and gender D. Procedures that affect the client, but do not affect the functioning of the family
A. Decision making that is dispersed throughout the family system ***B. Family concerns that focus on maintaining functioning C. Family roles that are assigned by age and gender D. Procedures that affect the client, but do not affect the functioning of the family In order to plan care for the client, the nurse must understand the implications of care giving for the aging grandparents. As well as caring for a young child from a Stage II or IV family, the grandparents are in a Stage VIII family. Among the grandparents' concerns is maintaining function during the aging process, especially since they are caring for a young child. The plan of care must include interventions that comprehensively address family needs. Family role assignment, decision making, and procedures the child will undergo do not directly affect the family's ability to cope.
Seven-year-old Jermaine Cast has a serious, but not life-threatening, illness. He will need to be kept home from school for a 2-month course of treatment. His parents both work and neither parent has a lot of vacation time. What is the most important information the nurse can give the parents? A. Discuss free, or sliding fee, clinics available to families who are underinsured B. Discuss coping strategies for families facing the stress of caring for a sick child C. Assist family to find a good day care center D. Provide information regarding Family and Medical Leave Act
A. Discuss free, or sliding fee, clinics available to families who are underinsured B. Discuss coping strategies for families facing the stress of caring for a sick child C. Assist family to find a good day care center ***D. Provide information regarding Family and Medical Leave Act Nurses should educate the parents about the Family and Medical Leave Act of 1993, so each could take time without pay to be able to be home with the child after they have exhausted their vacation or sick time. It is always helpful to discuss coping strategies with parents under stress, but it is not the most important information the nurse could offer in this situation. Day care is an appropriate place for preschool-age children while their parents are at work, but is not usually equipped to take care of a child with a serious health issue. Free clinics, or sliding fee clinics are helpful for many uninsured people but would not resolve a need for months of care for a sick child, nor is there evidence that this is an issue for this family.
You are conducting an assessment to create a family plan of care for 8-year-old Timothy Lopez. Which question is least appropriate for the nurse to ask his grandmother to help with developing your plan? A. Does either parent have health conditions? B. What are the family's eating habits? C. What is your religion? D. What medical treatments are they interested in?
A. Does either parent have health conditions? B. What are the family's eating habits? C. What is your religion? ***D. What medical treatments are they interested in? Asking what medical treatments interest the family is not a question that would provide information that could be incorporated in a family plan of care. Health beliefs of clients may include folklore and practices from different cultures. A family plan of care requires in-depth assessment of the immediate and extended family, as well as review and consideration of the following factors: health history, socioeconomic status, religion, culture, nutrition, and social habits and practices.
The nurse is caring for a 3-year-old client. The client and the family are immigrants. When assessing the client, the nurse finds that the child has not had immunizations. Which is the best action of the nurse? A. Educate the family about the importance of immunizations B. Identify reasons and beliefs that may be preventing immunization C. Respect the parents' decision not to immunize their child D. Ensure that the client receives immunizations while hospitalized
A. Educate the family about the importance of immunizations ***B. Identify reasons and beliefs that may be preventing immunization C. Respect the parents' decision not to immunize their child D. Ensure that the client receives immunizations while hospitalized The nurse should first assess why the parents have not had the child immunized, which could include the family's cultural practices. The nurse must ensure that immigrant families or clients with views that differ from those of the mainstream culture are aware of the rules and laws governing the care and protection of children against preventable diseases. The first step is to identify why the child has not been immunized; then the family can be educated to promote immunization. Immunizations are given only when parents consent to vaccinations. The nurse cannot administer vaccinations without permission. By respecting the parents' decision without investigating the reasons they have chosen not to vaccinate their child is not appropriate to providing holistic care.
The nurse is caring for 6-year-old Justin Sennet, who has come to the clinic for a physical. His father is impatient and speaks sharply to the child, who is walking around the examination room. The father mentions that his wife died 6 months ago. What is important for the nurse to include during this interview? A. Encouraging the father to set limits with the child B. Assessing for signs of complicated grief C. Providing information about parenting styles D. Telling the father to demonstrate more parental warmth
A. Encouraging the father to set limits with the child ***B. Assessing for signs of complicated grief C. Providing information about parenting styles D. Telling the father to demonstrate more parental warmth The nurse's approach would be to assess how the family is coping with its loss in order to prevent abuse and trauma and promote family competence following this major family alteration. The nurse would assess for signs of complicated or traumatic grief and family violence. It could be appropriate to provide information about therapy and support groups, teach about healthy coping strategies, and facilitate referrals to counselors and other professional resources. Parenting style, emotional availability, family communication patterns, discipline, and limit setting are factors that impact family development; these are at play in this parent-child interaction, and would be noted in the nurse's assessment.
A nurse makes the following statement, "Chinese people drink only hot tea, so don't put coffee on their trays. I know this because my last assignment was in San Francisco." The charge nurse identifies this remark as an example of which concept associated with culture? A. Ethnocentrism B. Prejudice C. Diversity D. Stereotyping
A. Ethnocentrism B. Prejudice C. Diversity ***D. Stereotyping Stereotyping is noted when a person assumes all members of a particular group have the same characteristics. This nurse is assuming all members of a group have the same eating habits. Ethnocentrism is the belief in the superiority of one's own culture and lifestyle. This nurse is making a generalization about a culture, not declaring the superiority of her own culture. Prejudice is a judgment about a person, place, or racial background that has no basis in knowledge. This nurse is making an assumption that all Chinese have the same traits. Diversity is a state of being different and occurs between and within cultural groups. It is not related to the statement this nurse made.
A family comes to the hospital for the father's preoperative visit. The nurse notes that the mother and children let the father answer all questions posed to family members. What should the nurse consider as she prepares the plan of care for this family? A. Family is showing self-disclosure B. Family has rigid flexibility C. Family is demonstrating diffuse boundaries D. Family is demonstrating resiliency
A. Family is showing self-disclosure ***B. Family has rigid flexibility C. Family is demonstrating diffuse boundaries D. Family is demonstrating resiliency The deferral of all family members to the father may indicate rigid family flexibility. A family with rigid flexibility demonstrates very low flexibility for change in the family's leadership, relationships, and rules. Low flexibility may impair the family's resiliency; its ability to respond productively to stress through adaptation and change during the father's illness and recovery. Family communication in high functioning families demonstrates self-disclosure in their communication patterns, where family members share personal feelings about themselves and others. Families with diffuse boundaries demonstrate very open contact with each other and outside systems. The nurse does not observe those behaviors in this family.
The nurse is caring for a 10-year-old client diagnosed with diabetes mellitus. Which assessment findings for this client and family members are teaching opportunities for the nurse? (Select all that apply.) A. Genogram B. Parental structuring C. Poverty-related stress D. Family members with BMI above 30 E. Family history of diabetes
A. Genogram B. Parental structuring ***C. Poverty-related stress ***D. Family members with BMI above 30 ***E. Family history of diabetes A family with a history of diabetes, body mass indices above 30 (indicates obesity), that is experiencing poverty-related stress needs education from the nurse about nutrition and its relationship to disease, as well as referrals to community resources that may be able to assist the family with needed food, medical care, and financial assistance. Parental structuring, an aspect of emotional availability, is the ability of parents to support the child's learning and inquiries without overwhelming the child's autonomy. A genogram is a map of gender, showing lines of descent through the generations of a family.
Which is a core belief about health in non-Western cultures? A. Health is an attribute of youth. B. Health is the absence of disease. C. Health is the strength to do anything you want. D. Health is a state of harmony that encompasses mind, body, and spirit.
A. Health is an attribute of youth. B. Health is the absence of disease. C. Health is the strength to do anything you want. ***D. Health is a state of harmony that encompasses mind, body, and spirit. Non-Western cultures view health as a harmonious state. Western society sees health as the absence of disease. Other views of health are more individual.
The nurse is caring for a 7-year-old child diagnosed with type 1 diabetes. The client is the only child in a two-parent nuclear family. The parents of this client would most likely be working on which developmental tasks in the family life cycle? (Select all that apply.) A. Learning to manage parental tasks B. Looking to retirement C. Managing external influences of friends D. Managing increased time commitments E. Being involved in child's sports, school, or clubs
A. Learning to manage parental tasks B. Looking to retirement ***C. Managing external influences of friends ***D. Managing increased time commitments ***E. Being involved in child's sports, school, or clubs The parents of a 7-year-old child would be working through Stage IV (family with school-age children). Developmental tasks at this stage of family development are facilitating peer relations, and maintaining family dynamics while adjusting to outside influences. At this stage of family development, parents are involved with school-related activities, sports, and clubs, and managing external influences of friends. Learning to manage parenting tasks and responsibilities occurs in Stage II (childbearing). Looking to retirement occurs in Stage VII (middle-aged parents).
The nurse wants to provide culturally competent care to a client who lives on a long-term care unit. Which activities are appropriate for the nurse to implement? (Select all that apply.) A. Memorizing which foods members of each culture eat to restore health B. Educating the client about the U.S. health care system C. Asking the client where he or she thinks illness originates D. Seeking to understand one's own culture, its beliefs, and its assumptions E. Asking the client and his or her family how the illness affects them
A. Memorizing which foods members of each culture eat to restore health B. Educating the client about the U.S. health care system ***C. Asking the client where he or she thinks illness originates ***D. Seeking to understand one's own culture, its beliefs, and its assumptions ***E. Asking the client and his or her family how the illness affects them To provide culturally competent care, the nurse must first understand his or her own culture, its beliefs, and its assumptions. To assist in evaluating a client's culture, the nurse should ask certain questions to understand the client's beliefs. Asking where the client thinks his or her illness comes from will help the nurse understand illness from the client's perspective. Not all members of a culture eat the same thing. Memorizing stereotypes will not help the nurse to provide culturally competent care. Educating the client about the U.S. health care system does not help the nurse in providing culturally competent care.
During a health history interview with a family, the nurse is concerned that a 12-year-old client is experiencing signs of grief reaction. What information from the family would cause the nurse to suspect this condition? A. Nurse observes listening and self-disclosure. B. Nurse observes a family alteration. C. Nurse observes structured family flexibility. D. Nurse observes changes in physical health status.
A. Nurse observes listening and self-disclosure. ***B. Nurse observes a family alteration. C. Nurse observes structured family flexibility. D. Nurse observes changes in physical health status. An alteration in the family, loss of a family member because of death or divorce, could result in a grief reaction, which could manifest in the interview as depression, anger, or anxiety. Communication patterns that include family members listening, speaking, self-disclosing, and tracking, and family flexibility are characteristic of high functioning families. Grief may manifest in weight loss, headaches, sleeplessness and other symptoms, but the nurse would observe that after the health history interview, during the physical examination of family members that would follow.
Which description best depicts a binuclear family? A. Parents with biological children from a previous relationship or marriage B. Two parents with biological or adopted children living together C. Male and female parents, living together outside of marriage D. A family where there is co-parenting with children sharing time between families
A. Parents with biological children from a previous relationship or marriage B. Two parents with biological or adopted children living together C. Male and female parents, living together outside of marriage ***D. A family where there is co-parenting with children sharing time between families Binuclear describes a combination of parenting by two nuclear families, which can happen after a divorce has ended the original nuclear family. Children still spend time with each new family.A nuclear family consists of two parents with biological or adopted children, or children in the new family from a previous relationship or marriage. Male and female parents, living together outside of marriage, are referred to as heterosexual cohabiting.
The nurse is planning discharge care for a 10-year-old child with an asthma exacerbation. Which roles in the binuclear family unit of the child should the nurse identify before teaching can begin? (Select all that apply.) A. Primary caregiver for the child B. Financial decision maker for the child C. Legal guardian of the child D. Medical decision maker for the child E. Parent that is working outside home
A. Primary caregiver for the child ***B. Financial decision maker for the child ***C. Legal guardian of the child ***D. Medical decision maker for the child E. Parent that is working outside home Family members take on different roles within the family. The decision maker in the family may not be the primary provider or caregiver, or the working parent. The nurse must identify the legal, medical, and financial decision maker for each family when planning care for a child.
A supervisor has asked a nurse to train new nursing staff in culturally competent care. Which information would the nurse include in the training? (Select all that apply.) A. Promoting participation of fathers, as well as mothers, in healthcare visits B. Reasons nuclear families are superior C. Variations in family structure D. Communication skills E. Cultures served by the nursing staff
A. Promoting participation of fathers, as well as mothers, in healthcare visits B. Reasons nuclear families are superior ***C. Variations in family structure ***D. Communication skills ***E. Cultures served by the nursing staff The nurse would include information about the cultures served locally by the healthcare organization, variations in family structure that nurses may encounter, and communications skills. In the training, the nurse would teach avoidance of judgments and assumptions, such as why nuclear families are superior to other family structures. The topic of why fathers and mothers should both participate in healthcare visits would be more appropriate for an educational program about facilitating the transition to parenthood.
The nurse is providing an assessment of a family to determine a need for interventions. Which description is an indication of high functioning family communication? A. Resiliency B. Self-disclosure C. Flexibility D. Emotional availability
A. Resiliency ***B. Self-disclosure C. Flexibility D. Emotional availability In high-functioning families, each family member listens empathically and attentively, speaks for him or herself and not for others, self-discloses by sharing personal feelings about self and other family members, and tracks (stays on topic). Family flexibility is the amount of flexibility in a family's leadership, rules, and roles, and the family's ability to deal with stress. Emotional availability refers to the quality of parent-child interactions. Resiliency is a family's ability to adapt, evolve, and change with circumstances.
The nurse learns that a client with school-age children is also her mother's caregiver. The client tells the nurse, open double quote"I cannot meet everyone's demands anymore.close double quote" Which is the most appropriate diagnosis for this client? A. Sandwich generation syndrome B. Risk for situational low self-esteem C. Adjusting to outside influences D. Readjustment of marital relationship
A. Sandwich generation syndrome ***B. Risk for situational low self-esteem C. Adjusting to outside influences D. Readjustment of marital relationship A nurse who is assessing an adult family member who cares for both her own children and an aging parent may diagnose any one of several conditions including, but not limited to, ineffective self-health management, interrupted family processes, compromised family coping, or risk for situational low self-esteem. Adults in this group are known as open double quote"The Sandwich Generation,close double quote" which is not a nursing diagnosis. Families in Stage IV of the family life cycle must adjust to outside influences as children start school. Spouses in Stage VI of the family life cycle readjust their marital relationship as the family launches young adults.
Angela Seitz, age 82, tells the nurse that the surgeon to whom she was referred told her that he does not do hip replacement surgery on someone as old as she. How would the nurse describe the surgeon's attitude? A. The surgeon is demonstrating homophobia. B. The surgeon is demonstrating ageism. C. The surgeon is demonstrating classism. D. The surgeon is demonstrating gender bias.
A. The surgeon is demonstrating homophobia. ***B. The surgeon is demonstrating ageism. C. The surgeon is demonstrating classism. D. The surgeon is demonstrating gender bias. Ageism is discrimination against older adults. Gender bias is demonstrating preferences towards one gender group over another. Classism involves oppressive practices based on socioeconomic status. Homophobia involves negative feelings or behaviors toward gays or lesbians.
The nurse is providing care to a client who is newly diagnosed with type 2 diabetes mellitus. The health care provider orders diabetic education, and notes that the client is noncompliant with his medication and diabetic diet. The client recently emigrated from Vietnam to live with his daughter and does not speak English. The client has expressed a desire to use traditional culturally based therapies to treat the diabetes. Repeat testing shows no improvement in glycemic control. Based on the client's culture, what are the barriers to the recommended diabetic care? (Select all that apply.) A. The lack of insurance B. Cultural belief that discussing the disease can influence the disease process C. The importance of the beliefs and cultural practices of the client's family and community D. The belief that illness is not related to pathophysiology E. Lack of trust in the health care system and providers
A. The lack of insurance ***B. Cultural belief that discussing the disease can influence the disease process ***C. The importance of the beliefs and cultural practices of the client's family and community ***D. The belief that illness is not related to pathophysiology ***E. Lack of trust in the health care system and providers Barriers to care that are influenced by cultural differences may include lack of trust in the health care system or the provider; the belief that illness is not related to pathophysiology; the influence of family and community as well as a cultural belief that discussing an illness can influence the disease process. Although a lack of insurance may influence the client's entry into care, it does not have cultural significance.
Sol, a 47-year-old man, wants to postpone his prostate surgery because his family will be gathering for Yom Kippur on that day. What is an appropriate nursing response? A. The nurse should insist that the client keep the surgery date. B. The nurse should ask the client whether his family will really mind if he doesn't join them for the holy day. C. The nurse should inform the surgeon of the scheduling problem and advocate for rescheduling the nonemergency procedure as soon as possible. D. The nurse should inform the client that his surgery may have to be postponed indefinitely.
A. The nurse should insist that the client keep the surgery date. B. The nurse should ask the client whether his family will really mind if he doesn't join them for the holy day. ***C. The nurse should inform the surgeon of the scheduling problem and advocate for rescheduling the nonemergency procedure as soon as possible. D. The nurse should inform the client that his surgery may have to be postponed indefinitely. Respecting the client's religious beliefs and practices is an important element in culturally competent nursing care. The nurse should not pressure clients about religious beliefs while informing them of medical concerns.
The nurse is taking care of a 10-year-old client receiving chemotherapy who is experiencing nausea that is distressing the client and parents. Which intervention would be most appropriate in implementing a family- centered plan of care? A. The nurse will provide small nutritious snacks to maintain body weight. B. The nurse will teach distraction techniques to decrease symptoms. C. The nurse will administer intravenous (IV) fluids to prevent dehydration. D. The nurse will administer pain medications as ordered to improve comfort.
A. The nurse will provide small nutritious snacks to maintain body weight. ***B. The nurse will teach distraction techniques to decrease symptoms. C. The nurse will administer intravenous (IV) fluids to prevent dehydration. D. The nurse will administer pain medications as ordered to improve comfort. Interventions are selected because they are related to a specific goal that is shared by the family and healthcare team. All of the interventions mentioned can be effectively used with the client receiving chemotherapy; however, only one intervention (teaching distraction) addresses the goal of decreasing symptoms of nausea.
Which is an accurate description of the term transsexual? A. Transsexuals are individuals born with anatomical characteristics that do not seem to fit the typical definitions of female or male B. Transsexuals demonstrate preferences toward one gender group over another. C. Transsexuals are individuals who perceive themselves to be in the "wrong body." D. Transsexuals have negative feelings or behaviors toward gays or lesbians.
A. Transsexuals are individuals born with anatomical characteristics that do not seem to fit the typical definitions of female or male B. Transsexuals demonstrate preferences toward one gender group over another. ***C. Transsexuals are individuals who perceive themselves to be in the "wrong body." D. Transsexuals have negative feelings or behaviors toward gays or lesbians. Transsexuals are individuals, of any anatomical gender who perceive themselves to be in the "wrong body." Intersex refers to individuals born with anatomical characteristics that do not seem to fit the typical definitions of female or male. Sexists demonstrate preferences toward one gender group over another. Homophobes have negative feelings or behaviors toward gays or lesbians.
Six-year-old Celine Toussaint has been diagnosed with sickle cell disease. She comes to the clinic with her grandparents and parents for follow-up care. In the assessment interview, the parents mention that they are both looking for work. Which nursing intervention would be appropriate for this family? A. Try to find a way to treat the child with less family involvement B. Facilitate connections with community resources C. Create an ecomap with the family D. Create a genogram with the family
A. Try to find a way to treat the child with less family involvement ***B. Facilitate connections with community resources C. Create an ecomap with the family D. Create a genogram with the family This family is at risk because of stressors related to serious illness and financial issues. The appropriate nursing intervention would be to facilitate connections with community resources that could address the family's immediate needs for employment. Intergenerational family support may be a major strength of this family, which the nurse would encourage. Family ecomaps and genograms are tools that nurses use in their assessments, not nursing interventions.
An immigrant Hmong family (parents and two children) comes to a local outpatient clinic in an area where many Hmong have settled. The mother, age 42, has a hacking cough. How should the nurse address the language barrier? A. Use signs and gestures to communicate B. Ask the oldest child to act as translator C. Ask the local immigrant service organization to provide an interpreter D. Conduct a physical assessment with no explanations
A. Use signs and gestures to communicate B. Ask the oldest child to act as translator ***C. Ask the local immigrant service organization to provide an interpreter D. Conduct a physical assessment with no explanations Asking a family member to act as translator may create confidentiality issues. Signs and gestures are inadequate for clear communication. A representative of a local organization will understand the culture and may even have specific helpful knowledge of the family's background. Federal law requires provision of an interpreter.
A nurse administrator is asked to write guidelines for the staff nurses for the use of the hospital's interpreter services for non-English-speaking clients. Which recommendations will the administrator include in the guidelines? (Select all that apply). A. Use technical medical terminology related to the client's diagnosis and treatment B. Provide teaching sheets in the client's language C. Address questions to the client D. Use family members as the first line of interpretation E. Use verbal and nonverbal cues when addressing the client
A. Use technical medical terminology related to the client's diagnosis and treatment ***B. Provide teaching sheets in the client's language ***C. Address questions to the client D. Use family members as the first line of interpretation ***E. Use verbal and nonverbal cues when addressing the client Effective communication with interpreter services includes using nonverbal and verbal communication, including eye contact; speaking in simple, not complex terms; and providing the client with teaching sheets in their language. Family members should not be used as interpreters for confidentiality reasons. Questions should be addressed to the client.
The nurse is assessing the cultural needs of an adult male client who states that he believes in the hot-cold theory. Which response by the nurse indicates understanding of the basis of this cultural belief? A. "What does this belief have to do with your health care?" B. "I am not familiar with this theory. Would you be willing to share more information about it with me?" C. "That is ridiculous and we cannot agree with this theory." D. "Is this the practice of voodoo?"
A. "What does this belief have to do with your health care?" ***B. "I am not familiar with this theory. Would you be willing to share more information about it with me?" C. "That is ridiculous and we cannot agree with this theory." D. "Is this the practice of voodoo?" Asking the client about his belief ensures that the nurse understands it. The nurse would not be judgmental or enforce beliefs onto the client, and using words like "ridiculous" is unacceptable and shows no cultural knowledge. Asking the client if the practice of the hot-cold theory is voodoo would indicate that the nurse does not have a cultural knowledge or understanding and would not make the client feel comfortable. Asking this client what his belief has to do with his health care would indicate that the nurse does not have an interest in incorporating the cultural beliefs of the client into a health care plan and would be inappropriate.