Ha ch. 31, 11, 12, 28

When the nurse palpates the abdomen of a preschool boy, he begins to giggle and draw his legs up onto his abdomen. Which of the following would be most appropriate for the nurse to do?

Palpate with the child's hand under the nurse's hand,

After inspecting an adolescent male's genitalia. the urse documents the findings as Tanner stage 3. Which of the following findings would be most likely?

Penis elongated; pubic hair sparse over pubis, coarse and curly

The nurse has assessed the head circumference (HC) of an 18-month-old during a checkup The nurse should compare the percentile of the child's HC to which of regular the following?

The child's height and weight percentiles

A clinic nurse is conducting a comprehensive assessment t of a 70-year-old male elient of Native American ethnicity. The nurse observes that the client rarely makes eye contact and holds his head low during the assessment. How should the nurse best interpret this practice?

The client may be showing the nurse respect

During palpation of a young child's abdomen, the nurse assesses the liver . Which of the following would the nurse expect to find?

The liver is located 2 cm below the right costal margin

A preadolescent girl comes to the clinic for a sports physical exam. The nurse notes beginning breast development and documents which of the following?

Thelarche

A nurse is working with a 22-year-old" woman of Asian ethnicity who has been diagnosed with bipolar disorder. When planning culturally appropriate care, the nurse sthould consider which of the following

There may be shame associated with having psychiatric disorder.

The nurse is assessing the diet and nutritional status of a client from a different culture, Which of the following questions would be appropriate for the nurse to ask Select all that apply.

What foods do you commonly ear? Do you have any special routine for eating? Do you have certain foods to keep you healthy?

The nurse is teaching a group of parents of children of various ages how to best measure a child's temperature. The nurse instructs the parents that rectal temperature measurement is indicated in which situation

When no other route is feasible

Which technique should the nurse use to perform scoliosis screening in a school-age child?

Have the child bend forward at the waist.

The nurse's inspection of a young child's anus reveals the presence of hemorrhoids. How should the nurse best interpret this assessment finding?

Hemorrhoids are unusual in children and warrant further assessment

A nurse is relying heavily on gestures and simplified language during the assessment of a. client from another culture who speaks minimal English. During the lengtty assessment, the nurse asks the client if she is iokavi by making a circle with his thumb and forefinger, the nurse should be aware of which of the following?

In some cultures this gesture is offensive

The nurse inspects a 10-day-old infant's umbilicus and notes that it is reddened with the presence of slight discharge What nursing diagnosis is suggested by these data?

Infection

A nurse educator is reviewing the unit's resources about religious groups and their views about blood and blood products, organ donations, and autopsy. A member of which group is most likely "to refuse a blood transfusion

Jehovah's Witesses

The nurse is preparing to lead a health promotion activity among a group of clients from different cultures. The nurse would expect that which client would require the least amount of personal space'

Middle Easterner

A nurse has identified the goal of becoming more culurally sensitive and competent. What is the primary rationle for cultural sensitivity in health care settings?

Obtain accurate assessment data

The nurse assesses the respiratory rate of a 5-year-old boy. Which finding would indicate to ther nurse that his rale is within the age-appropriate range for this child?

24 breaths/minute

The nurse is participating in a vision-screening program for children age 3 to 10 years The nurse would expect a child to have 20/20 vision at what age?

6 to 7

A mother voices concern about the amount of time her school-age child sleeps When $ responding 1o the mother, the nurse understands that this age group sleeps an average of how many hours each night?

8 to 9.5

The school nurse is assessing a 15-year-old client. The nurse should understand that this child's current priorities will most likely reflect what developmental task?

Developing a personal identity

A nurse is assessing an Aftican -American client who has a longstanding diagnosis of hypertension. The nurse should be aware that the client may experience a greater-than, average effect of what medication

A diuretic

A nurse is conducting a workshop with a group of adults who are enrolled in a parenting class, Which of the following would the nurse emnhasize as imnortant in helping the school-age child achieve the psychosocial task of industry and avoid inferiority?

Acknowledge accomplishments

When describing cultural differences related to tooth eruption. the nurse explains that permanent teeth typically appear earlier in which group

African Americans

When reviewing cultural differences that relate to the incidence and prevalence of disease among various cultural groups, the nurse would expect to see the highest prevalence of asthma in which group'

African Americans

A nurse is validating findings with a client and the client proceeds to assessment describe some of the psychological and spiritual components that she believes underlie her disease process. Thist understanding or the cause Or illness is most closely associated with which of the following?

Asian cultures

A 4-year-old boy is brought to the emergency department by his parents, who state that he has been crying and saying his itummy hurts.i Which method would be most appropriate for the nurse to initially assess the problem?

Ask the child to point with one finger where it hurts

The nurse's assessment of a child's hair reveals that it is clean and neatly trimmed but exceptionally dry and britle. Whal is the nurse's best response to this finding?

Assess the child for signs and symptoms of impaired nutrition,

A school nurse plans to test hearing acuity in students who range between kindergarten and sixth grade- Which of the following would be the most appropriate method?

Audiometry

The nurse has identified a need to discuss sexuality with a 15-year-old client. How should the nurse best plan this aspect of the health interview?

Discuss the matter when a parent is not present

When assessing adolescent girls, the nurse should know that which of the following usually appears first?

Breast buds

a nurse who provides care in a busy, inner-city clinic performs physical examinations on clients of various cultures. In a client from which group would the nurse expect to find the greatest amount of body odor from perspiration?

Caucasian

A nurse is providing an in-service presentation to a group of new pediatric nurses and reviewing differences in assessment of children and adults. When deseribing the heart sound typically auscultated in children in comparison to an adult, which characteristic would the nurse describe?

Children typically have higher pitched heart sounds.

A cardiac care nurse works with a diverse client population . The nurse would assess a client from which cultural group for an increased effect of an antihypertensive medication?

Chinese

During the health history, a nurse asks a mother to describe the play activities of her school-age son. The mother reports activities that are typical for this age group. The nurse would document this as which type of play?

Competitive

A nurse is caring for a 70-year-old cient from a different culture whose breast cancer has metastasized. The nurse observes that the client tends to defer responsibility for nurse decision making around treatment options to her cldest son. How should the nurse respond to this?

Confirm that the client wants her son to make decisions and follow those decisions accordingly.

Based on a colleague's feedback, a nurse learns that she is aware of cultural differences in a general way but docs not tnow what the specifie differences are or how to communicate with a person of a specific culture. This nurse exhibits which of the following?

Conscious incompetence

A nurse is participating in an educational exercise in which she is conducting a self- examination of her own biases. This activity addresses what construct of cultural competence

Cultural awareness

A group of students is reviewing material on cultural competence. The students demonstrate understanding of this concept when they identify which of the following as the starting point?

Cultural desire

The nurse atends a Native-American Alcoholic A nonymous support group and develops close relationships with three group members. The nurse is demonstrating which of the following?

Cultural encounter

The nurse is assessing a 6-year-old child. While auscultating the child's apical heant rate he nurse notes that the child's heant rate increases during inspiration . What is the nurse' most appropriate action?

Document this as an expected assessment finding

A nurse is assessing a client of East Asian descent. Which biological variation would the nurse expect?

Dry cerumen in the client's ears

A male Hispanic client deseribes the fact that he mixed hot and cold foods, causing them to lump together and iget stuck in his intestines,i causing diarrhea and abdominal pain. The nurse would document this as which of the following?

Empacho

The nurse is experiencing challenges in eliciting information during the health interview of a 4-year-old boy. How can the nurse best foster communication with the child?

Engage the child in play.

A nurse's reflection of his practice reveals that he tends to see his own culture as the gold standard to which all other cultures should aspire. This nurse should create learning goals to address what phenomenon?

Ethnocentrism

A nurse is admitting a client who is from another culture. Prior to caring for a client from another culture, the nurse should place primary importance on which action?

Examining personal biases and prejudices

An African-American woman collapses at the funeral of her mother and later states that she could hear everything pcople were saying to her but, for a brief period, she could not move. The nurse interprets this s as which of the following?

Falling out

The nurse is meeting the parents of an ill child for the first time and is preparing t perform the health interview, In addition to gauthering health data, what additional goal should the nurse prioritize during this interaction?

Foster trust with the child's parents

A nurse is having difficuly geting a 14-year-old child to iopen upt during the healt interview What strategy is most likely enhance the nurse's communication with this child?

Give the child some control over the course and content of the interview

A nurse is assessing an Asian client and observes several reddened and bruised areas on the skin. Further assessment reveals that the client was using cupping to treat back pain, the skin. The nurse understands this as which of the following

Placing heated glass jars on the skin that are allowed to cool

A nurse is modifying an Asian client's diet to accommodate the concept of hot and cold. The nurse demonstrates an understanding of this concept when identif ying which of the following as a cold condition?

Pneumonia

Which finding would require further evaluation or referral when auscultating heart sounds on an 8-year-old cient during a routine physical exam?

Pulse rate 120 beats per minute

A nurse has completed an assessment of a school-age child. The nurse has identified several soft signs of potential neurologic impairment. How should the nurse best interpret these findings?

Recognize that the findings may or may not indicate the presence of a neurologic problem

During a wellchild visit, a parent asks the nurse the best way to manage negativism in her toddler., Which suggestions by the nurse would be most appropriate?

Reduce the opportunities for a no answer.,

The nurse is interviewing a female Hispanic client who is scheduled for a cardiovascular education program., The client states. 1lcan't cat and I don't sleep because my daughter left to return to Mexico. I am sad and nervous, I ned resti The nurse suspects that she is suffering from Susto. Which action by the nurse would be best?

Reschedule the education program.

When considering the various cultural aspects associated with death rituals, which of the following should guide a nurse's practice'

Rituals for burial and bereavement are likely to reflect original cultural practices.

A nurse admits to a colleague, i sometimes tend to avoid clients from other cultures because it's awkward and it's usually frustrating for me and for the client. This nurse is likely lacking in what construct of cultural competency?

cultural desire

The pediatic nurse is obtaining the nursing history of a 4-year-old girl who is accompanied by her mother. What question should the nurse pose to the child's mother?

does your daughter often ask why?

A nurse educator is leading a group of nurses in exercises aimed at improving cultural competence. Which of the following would the educator use to best describe an aspect of the term culture

lt is shared through norms for behaviors. values and beliefs.

A nurse states, Hispanic people have no clue about primary prevention of illness.The nurse is demonstrating which of the following?

stereotyping

A nurse will be working in a clinic in South Asia for several weeks. where the maioritv of residents have darkly pigmented skin. The nurse should expect a higher-than-average incidence of what integumentary health problem'?

vitiligo