EXAM (NUTRITION/CULTURE)

The nurse is caring for a Jewish client who follows a kosher diet. Which foods should the nurse use in planning meals for the client? Select all that apply.

1.Tuna 3.Chicken 4.Potatoes 5.Apples Rationale: Clients who follow a kosher diet avoid meat from carnivores, pork products, and fish without scales or fins. Fruits and vegetables are considered kosher as long as there are no bugs present. Tuna, chicken, potatoes, and apples are considered kosher and appropriate.

A student nurse examines an Asian-American infant's eyes and notes that the infant's eyes are crossed. Which statement by the student to the nurse indicates an understanding of this finding?

2."It probably isn't strabismus but appears that way because of the child's ethnic background." Rationale: Asian-American, American-Indian, and Alaskan-Native infants often have a pseudostrabismus because of a flattened nasal bridge. It needs to be distinguished from a true strabismus in the assessment. Options 1, 3, and 4 are inaccurate statements.

The nurse is reinforcing instructions to a client regarding how to decrease the intake of phosphorus in the diet. The nurse should tell the client that which food item contains the least amount of phosphorus?

2.Oranges Rationale: An orange contains the least amount of phosphorus. Foods high in phosphorus include fish, pork, beef, chicken, organ meats, nuts, whole-grain breads, and cereals.

The nurse is reinforcing instructions to a Native-American client regarding the procedure for collecting a urine sample. The nurse observes that the client continually stares at the floor during the instructional session. The nurse interprets this as being indicative of which behavior?

Attentiveness Rationale: Native-American clients often stare at the floor when the nurse is talking. This culturally appropriate behavior indicates that the listener is paying close attention to the speaker. Options 1, 2, and 4 are inappropriate interpretations of the client's behavior.

A postoperative client has been placed on a clear liquid diet. Which items is the client allowed to consume? Select all that apply

BROTH COFFEE GELATIN Rationale: A clear liquid diet consists of foods that are relatively transparent to light and are clear and liquid at room and body temperature. These foods include water, bouillon, clear broth, carbonated beverages, gelatin, hard candy, lemonade, Popsicles, and regular or decaffeinated coffee or tea. The incorrect food items are allowed on a full liquid diet.

The nurse provides dietary instructions to a client at risk for hypokalemia about the foods high in potassium that should be included in the daily diet. The nurse tells the client that the fruit highest in potassium is which selection?

Kiwifruit Rationale: Foods that are high in potassium include bananas, cantaloupe, kiwifruit, and oranges. Fruits low in potassium include apples, cherries, grapefruit, peaches, pineapple, and cranberries.

An Appalachian family has brought a toddler to the emergency department with a fractured arm. The nurse knows that nonverbal communication is important to evaluate with assessing the family. Which factors are involved in non-verbal communication? Select all that apply.

1. Touch 3.Body posture 4.Use of space 5.Eye behavior 6.Facial expression Rationale: Communication involves nonverbal messages, which include touch, facial expressions, eye behavior, body posture, and the use of space. Nonverbal communication is powerful and honest, its importance and meaning vary among cultures; therefore, it is essential that the nurse has an awareness of the role that nonverbal cues may have in the communication process. Intonation is specific to verbal communication.

The nurse is preparing to administer a continuous tube feeding to a client with a nasogastric tube. The health care provider has prescribed an amount of 100 mL/hr. How much formula should the nurse plan to add to fill the feeding bag?

1.400 mL of formula Rationale: Feeding can be hung at room temperature for a period of 4 hours. If 100 mL/hr is prescribed, the nurse should fill the feeding bag with a maximum amount of 400 mL. Feeding hung longer than 4 hours at room temperature creates the risk of bacterial invasion in the formula.

An older postoperative client has been tolerating a full liquid diet, and the nurse plans to advance the diet to solid food as prescribed. The nurse collects data regarding which important item before advancing the diet to solids?

1.Ability to chew Rationale: It may be necessary to modify a client's diet to a soft or mechanical chopped diet if the client has difficulty chewing. Food and cultural preferences should have been determined on admission. Bowel sounds should be present before introducing any diet.

The nurse needs to increase the calcium in the diet of a client who is lactose intolerant. Which food items should the nurse encourage? Select all that apply

2.Tofu 4.Broccoli 5.Sardines 6.Mustard greens Rationale: Lactose-intolerant clients should not eat dairy products. Therefore, these clients need high-calcium foods from nondairy sources. Tofu, broccoli, mustard greens, and sardines are foods that are high in calcium that do not come from dairy sources. Although milk and cheese are high in calcium, they are dairy products, which lactose-intolerant clients need to avoid.

A client with heart disease is instructed regarding a low-fat diet. The nurse determines that the client understands the diet if the client states to avoid which food item?

Cheese Rationale: Fruits, vegetables, and skim milk contain minimal amounts of fat. Cheese is high in fat.

Which statement made by the nursing student indicates a need for further teaching by the nursing instructor on the concept of ethnocentrism?

"It is imposing one's beliefs on individuals from another culture." Rationale: Ethnocentrism is a tendency to view one's own ways of life as the most desirable, acceptable, or best, and to act in a superior manner toward another culture. Cultural imposition is the tendency to impose one's own beliefs, values, and patterns of behavior on individuals from another culture.

The nurse is caring for a Southeast Asian woman who presented to the emergency department with complaints of a headache and nausea. The client is accompanied by her adult son. Upon examination, the nurse notes long pale red welts on both arms. Which actions should the nurse take next? Select all that apply.

1.Ask if she has used any home remedies. 2.Assess cultural health beliefs and practices. 5.Recognize the redness is a result of a traditional form of healing. Rationale: The nurse should ask the client if she has used any home remedies. The nurse should assess cultural health beliefs and practices and understand that "coining or coin rubbing" is a traditional form of healing. The nurse should recognize the redness as a result of a traditional form of healing. Coining is an attempt to heal an illness and is not harmful to the client. The son should not be removed from the room unless the client requests. The nurse should not report the use of coining to social services because the practice is not abusive.

A low-sodium diet has been prescribed for a client with hypertension. Which food selected from the menu by the client indicates an understanding of this diet?

1.Baked turkey Rationale: Regular soup (1 cup) contains 900 mg of sodium. Fresh shellfish (1 oz) contains 50 mg of sodium. Poultry (1 oz) contains 25 mg of sodium.

The nurse is collecting data from a client about medications being taken, and the client tells the nurse that he is taking herbal supplements for the treatment of varicose veins. The nurse understands that the client is most likely taking which?

1.Bilberry Rationale: Bilberry is an herbal supplement that has been used to treat varicose veins. This supplement has also been used to treat cataracts, retinopathy, diabetes mellitus, and peripheral vascular disease. Ginseng has been used to improve memory performance and decrease blood glucose levels in type 2 diabetes mellitus. Feverfew is used to prevent migraine headaches and to treat rheumatoid arthritis. Evening primrose is used to treat eczema and skin irritation.

A client with hyperkalemia has a prescription for taking sodium polystyrene sulfonate (Kayexalate) for several days. The client also needs to consume a diet low in potassium. Which foods high in potassium content should the client avoid? Select all that apply.

1.Cabbage 4.Mushrooms 5.Strawberries Rationale: Foods high in potassium content include cabbage, mushrooms, and strawberries. Foods low in potassium content are peaches and soybeans.

The nurse is caring for an African-American client. The nurse enters the room and, following a greeting and introduction to the client, begins to describe the procedure for a prescribed soapsuds enema. The client turns away from the nurse. Which nursing action is appropriate?

1.Continue with the explanation. Rationale: In the African-American culture, direct eye contact may be viewed as being rude. If the client turns away from the nurse during a conversation, the best action is to continue with the conversation. Walking around to the client so that the nurse faces the client is in direct conflict with the cultural practice. Leaving the room and returning later to continue with the explanation may be viewed as a rude gesture by the client. Option 2 is nontherapeutic

The nurse is reinforcing discharge instructions to a Chinese client regarding prescribed dietary modifications. During the teaching session the client continually turns away from the nurse. Which nursing action is most appropriate?

1.Continue with the instructions, verifying client understanding. Rationale: Most Chinese people maintain a formal distance with each other, which is a form of respect. Many Chinese are uncomfortable with face-to-face communication, especially when direct eye contact is involved. If the client turns away from the nurse during a conversation, the best action is to continue with the conversation. Walking around the client so that the nurse faces the client is in direct conflict with the cultural practice. Identifying the importance of the instructions for the maintenance of health care may be viewed as degrading. Returning later to continue with the explanation may be viewed as a rude gesture.

The nurse who is assisting in conducting a weight loss program prepares to monitor a client's weight. The nurse understands that which data mostaccurately determines the effectiveness of weight loss?

1.Daily weights Rationale: The most accurate measurement of weight loss is daily weighing of the client at the same time, in the same clothes, and using the same scale. However, the health care provider's recommendations about daily weight should be followed because of the frequent fluctuations resulting from retained water (including urine) and elimination of feces. Options 2, 3, and 4 assist in measuring nutrition and hydration status rather than actual loss of pounds.

The nurse is reinforcing instructions to a client about complete/high quality protein foods. Which food choice should indicate the client understood the teaching?

1.Eggs Rationale: Complete/high-quality proteins are found in a variety of meats and dairy products, specifically eggs. Beans are incomplete/low-quality proteins as are some cereals. Oranges contain vitamins and minerals.

A client is a lacto-vegetarian. Which food item should the nurse remove from the tray?

1.Eggs Rationale: Eggs are not consumed by lacto-vegetarians. Other dairy and plant products are eaten by lacto-vegetarians.

The nurse instructs a client at risk for hypokalemia about the foods high in potassium that should be included in the daily diet. The nurse determines that the client needs further teaching if the client states that which food is high in potassium?

1.Eggs Rationale: One large egg provides 66 mg of potassium. One-half cup of raisins contains 700 mg of potassium. Four ounces of beef contains 420 mg, and 4 ounces of pork contains 525 mg of potassium.

The nurse knows when preparing the Filipino American client for a surgical procedure it is important to assess for which culturally relevant influences? Select all that apply.

1.Familial hierarchy 2.Cultural practices 3.Reactions to surgery 4.Pain management plans Rationale: To provide culturally competent care to a surgical client, begin by assessing the family hierarchy to determine who needs to be involved in the client's decisions regarding surgery. It is important to identify cultural and religious beliefs and practices that affect a client's and/or family's reactions to surgery and other treatment measures. Pain management plans are important to address because Filipinos believe that pain medication leads to addiction. Practitioner's time management would not be a factor in the nursing assessment.

The nurse is caring for a new immigrant from the Philippines who is in labor. The client is 4 cm dilated and 30% effaced. This is her first child. The mother is grimacing. Her pulse, respiratory rate, and blood pressure are elevated. The nurse offers to check on a prescription for an epidural. The mother declines. The nurse hypothesizes the client declines the epidural for which reasons? Select all that apply.

1.Filipino mothers fear drug addiction. 5.Filipino mothers believe pain is a form of spiritual atonement for one's past deeds. Rationale: Childbirth experiences differ among different cultures. Filipino mothers fear drug addiction. They also believe that pain is a form of spiritual atonement. Hispanic and Arab-American mothers are more vocal during childbirth. Mexican mothers have parteras (specially trained persons) attend them during the childbirth process. Vietnamese mothers are quiet during childbirth and view it as a normal part of life.

A 17-year-old pregnant client is being seen at the obstetric clinic. The nurse is reviewing the following laboratory results, which were obtained 2 hours after breakfast: hemoglobin 10.5 g/dL, sodium 140 mEq, glucose 120 mg/dL, potassium 4.1 mEq. Which dietary instruction should the nurse reinforce for this client?

1.Increase the amount of red meats. Rationale: This client's hemoglobin level is low; red meats are a good source of iron. The glucose level is within range of nonfasting samples. Based on the laboratory results, there is no reason for the client to increase the milk intake or limit the number of bananas consumed daily.

The nurse teaches the family of an infant with spina bifida that the infant should not be given which baby foods that may trigger a latex-type food allergy? Select all that apply.

1.Kiwi 4.Bananas 5.Avocados Rationale: Infants with spina bifida develop a latex allergy and should be in a latex-free environment. Parents should be informed about food sensitivities that are common to children with latex allergies. Foods that should be avoided are bananas, avocados, and kiwi. Prunes and apples will not cause a latex-type reaction.

A nursing student is asked to identify the practices and beliefs of the Amish society. Which should the student identify? Select all that apply.

1.Many choose not to have health insurance. 2.They believe that health is a gift from God. 5.They use both traditional and alternative health care, such as healers, herbs, and massage. 6.Funerals are conducted in the home without a eulogy, flower decorations, or any other display. Caskets are plain and simple, without adornment. Rationale: The Amish society maintains a culture that is distinct and separate from the non-Amish society, and some members generally remain separate from the rest of the world, both physically and socially. Family life has a patriarchal structure, and although the roles of women are considered equally important to those of men, they are very unequal in terms of authority. Amish society rejects materialism and worldliness. Members value living simply, and they may choose to avoid technology, such as electricity and cars. They highly value responsibility, generosity, and helping others, and they often work as farmers, builders, quilters, and homemakers. The Amish use traditional health care and alternative health care, such as healers, herbs, and massage. They believe that health is a gift from God but that clean living and a balanced diet help maintain it. They may choose not to have health insurance and instead maintain mutual aid funds for those members who need help with medical costs. Funerals are conducted in the home without a eulogy, flower decorations, or any other display. Caskets are plain and simple, without adornment. At death, women are usually buried in their bridal dresses.

The nurse reinforces instructions to a client to increase the amount of riboflavin in the diet. The nurse should tell the client to select which food item that is high in riboflavin?

1.Milk Rationale: Food sources of riboflavin include milk, lean meats, fish, and grains. Tomatoes and citrus fruits are high in vitamin C. Green leafy vegetables are high in folic acid.

An African-American client has been admitted for a skin rash on his lower back. Which should the nurse rely on when assessing the skin rash? Select all that apply.

1.Palpation 2.Induration Rationale: The darker a person's skin, the more difficult it is to assess for changes in color. To assess rashes and skin inflammation in dark-skinned individuals, the nurse should rely on palpation for warmth and induration rather than observation. Visualization is often not helpful because of skin color; percussion and auscultation are not the appropriate assessment skills for skin rash.

The nurse consults with a dietitian regarding the dietary preferences of an Asian-American client. Which food should the nurse suggest to include in the diet plan?

1.Rice Rationale: Asian-American food preferences include raw fish, rice, and soy sauce. African-American food preferences include chicken, pork, greens, rice, and fried foods. Hispanic Americans prefer beans, fried foods, spicy foods, chili, and carbonated beverages. European Americans prefer carbohydrates and red meat.

The nurse is providing dietary instructions to a client with gout. The nurse should tell the client to avoid which food item?

1.Scallops Rationale: Scallops should be omitted from the diet of a client who has gout because of the high purine content. The food items identified in the remaining options have negligible purine content and may be consumed by the client with gout.

The nurse caring for a client with a neurological disorder is assisting in planning care to maintain nutritional status. The nurse is concerned about the client's swallowing ability. The nurse avoids including which food item in this client's diet?

1.Spinach Rationale: Moist pastas, casseroles, egg dishes, and potatoes are usually well tolerated by the client who has difficulty swallowing. Raw vegetables, chunky vegetables such as diced beets, and stringy vegetables such as spinach, corn, and peas are foods commonly excluded from the diet of a client who has difficulty swallowing.

The nurse is caring for an older Orthodox Jewish client whose condition is terminal. The nurse is implementing a plan of care and wishes to communicate this plan with the family and client. The nurse should be aware of which end-of-life religious practices when planning and communicating with the client and family? Select all that apply.

1.The client may demonstrate a high level of anxiety. 2.Religious laws are suspended during times of severe illness. 5.If the client dies, care is given so that the body is not be touched by a person of the opposite sex. Rationale: Outward expressions of anxiety are commonly seen among Orthodox Jewish members, especially the older individual. The Orthodox Jew strictly follows the laws of Judaism, however, during times of severe illness, Jewish laws are not observed if doing so will endanger the client's health. In the Orthodox Jewish faith, if the client dies, care is given so that the body is not be touched by a person of the opposite sex. During times of illness or death, the Orthodox Jewish community including family and friends will frequently visit and are considered the nucleus of the Jewish culture. Clients of the Orthodox Jewish faith are generally very verbal about what they are feeling, especially in the older population.

The nurse receives the culture test results for a Hispanic client who developed a bloodstream infection from a central venous device. The culture report indicates that the infection is exogenous. The client asks the nurse how she could have contracted this infection. Which should the nurse include in the explanation of potential sources of infectious organisms? Select all that apply.

1.The health care facility 2.The nurse caring for the client 5.The use of contaminated intravenous fluids Rationale: An exogenous infection is the result of microorganisms that are found outside the individual and are not part of a person's normal flora. This could be from contaminated sources such as a device, the nurse caring for the client, contaminated intravenous fluids, personnel, roommates, etc. The client's home use of homeopathies is not a factor. Endogenous infections are the result of a reactivation of a previous dormant organism, or from the clients themselves such as herpes zoster.

The nurse is caring for a non-English speaking client. Best practices for client safety and quality of care incorporates which actions by the nurse? Select all that apply.

1.Use interpreters who are familiar with health care. 3. Avoid the use of relatives as interpreters to prevent misinterpretation. 4.Use dialect-specific interpreters who are the same gender if possible. 5.Become familiar with common health care words used in the client's language Rationale: Guidelines for communicating with non-English speaking clients include the use of dialect-specific interpreters who are the same gender and age, the use of interpreters who are familiar with health and health care, avoiding the use of relatives as interpreters to decrease the occurrence of bias and misinterpretation, using common health care terms in the client's language, maintaining eye contact with the client when communicating unless it is not culturally accepted, and realizing that clients can often understand English better than they can speak English.

The nurse is caring for an elderly Hispanic client who is a migrant farm worker and has been admitted for asthma. The nurse is unfamiliar with the cultural practices and beliefs of the client's home land. Which questions are appropriate for the nurse to ask when caring for this client? Select all that apply.

1.What do you believe is causing your illness? 4.Are there any remedies you have used in the past? 5.Who do you usually see for help when you are sick? Rationale: When caring for clients of an unfamiliar culture, the nurse should inquire about the clients' health beliefs and practices, their health care provider, and their beliefs regarding the origin of illness in order to provide culturally competent care. Asking the client "why don't you take some asthma medication," may have an accusatory undertone. This type of question will not assist the nurse in developing a rapport. A person's reason for wearing an amulet is not relevant to this situation, and this question may be perceived as intrusive.

A caregiver states that the client eats only about 25% of the food that is offered and seems to be losing weight. The caregiver asks the nurse about feeding the client by a tube into the stomach. Whichinitial response by the nurse would be appropriate?

2."Tube feedings can provide adequate amounts of required nutrients." Rationale: Weight loss and a dietary intake of only 25% indicate that alternative sources of nutritional intake should be sought. Tube feeding is an alternative for temporary or permanent nutritional maintenance. Enteral tube feedings are generally safer and significantly less costly than peripheral or parenteral nutrition. Option 1 is incorrect because tube feedings are often temporary measures. Option 3 may be correct; however, it is not the best response to a caregiver seeking initial information. Option 4 is unrelated to the situation of this question.

A client with a burn injury is transferred to the nursing unit and a regular diet has been prescribed. The nurse encourages the client to eat which dietary items to promote wound healing?

2.Chicken breast, broccoli, strawberries, and milk Rationale: Protein and vitamin C are necessary for wound healing. Poultry and milk are good sources of protein. Broccoli and strawberries are good sources of vitamin C. Peanut butter is a source of niacin. Gelatin and jelly have no nutrient value. Spaghetti is a complex carbohydrate.

A client who has calcium phosphate kidney stones tells the nurse, "Tell me what I can do, so that I never have this pain again." Which instructions should the nurse plan to include in the reinforcement of dietary instructions? Select all that apply.

2.Decrease sodium intake. 4.Limit the intake of whole grains. 5.Limit protein to 5 to 7 servings per week. Rationale: The client should decrease sodium intake because sodium decreases the kidney tubular calcium reabsorption, which will result in increased phosphorus. Limiting whole grains can aid in the reduction of urinary phosphate. Limiting proteins can decrease the acidity of urine, which prevents calcium precipitation. Spinach should be limited in clients with calcium oxalate calculi, not calcium phosphate calculi. Organ meat should be limited in clients with uric acid calculi stones because of purine content.

A client has a diagnosis of hyperphosphatemia. The nurse reinforces teaching the client to eliminate which from the diet?

2.Fish Rationale: Foods naturally high in phosphates should be avoided by the client with hyperphosphatemia. These include fish, eggs, milk products, vegetables, whole grains, and carbonated beverages. Coffee, tea, and cocoa are not high in phosphates.

The nurse is preparing a session regarding nutrition for a group of culturally diverse pregnant women. The nurse determines that the priority nursing intervention includes which action?

2.Identify the cultural food preferences of each client. Rationale: The priority nursing intervention is to identify the cultural food preferences of each client. This information is needed in order to adequately provide information regarding appropriate nutrition. The socioeconomic status may be an important component, particularly when the nurse is determining whether a client's financial situation permits the purchase of appropriate food items. A baseline weight also may be important. Encouraging appropriate nutrition and the need to avoid fast-food restaurants is also important. However, an adequate nutritional plan can be formulated only if cultural food preferences are identified.

A client who has recently been started on enteral feedings begins to complain of abdominal cramping, followed by passage of two liquid stools. The nurse notes that the client has abdominal distention as well. The nurse reviews the nutritional content on the label of the can to see if it contains which ingredient?

2.Lactose Rationale: Several tube feeding formulas contain lactose. A client with an unreported history of lactose intolerance would develop symptoms such as these in response to nutritional therapy with these formulas. If the client is diagnosed as lactose intolerant, a lactose-free formula should be prescribed by the health care provider. This will resolve the client's symptoms and promote adequate nutrition for the client.

The nurse caring for a Chinese-American client plans to use communication according to Chinese-American cultural beliefs and practices. Which techniques are considered disrespectful in the Chinese-American's view of communication? Select all that apply

2.Maintaining eye contact 3.Closing the conversation abruptly 4.Touching the opposite sex in public Rationale: Chinese-Americans are uncomfortable with face-to-face conversations. They prefer to sit side-to-side or at right angles to carry on conversation. Among American Indian, Chinese, and Japanese cultures, silence is sometimes used to allow the listener to consider what the speaker has said before continuing. Maintaining eye contact is often considered ill-mannered and disrespectful. In Eastern cultures including Chinese, East Indian Hindu, Filipino, and Korean, schedules and time are much more flexible concepts. Some Asians will spend a lot of time getting to know someone and will view abrupt endings to a conversation as rude. Although touch is possibly acceptable among same-sex acquaintances, touching in public between opposite sexes is not acceptable.

The nurse knows that spatial behavior is related to territoriality in many Latino cultures. Which client needs are associated with territoriality? Select all that apply.

2.Privacy 3.Security 4.Autonomy 5.Self-identity Rationale: Spatial behavior should be assessed for every client. Territoriality is common to all individuals and groups. Territoriality meets the needs for security, privacy, autonomy, and self-identity. In cultures where priority is given to the group over the individual (Asian cultures, many Latino and most Arab cultures), group rights and shared space are important considerations to make when caring for the clients. Utility is defined as practicality or helpfulness. Philosophy is defined as attitude or thinking.

The nurse is assisting with collecting data from an African-American client admitted to the ambulatory care unit who is scheduled for a hernia repair. Which information about the client is of least priorityduring the data collection?

2.Psychosocial Rationale: The psychosocial data is the least priority during the initial admission data collection. In the African-American culture, it is considered intrusive to ask personal questions during the initial contact or meeting. Additionally, respiratory, neurological, and cardiovascular data include physiological assessments that would be the priority.

A client is seen in the clinic for a physical examination. Laboratory studies are performed and reveal that the hemoglobin and hematocrit are low, indicating the need for further diagnostic studies and a blood transfusion. The client is a Jehovah's Witness and refuses to have a blood transfusion. Which should be an appropriate action by the clinic nurse?

2.Support the client's decision not to receive a blood transfusion. Rationale: Cultural and ethnic background influences an individual's response to health, illness, surgery, and death. Awareness of cultural differences enhances the nurse's knowledge of how a health care experience may be perceived by the client or family. In the Jehovah's Witness religion, the administration of blood and blood products is forbidden. Therefore, the nurse should support the client's decision.

The mother of an infant newly diagnosed with cystic fibrosis is being taught proper nutritional needs for the infant. The nurse determines that the mother understands nutritional needs when the mother gives which response?

3."I know I need to monitor my infant's stools, and if there are more than four stools a day, I will increase the pancreatic enzyme." Rationale: Cystic fibrosis requires a high-calorie, high-protein diet with pancreatic enzyme replacement therapy. The infant needs to remain on the predigested formula until 1 year of age, when formula can be discontinued and then fat-free milk consumed. The pancreatic enzyme should not be mixed with warmed foods because this inactivates the enzyme. Stools must be monitored, and pancreatic enzymes are administered based on the stool pattern.

An antihypertensive medication has been prescribed for a client with hypertension. The client tells the nurse that she would like to take an herbal substance to help lower her blood pressure. Which statement by the nurse is the most important to provide to the client?

3."You will need to talk to your health care provider (HCP) before using an herbal substance." Rationale: Although herbal substances may have some beneficial effects, not all herbs are safe to use. Clients who are being treated with conventional medication therapy should be advised to avoid herbal substances with similar pharmacological effects, because the combination may lead to an excessive reaction or unknown interaction effects. Therefore, the nurse would advise the client to discuss the use of the herbal substance with the HCP.

Why should the nurse who is focusing on facilitating positive outcomes regarding health care services become familiar with the cultural beliefs and practices of a childbearing woman?

3.A culturally diverse woman may have beliefs that impact the delivery of health care services. Rationale: The nurse providing care for women in their childbearing years must be familiar with the cultural framework within which the client lives and operates. Once this is achieved, appropriate communication techniques can be used to facilitate client assessment and care and to identify health promotion educational strategies and delivery of services. Although the other options may be true, their impact on services is not as influential as that of option 3.

The nurse is caring for a Hispanic client who reports that she is a practicing Roman Catholic. Which actions by the nurse demonstrate spiritual and cultural sensitivity? Select all that apply.

3.Allow client to observe communion daily if requested. 4.Facilitate anointing of the client by a priest if requested. Rationale: During response to illness, practicing Roman Catholics may request to be anointed while sick. They may also practice daily Holy Communion. Meals permissible by Muslims include Halal foods. Muslims also prefer to turn their bed toward the East, toward Mecca. Jehovah's Witness belief system includes refusal of blood products.

The nurse checks the food on a tray delivered for an Orthodox Jewish client and notes that the client has received a cheeseburger and potato fries with whole milk as a beverage. Which action should the nurse take?

3.Call the dietary department and ask for a different meal. Rationale: In the Orthodox Jewish tradition, members avoid meat from carnivores, pork products, and certain fish. The nurse should not deliver the food tray to the client and should ask the dietary department to deliver a different meal. Meat and dairy are served separately, thus the dairy-meat combination is not acceptable, making option 2 incorrect. Option 4 is incorrect because pork and pork products are also not allowed in the diet.

The nurse is preparing to deliver a food tray to a client whose religion is Judaism. The nurse checks the food on the tray and notes that the client has received a roast beef dinner with whole milk as a beverage. Which action should the nurse take?

3.Call the dietary department and ask for a new meal tray. Rationale: In the Jewish religion, the dairy-meat combination is not acceptable. Pork and pork products are not allowed in the traditional Jewish religion. The only correct nursing action noted in the options is to ask the dietary department to deliver a new meal tray.

A client receiving total parenteral nutrition complains of nausea, excessive thirst, and increased frequency of voiding. The nurse should initially review which client data

3.Capillary blood glucose level Rationale: The symptoms exhibited by the client are consistent with hyperglycemia. The nurse would need to check the client's blood glucose level to verify this. Clients receiving parenteral nutrition are at risk for hyperglycemia related to the increased glucose load of the solution. The other options would not provide any information that would correlate with the client symptoms.

The nurse is asked to assist with preparing a client who will be receiving a total parenteral nutrition (TPN) solution via a central line. The nurse plans to obtain which essential piece of equipment for this procedure?

3.Electronic infusion pump Rationale: The nurse obtains an electronic infusion pump in preparation for the administration of TPN. It is necessary to use an infusion pump to ensure that the solution does not infuse too rapidly or fall too far behind. Because the client's blood glucose level is monitored every 6 to 8 hours during the administration of TPN, a blood glucose meter will also be needed, but this is not the most essential item. Use of urine test strips to measure spilled glucose is not necessary and is not an accurate measure of a complication. A noninvasive blood pressure cuff is unnecessary for this procedure.

A 24-year-old Chinese American is breastfeeding her infant girl. The client's mother asked the nurse not to include cold foods on her daughter's tray because they are not good for the baby. The nurse responds by telling the client that she can have what she wants; it is not up to her mother. This response demonstrates which cultural characteristic?

3.Ethnocentrism Rationale: Ethnocentrism is the perception that one's own way is best. In the nursing profession, there is a tendency to be ethnocentric. Nurses must remain cognizant of the fact that their ways are not necessarily the best and that other people's ideas are not inferior to their own. Nurses must remember that the ideas of laypersons may be valid for them and will influence their health care behavior. Subculture is a culture within a group or culture. Assimilation is defined as accommodation or adjustments. Cultural relativism is the view that all beliefs, customs, and ethics are relative to the individual within their own social context.

The nurse is planning to reinforce nutrition instructions to an African-American client. When reviewing the plan, the nurse is aware that which food is a common dietary practice of clients with African-American heritage?

3.Fried foods Rationale: African-American food preferences include chicken, pork, greens, rice, and fried foods. Asian Americans eat raw fish, rice, and soy sauce. Hispanic Americans prefer beans, fried foods, spicy foods, chili, and carbonated beverages. European Americans prefer carbohydrates and red meat.

The nurse is assigned to care for an Asian-American client. The nurse develops a plan of care based on which belief?

3.Illness is caused by an imbalance between yin and yang. Rationale: Asian Americans believe that illness is caused by an imbalance between yin and yang, by prolonged sitting or lying, or by overexertion. In the African-American culture, illness is viewed as a disharmonious state that may be caused by demons and spirits. Native Americans believe that illness is caused by supernatural forces.

The nurse has conducted dietary teaching with the client diagnosed with iron deficiency anemia. The nurse determines that the client understands the information if the client states to increase intake of which food?

3.Kidney beans Rationale: The client with iron deficiency anemia should increase intake of foods that are naturally high in iron. The best sources of dietary iron are red meat, liver, other organ meats, blackstrap molasses, and oysters. Other good sources of iron are kidney beans, whole wheat bread, egg yolk, spinach, kale, turnip tops, beet greens, carrots, raisins, and apricots.

The nurse employed in a well-baby clinic is reinforcing nutrition instructions to the mother of a 1-month-old infant. Which instruction should the nurse provide the mother?

3.Offer breast milk or formula as the main food. Rationale: Breast milk or formula is the main food throughout infancy. Rice cereal mixed with breast milk or formula is introduced at 4 months of age. Strained vegetables, fruits, and meats, are introduced one at a time and can begin at 6 months of age.

A newly pregnant client is asking how to prevent neural-tube birth defects. Which food choice should the nurse recommend?

3.Oranges Rationale: Folic acid (folate) helps prevent neural-tube birth defects; it is found in green, leafy vegetables; liver, beef, and fish; legumes; and grapefruit and oranges. Peanuts are high in protein and niacin. Milk is high in carbohydrates and vitamin D. Egg yolks are high in vitamin A, iron, and cholesterol.

The nurse is preparing to administer an intermittent tube feeding to a client. The nurse aspirates 90 mL of residual tube feeding. Which action should the nurse take with the aspirated residual?

3.Reinstill the residual and administer the feeding. Rationale: Unless otherwise instructed (or per agency policy), a residual amount of less than 100 mL may be reinstilled and the prescribed amount of tube feeding administered. It is important to return the contents to the stomach to prevent electrolyte imbalances. Therefore, options 1, 2, and 4 are incorrect.

The nurse is preparing to administer an intermittent tube feeding to a client. The nurse aspirates 90 mL of residual from the tube. What should the nurse do with the aspirated residual?

3.Reinstill the residual and administer the feeding. Rationale: Unless otherwise instructed or if the residual contents appear abnormal, an amount of less than 100 mL may be reinstituted; then a normal amount of prescribed tube feeding is administered. It is important to return the contents to the stomach to prevent electrolyte imbalances. Therefore, options 1, 2, and 4 are incorrect.

The nurse is developing a nutritional plan for an assigned client. Which is the most critical piece of data to collect before formulating the plan?

3.The presence of food allergies Rationale: The presence of food allergies is critical to know before developing a nutritional plan. The items listed in the other options also provide good information but are not as crucial as the presence of food allergies.

A client who is receiving total parenteral nutrition may begin to take small amounts of clear liquids today. The nurse's priority is to collect data regarding which criterion before giving the client anything by mouth?

3.The presence of the swallow reflex Rationale: The nurse ensures that the client has intact gag and swallow reflexes before giving clear liquids. The nurse should also check for the presence of bowel sounds. The pulse, blood pressure, and weight require ongoing monitoring, but they are not the most important items given the wording of the question. The client may be expected to have a poor appetite after being without oral intake for a period of time.

The nurse is reinforcing diet teaching for a client on a low-sodium diet for hypertension. The nurse determines that the client needs further teachingwhen the client makes which statement?

4."Canned foods are inexpensive and are good to use on a low-sodium diet." Rationale: A low-sodium diet is used as an adjunct to antihypertensive medications for the treatment of hypertension. Sodium retains fluid, which leads to hypertension secondary to increased fluid volume. Canned foods use salt as a preservative and should not be encouraged as part of a low-sodium diet. Lifelong medication is necessary in the treatment of hypertension.

The nurse educator is providing an in-service education to the nursing staff regarding transcultural nursing care. A staff member asks the nurse educator to describe the concept of acculturation. Which response is appropriate?

4."It is a process of learning a different culture to adapt to a new or changing environment." Rationale: Acculturation is a process of learning a different culture to adapt to a new or changing environment. Option 1 describes ethnic identity. Option 2 describes an ethnic group. Option 3 describes a subculture.

A nursing student is discussing cultural issues in a clinical conference. The nursing instructor asks the student to describe ethnocentrism. Which statement by the student indicates a lack of understandingof the issue of ethnocentrism?

4."It is imposing one's beliefs on individuals from another culture." Rationale: Ethnocentrism is a tendency to view one's own ways of life as the most desirable, acceptable, or best and to act in a superior manner toward another culture. Cultural imposition is the tendency to impose one's own beliefs, values, and patterns of behavior on individuals from another culture.

A client is diagnosed with cancer and is told that surgery followed by chemotherapy will be necessary. The client states to the nurse, "I have read a lot about complementary therapies. Do you think I should try any?" The nurse should respond by making which appropriate statement?

4."Let's talk more about the different forms of complementary therapies." Rationale: Complementary (alternative) therapies include a wide variety of treatment modalities that are used in addition to conventional treatment to treat a disease or illness. These therapies complement conventional treatment, but they should be approved by the person's health care provider (HCP) to ensure that the treatment does not interact with prescribed therapy. Although the HCP should approve the use of a complementary therapy, it is important for the nurse to explore the complementary therapies first with the client, which would eliminate option 2. The statement in option 3 is inappropriate. Similarly, option 1 is an inappropriate response to the client. Option 4 addresses the client's question and encourages discussion.

The nurse is preparing to assist a client of Orthodox Jewish faith with eating lunch. A kosher meal is delivered to the client. Which nursing action is appropriate when assisting the client with the meal?

4.Allowing the client to unwrap the utensils and prepare his own meal for eating Rationale: Kosher meals arrive on paper plates and with plastic utensils sealed. Health care providers should not unwrap the utensils or transfer the food to another serving dish. Although the nurse may want to be helpful by assisting the client with the meal, the only appropriate option for this client is option 4.

A client has a serum sodium level of 151 mEq/L, and the nurse reinforces dietary teaching about the types of foods to avoid. The nurse determines that the client needs further teaching if the client states that which is a good food choice?

4.American cheese Rationale: The client's laboratory value reflects hypernatremia because the normal serum sodium level is 135 to 145 mEq/L. Based on this finding, the nurse should instruct the client to avoid foods high in sodium. These should include foods from animal sources, which contain physiological saline, and highly processed meats and other foods that often have sodium added as a preservative. Spinach and rhubarb are good food sources of calcium. Fish is high in phosphorus.

A client states that he has removed all dairy foods from his diet because he is lactose intolerant. The nurse plans care for the client, knowing which information?

4.Calcium and protein are valuable nutrients and need to be supplemented in some form. Rationale: Calcium and protein need to be supplemented in some form in the diet of the client with lactose intolerance. Lactose enzymes may help clients with lactose intolerance, but they may not eliminate the client's problems. An individual generally does not consume enough leafy green vegetables daily to obtain sufficient calcium.

A client is admitted to a long-term care facility with the diagnosis of weight loss secondary to anorexia. The health care provider inserts a nasogastric tube and prescribes a tube feeding of a standard formula feeding to run at 50 mL/hr. The nurse plans care, knowing that which is true regarding enteral feedings?

4.Enteral feedings require the normal digestive capabilities of the gastrointestinal (GI) tract. Rationale: Enteral nutrition can include providing nutrients by mouth, nasogastric tube, gastrostomy tubes, or a percutaneous endoscopic gastrostomy (PEG) tube. The common element in each of these methods of delivery is that the client must have normal GI digestive capabilities. If the client does not have a normal GI tract, other methods of nutrient delivery must be sought, such as parenteral nutrition. Enteral feedings may cause aspiration pneumonia because of regurgitation of formula into the lungs; however, they are not generally associated with sepsis. Tube feedings should be given at room temperature to avoid problems with diarrhea. The caloric value of most standard enteral feeding formulas is 1 to 2 kcal/mL.

A client receiving enteral feedings develops abdominal distention and diarrhea shortly after initiation of the feedings. In review of the nursing history for this client, which of these notations indicates the need to notify the health care provider?

4.Lactose intolerance since childhood Rationale: Lactose intolerance would require the client to be placed on a lactose-free formula. The primary health care provider would be notified to change the prescribed enteral solution. Options 1, 2, and 3 are unrelated to the client's problem.

The nurse is caring for a client following a total hip replacement. The client has been diagnosed with iron deficiency anemia. The nurse instructs the client to increase intake of which foods?

4.Lean beef and chicken liver Rationale: The client with iron deficiency anemia should increase intake of foods that are naturally high in iron. The best sources of dietary iron are red meat, liver, and other organ meats, blackstrap molasses, and oysters. Milk products are lowest in iron of all of the food sources listed.

The nurse is reinforcing dietary instructions to a client with tuberculosis. The nurse should specifically instruct the client to increase intake of which food items in the daily diet?

4.Meats and citrus fruits Rationale: The nurse teaches the client with tuberculosis to increase intake of protein, iron, and vitamin C. Food sources that are rich in protein include meats and legumes. Food rich in iron include liver and other meats, from which 10% to 30% of available iron is absorbed. Foods rich in vitamin C include citrus fruits, berries, melons, pineapple, broccoli, cabbage, green peppers, tomatoes, potatoes, chard, kale, asparagus, and turnip greens. Less than 10% of iron is absorbed from eggs, and less than 5% is absorbed from grains and vegetables.

A client is recovering from abdominal surgery and has a large abdominal wound. The nurse encourages the client to eat which food that is naturally high in vitamin C to promote wound healing?

4.Oranges Rationale: Citrus fruits and juices are especially high in vitamin C. Other sources are potatoes, tomatoes, and other fruits and vegetables. Meats and dairy products are two food groups that are not especially high in vitamin C.

The nurse reviews a client's serum sodium level and notes that the level is 150 mEq/L. The health care provider prescribes dietary instructions for the client based on the sodium level. Which food item should the nurse instruct the client to avoid

4.Processed oat cereals Rationale: The normal serum sodium level is 135 to 145 mEq/L. A serum sodium level of 150 mEq/L is indicative of hypernatremia. Based on this finding, the nurse should instruct the client to avoid foods high in sodium, such as processed foods. Spinach and molasses are good food sources of calcium. Squash is high in phosphorus.

The nurse is providing care to a Cuban-American client who is terminally ill. Numerous family members are present most of the time, and many of the family members are very emotional. Which nursing action is most appropriate?

4.Request permission to move the client to a private room, and allow the family members to visit. Rationale: In the Cuban culture, loud crying and other physical symptoms of grief are considered socially acceptable. Of the options provided, option 4 is the only option that identifies a culturally sensitive approach on the part of the nurse. Options 1, 2, and 3 are inappropriate nursing interventions.

The nurse is assisting in preparing a plan of care for a client who is a Jehovah's Witness. The client has been told that surgery is necessary. Considering the client's religious preferences, the nurse documents which information?

4.The administration of blood and blood products is forbidden. Rationale: In the Jehovah's Witness religion, surgery is not opposed, but the administration of blood and blood products is forbidden. Medication is an acceptable practice except if the medication is derived from blood products. Faith healing is forbidden in this religious group.

The nurse educator is describing the yin and yang theory of the ancient Chinese philosophy of Tao to a group of nursing students. The nurse educator explains that in this theory, foods are classified as hot and cold and are transformed into yin and yang energy when metabolized by the body. The nursing student understands this theory when the student makes which statement?

4.The client consumes cold foods when a "hot" illness is present. Rationale: In the yin and yang theory, health is believed to exist when all aspects of the person are in perfect balance. Foods are classified as hot or cold and are transformed into yin and yang energy when metabolized by the body. Yin foods are cold, and yang foods are hot. Cold foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illness.

A Hispanic-American mother brings her child to the clinic for an examination. Which is most importantwhen gathering data about the child?

4.Touching the child during the examination Rationale: In the Hispanic-American culture, eye behavior is significant. It is believed that the "bad/evil eye" can be given to a child if a person looks at and admires a child without touching the child. Therefore, touching the child during the examination is very important. Although avoiding eye contact indicates respect and attentiveness, this is not the most important intervention. Avoiding speaking to the child and using body language only are not therapeutic interventions.

A client has been diagnosed with pernicious anemia. In planning care for the client, the nurse anticipates that the client will be treated with which?

4.Vitamin B12 Rationale: Pernicious anemia is caused by a deficiency of vitamin B12. Treatment consists of monthly injections of vitamin B12. Thiamine is most often prescribed for the client with alcoholism. Iron is administered for iron deficiency anemia, and folic acid is prescribed for folic acid deficiency.

The hospice nurse is caring for five clients from various religious backgrounds. Which observations should the nurse expect for the clients of the various religious backgrounds? Select all that apply.

A client of the Muslim faith having their bed positioned toward Mecca -A Hindu-believing family arranges to have the clients' body cremated within 24 hours of death Rationale: Those of the Muslim faith desire their body to be facing Mecca. Those of the Hindu faith believe in cremation within 24 hours to release their soul from earthly attachments. A priest hears confessions of the Catholic faith, not the Methodist faith. The number 4 is avoided by those of an Asian background because it symbolizes death. Catholics, not Baptists, avoid warm-blooded meats on Fridays.

The nurse is caring for an older Appalachian client recovering from open heart surgery. In order to provide culturally appropriate care, the nurse should be aware that which aspects of reporting pain may be impacted by the Appalachian culture? Select all that apply.

Appalachian clients may want to appear to be stoic. -Appalachian clients may be afraid of addiction tendencies. -Appalachian clients may not want to appear to be complainers. Rationale: In the Appalachian culture, clients often appear stoic and do not want to complain. Clients may not want to appear to be a complainer or a bother to someone, so often they do not report their pain. Addiction tendencies may be a concern to clients from many different backgrounds.. It is a common myth that all Appalachian clients are illiterate. The nurse must not assume that all Appalachian clients are illiterate.

A clear liquid diet has been prescribed for a client with gastroenteritis. Which item is appropriate to offer to the client?

Fat-free beef broth Rationale: A clear liquid diet consists of foods that are relatively transparent. Soft custard and orange juice would be included in a full liquid diet because they are opaque, not clear. Clam chowder is opaque and also includes pieces of clams, thus eliminating it from a full liquid diet.

A client with hypertension has been prescribed a low-sodium diet. The nurse teaching this client about foods that are allowed should include which food in a list provided to the client?

Summer squash Rationale: Foods that are lower in sodium are fruits and vegetables (option 4) because they do not contain physiological saline. Highly processed or refined foods (options 1 and 3) are higher in sodium unless they are noted specifically to be "low sodium." Saltwater fish and shellfish are high in sodium.