Prep U's - Chapter 5 - Cultural Diversity (TF)

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

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

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

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

When an American client states, "I only want an American doctor," the client is expressing: A. ethnocentrism. B. racism. C. cultural relativity. D. cultural pervasiveness.

Answer: A Rationale: Viewing one's own culture as superior to all others is ethnocentrism. Cultural relativity is the belief that to understand a person, you must understand that person's cultural context. Cultural pervasiveness refers to how widespread the effects of a culture are. Racism is the belief that one's race is superior to others.

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

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

The nurse is caring for two clients with the same ethnic background. The nurse notices some differences between the two in the religious practices and the slang used for communicating. What is most likely the etiology of these differences? A. cultural norms B. ethnocentrism C. cultural relativity D. ethnicity

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

A family has recently immigrated. All members are quickly learning the language and the children are all in public school. Both parents are working and adapting to the new culture. What is this family demonstrating? A. Culture shock B. Cultural blindness C. Cultural imposition D. Cultural assimilation

Answer: D Rationale: When a minority group lives within a dominant group, many members may lose the cultural characteristics that once made them different and take on the values of the dominant culture. This process is called cultural assimilation.

The nurse obtains a health history interview on a client with lung cancer. The client states, "I became too focused at work; I did not have time to rest. I usually work 8 hours per day but, for the past few months, I have been spending at least 12 hours per day at the office. That is probably the reason why I was diagnosed with cancer. Maybe when I try to go back to my usual schedule, the cancer will go away. I did not want to be here, but my wife is insistent. I do not think medications work. My brother-in-law died of cancer. He took a lot of medicines and prayed really hard, but he died just the same." The nurse determines that the client believes in the ________________ (holistic, magico-religious, biomedical) cause of illness as manifested by _______________ (commenting on the lack of confidence in the power of prayer, believing one can be cured of cancer by limiting work hours, expressing a lack of confidence in medication use and their ability to cure the illness).

Answer: holistic, believing one can be cured of cancer by limiting work hours. Rationale: The holistic perspective presupposes that health is achieved when an individual is in harmony or in balance with the internal/external environment; illness is caused by any imbalance or disharmony. Believing that the cancer will be cured if the client cuts back on work hours is a means of restoring balance and harmony; thus, supports the holistic perspective of health. The biomedical perspective relies on empirical findings to explain health and illness. Believing in the effectiveness of medications supports the biomedical model. This perspective does not apply because the client is skeptical about relying on medications to cure the cancer. The client states, "I do not think medications work" and comments about how the brother-in-law took "a lot of medicines" and still died. The belief that supernatural forces influence health and illness supports the magico-religious perspective. Exhibiting confidence in the power of prayer to alleviate and/or cure illnesses falls under the magico-religious belief. The client comments that the brother-in-law died even though the brother-in-law prayed "really hard," which leads the nurse to believe the client does not hold the belief that prayer will cure the illness.

The nurse is caring for a client whose language skills are very limited in the dominant language, and an interpreter has been obtained. The interpreter appears to be telling the client more than the nurse is saying and possibly providing an opinion or medical advice. Which action is appropriate for the nurse to take? A. Speak privately with the interpreter and instruct them to only provide language interpretation. B. Continue with the method of communication because the nurse does not speak the language. C. Document in the medical record that the client is not making his own decisions. D. Use a computerized application to confirm what the interpreter is saying.

Answer: A Rationale: All clients have a right to proper communication with a healthcare provider. Obtaining a certified interpreter is the most appropriate way to ensure accurate communication between a client and the provider. However, the interpreter must have a clear understanding of their role as a language interpreter only and not provide medical information or advice. The nurse should speak privately with the interpreter if there is a suspicion that the interpreter is not respecting boundaries. Using a computerized application to identify key medical words does not allow full communication to take place, and thus, key health information can be missed.

A client is admitted to the health care facility with hypoglycemia. After the client is stable, the nurse discovers that the client has not taken the prescribed medicines. The client believes that eating saffron will keep blood sugar under control. What is the most appropriate response by the nurse? A. "What would you think about taking the medicines, too, and benefitting from both?" B. "Let me inform the health care provider that you are not taking your medicines." C. "Saffron does not have any effect on blood sugar level." D. "Yes, I agree that you should continue taking saffron for diabetes."

Answer: A Rationale: Although the nurse may disagree with the client's beliefs concerning the cause of health or illness, respect for these beliefs helps the nurse to achieve health care goals. Asking the client to consider the benefits of medicine is appropriate because the nurse, without disrespecting the client's beliefs, persuades the client to have medicines also. Stating that saffron does not have any effect on blood sugar level is inappropriate, as it disregards the client's beliefs. Agreeing with the client may encourage him or her and indicate low faith in the present treatment. It is inappropriate to call the health care provider and report on the client.

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

Answer: A Rationale: Cultural conflict occurs when people become aware of cultural differences (the younger nurses) and feel threatened (most likely by their younger age) and respond by ridiculing the beliefs or actions of others to make themselves feel more secure. Cultural assimilation occurs when one adapts to a new culture. Cultural blindness occurs when one ignores a cultural difference. Cultural diversity encompasses culture, race, ethnicity, religion, language, gender, socioeconomic status, and more.

How is culture learned by each new generation? A. Formal and informal experiences. B. Ethnic heritage C. Belonging to a subculture. D. Involvement in religious activities.

Answer: A Rationale: Culture is a shared system of beliefs, values, and behavioral expectations that provide social structure for daily living. Culture includes the beliefs, habits, likes, dislikes, customs, rituals, and ethnic heritage that are learned through formal and informal experiences within one's family and within the cultural group to which one belongs. Involvement in religious experiences can be part of the culture learned through formal and informal experiences.

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

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

Nurses are responsible for delivering culturally competent care for all clients. Culturally competent care does not account for: A. client's height. B. available technology. C. individual values. D. developmental level.

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

When talking with a client, the nurse notes that the client keeps backing up. What would be the most appropriate response? A. Ask the client about personal space preferences. B. Move closer to the client. C. Ask the client why he or she is backing away. D. Back away from the client.

Answer: A Rationale: It is most appropriate to ask the client what is preferred in regard to personal space. If the nurse needs to invade the client's personal space to do an examination or take vital signs, it is important to discuss the matter. It is not appropriate to back away without assessing preference. It may make the client feel judged if the nurse asks why he or she is backing away. Moving closer to the client just perpetuates the problem.

A client who practices Islam dies at the hospital surrounded by family members. Which action by the nurse demonstrates cultural sensitivity related to the client's death? A. consulting the family member prior to performing post-mortem care. B. informing the family members they may say their goodbyes so that care can be provided. C. having the family members consult with the funeral home for transport. D. allowing the family to remain present when the nurse washes the client prior to shrouding.

Answer: A Rationale: Only family members may touch or wash the body of a deceased individual who practiced the Islamic faith, so the nurse should ask for permission prior to providing post-mortem care. The family may choose to remain, but the nurse will not be allowed to wash the body. It will be the nurse's responsibility to arrange for transport to the funeral home after care is rendered by the family.

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

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

A nurse is conducting a cultural assessment of a client. Which person would the nurse identify as the expert? A. Client. B. Health care provider. C. Older family member. D. Nurse.

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

A client is experiencing culture shock. Which findings would the nurse likely assess? Select all that apply. A. Stress B. Increased activity C. Disorientation D. Weakness E. Calm demeanor

Answer: A, C Rationale: When the culture one has learned differs from the culture in one's environment, the acute reaction is called culture shock, and a person can become disoriented and stressed. Increased activity, calm demeanor and weakness are not associated with culture shock.

The nurse is caring for a client admitted with an upper respiratory infection. The client tells the nurse about following the holistic belief of hot/cold. Which food items should the nurse provide to the client based on this information? A. Fruit salad, apple juice, and pudding. B. Soup, hot tea, and toast. C. Turkey sandwich, milk, and gelatin. D. Chicken salad, water, and a frozen fruit juice bar.

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

The nurse works in an urban hospital and cares for a diverse population of clients. Which action(s) by the nurse demonstrates the delivery of culturally sensitive care to clients? Select all that apply. A. asking the client questions regarding health care beliefs related to the client's culture. B. indicating that the cultural groups should adapt to the Anglo-American culture. C. integrating the client's cultural practices when assisting with the creation of the plan of care. D. maintaining direct eye contact during conversations with all cultural groups. E. allowing the client to keep a religious necklace on until going into the operating room.

Answer: A, C, E Rationale: There are many ways in which nurses should deliver culturally sensitive care, but the priority is to understand the difference in culture and ethnicity and integrate these beliefs into the care delivery system. Asking questions related to culture is important since not all cultural groups follow a general belief practice. This should be considered whenever the plan of care is being developed. Allowing a client to wear a religious necklace until going into the operating room and keeping it in a safe place to be returned after a procedure is a demonstration of cultural sensitivity. Implying that a cultural group should adapt to the Anglo-American way is not culturally sensitive. Not all cultural groups respond to direct eye contact and the nurse should be aware of how this may be perceived.

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

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

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

Answer: B Rationale: Culture is learned through life experiences from one generation to the next. Culture helping to define identity, language being the primary way that people share their culture, and culture being seen in attitudes of certain populations are correct options; these are all components that define culture.

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

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

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

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

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

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

Which nursing intervention reflects practice according to Madeline Leininger's transcultural nursing theory? A. Planning dietary interventions according to physiological condition. B. Incorporating the client's request for complementary treatment therapy. C. Contacting a chaplain for every client. D. Providing the same care to each client who has had a myocardial infarction.

Answer: B Rationale: Leininger's theory of transcultural nursing includes assessing a cultural nature, accepting each client as an individual, having knowledge of health problems that affect particular cultural groups, and planning of care within the client's health belief system to achieve the best health outcomes. Therefore, incorporating the client's request for complementary treatment therapy is an example of this theory. The others do not support this theory.

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

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

A nurse caring for clients of different cultures in a hospital setting attempts to make eye contact with clients when performing the initial assessment. What assumption might the nurse make based on common cultural practices? A. A Native American/First Nations man stares at the floor while talking with the nurse. Assumption: The client is embarrassed by the conversation. B. A Muslim-Arab woman refuses to make eye contact with her male nurse. Assumption: She is being modest. C. A Black man rolls his eyes when asked how he copes with stress in the workplace. Assumption: He may feel he has already answered this question and has become impatient. D. A Hasidic Jewish man listens intently to a male health care provider, making direct eye contact with him, but refuses to make eye contact with a female nursing student. Assumption: Jewish men consider women inferior to men.

Answer: B Rationale: The dominant culture in Western societies emphasizes eye contact while speaking, but many other cultures regard this behavior in different ways. For example, direct eye contact may be considered impolite or aggressive by many Asians, Native Americans/First Nations, Indochinese, Arabs, and Appalachians; these groups of people tend to avert their eyes while speaking. Hispanics may look downward in deference to age, gender, social position, economic status, or authority. Muslim-Arab women often indicate modesty by avoiding eye contact with men, and Hasidic Jewish men may avoid direct eye contact with women. The only option above that has the correct assumption is the option regarding a Muslim-Arab woman refusing to make eye contact with her male nurse due to modesty. The nurse must be aware of the cultural meaning of eye contact in relationship to the health care situation.

A nurse is conducting an ethnographic interview with a client. Which step would the nurse do first? A. Identify clues to what may be important. B. Request clarification of a key term. C. Ask an open-ended, general question. D. Document the client's view of self.

Answer: C Rationale: An ethnographic interview begins with an open-ended, general question. Then, based on the client's response, the nurse selects some key terms and asks for clarification, repeating the exact words and phrases that the client used. The terms are clues to what is important to the client, so the nurse asks the client to talk more about them. Finally, the nurse documents the information on the client's view of self or of the issue discussed.

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

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

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

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

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

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

Which term describes the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture? A. Acculturation. B. Cultural taboos. C. Cultural imposition. D. Cultural blindness.

Answer: C Rationale: Cultural imposition is the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture. Cultural blindness occurs when one ignores differences and proceeds as though they do not exist. Acculturation is the process by which members of a cultural group adapt to, or learn how to, take on the behaviors of another group. Cultural taboos are activities or behaviors that are avoided, forbidden, or prohibited by a particular cultural group.

A client says to the nurse, "Why don't you wear a white cap like nurses do on the soap operas?" This is an ethnocentric statement based on the: A. nursing personality. B. genetics. C. media. D. books.

Answer: C Rationale: Ethnocentrism is a way of looking at the world through a personal lens that has been influenced by personality, genetics, family/relationships, and media. None of the remaining options play a role in the client's comment to the nurse.

A client is admitted to the hospital and the nurse is attempting to complete an admission assessment. The client reports that the spiritual healer will be coming in soon and is upset by the admission questions. What is the most appropriate response by the nurse? A. "These questions are important and must be answered." B. "We can wait for your healer, but the healer cannot do anything to provide care in this care environment." C. "We can wait for your healer to come and then work together to answer these questions." D. "When your spiritual healer gets here, please have him or her complete this admission information."

Answer: C Rationale: In some cultures, a client may associate admission questions with incompetence because they are used to a traditional healer, who is often well acquainted with the client's care needs. As long as the client is stable, it is acceptable to wait until the client is more comfortable to complete the admission questionnaire. By saying that the nurse and the healer can work together, it shows acceptance outside of the realm of traditional medicine. It is inappropriate for the healer to complete the admission assessment. It is also inappropriate to say the healer cannot "do anything" in the traditional care environment.

The nurse is caring for a client from another culture who is diagnosed with lung cancer. Which nursing action best demonstrates culturally sensitive care? A. Implementing a standardized care plan for the client with lung cancer after explaining the procedure in the client's native language. B. Treating all clients, the same based on the diagnosis to demonstrate unbiased care. C. Incorporating the client's need for daily prayer into the nursing care plan. D. Explaining the biomedical culture to the client.

Answer: C Rationale: Nurses should be culturally competent and sensitive to provide care that respects (not just not offends) and incorporates the client's culture. Incorporating the client's culture creates an individual plan of care and not a treatment plan for all clients with the same diagnosis. The nurse should not use unmodified standardized care plans that do not account for cultural differences. Explaining the biomedical culture to the client does not ensure culturally sensitive care. The nurse should attempt to understand the client's culture, not have the client understand the culture of the health care system.

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

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

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

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

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

Answer: C, D, E Rationale: The nurse determines that the client understands and can apply the education provided when the client states the intention to substitute milk for non-dairy coffee creamer, substitute milk for a lactose-free milk product, and use kosher parve (kosher neutral) products, which are not made with milk products. The statement about drinking a large glass of milk once daily instead of several times a day indicates the client requires further education, because the client should avoid milk or only drink small amounts. Dry milk solids contain milk and should be avoided; examples include some bread, cereals, puddings, gravy mixes, caramels, or chocolate.

Which nursing actions are appropriate when collecting a health history for a client whose primary language differs from the dominant language? Select all that apply. A. Speak in detailed sentences using exact medical terminology. B. Ask the client's adolescent child to answer questions. C. Request assistance from a certified interpreter. D. Have a bilingual nurse assist with the health history. E. Use the facility telephonic interpreting system.

Answer: C, D, E Rationale: When caring for a client whose primary language differs from that of the nurse, the nurse should first use a certified interpreter. If a certified interpreter is unavailable, the nurse should then use the telephonic interpreting system or a bilingual staff member. The nurse should never use children to interpret. The nurse should speak in short sentences, using simple terminology.

The nurse is performing an assessment for a Native American/First Nations client who is hesitant to answer questions related to psychosocial history. What action by the nurse will facilitate communication between the nurse and the client? A. Inform the client that the questions must be answered for the client to receive the health care needed. B. Instruct the client that the interview is quick, and answers should be brief. C. Have another family member with the client to answer questions that the client will not respond to. D. Wait to write down notes or put the information in the computer until after the interview, if possible.

Answer: D Rationale: A Native American/First Nations client may be very private and not feel comfortable discussing personal situations with the nurse, considering these questions to be intrusive. The client may opt not to answer questions asked. The family member should not be asked the questions if the client does not choose to answer the question since this may also be determined as disrespectful. The client should not be made to feel pressured to answer questions with the threat of treatment withheld since this is not a valid or therapeutic response. The nurse should be patient when awaiting a response from the client after asking a question and not rush through the interview. Waiting to write down or input the conversation into the computer will facilitate a more trusting and respectful relationship between the nurse and the client.

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

Answer: D Rationale: Ageism is a form of negative stereotypical thinking about older adults. This can include thinking all older adults are physically and cognitively impaired, have lack of interest in sex, or are burdensome to families and society. The instructor should first help the student recognize the stereotypical attitude and then provide tips on how to best address this attitude and not how to change the client's actions.

While caring for a client from a culture different from the nurse's, the nurse inadvertently offends the client. What is the best action by the nurse? A. Recognize that there is a cultural bias that led to the mistake. B. Examine the interaction and focus on the majority culture. C. Ask the client why the client is so mad. D. Learn from the mistake and do not repeat it.

Answer: D Rationale: All nurses make mistakes at some time when caring for culturally diverse clients. The best action is to learn from the mistake and not repeat the offense. Although it may be appropriate to discuss with the client, asking why the client is so mad is aggressive and may make the situation worse. The mistake was inadvertent and may not be the result of cultural bias. Focusing on your own majority culture will not help bring about learning associated with the mistake.

A 12-year-old black client has experienced significant blood loss and may require a blood transfusion. The client's mother, father, and sisters are currently present at the bedside in the emergency department. How should the nurse direct questions and education about the client's condition and treatment? A. Ask the child's father what should be done but make eye contact with everyone in the room. B. Direct questions to the family collectively to avoid presuming who is dominant. C. Address the mother, because black families are commonly matriarchal. D. Assess who is the dominant member of the family and then address that person.

Answer: D Rationale: Although black families can be matriarchal, this fact does not mean that the nurse should not assess the structure and roles of the family on an individual basis. This assessment is preferable to acting on a generalization, even if it is a generalization that may be accurate for many families who are culturally similar. The nurse should avoid directing questions to either the mother or the father without first assessing who the dominant person is, to avoid presuming, as this is culturally insensitive.

Which scenario is an example of cultural competence in nursing? A. Assuming the provider and the client share beliefs and values. B. Attending one's own church. C. Assessing the rate at which an illness causes death in a culture. D. Attending a conference for cultural diversity.

Answer: D Rationale: Cultural competence can be shown by actively learning about culture through attending a conference. Assessing the rate at which an illness leads to death does not develop cultural competence. One's own church is a familiar culture, and attending it does not breed cultural expansion or competence. The provider should never assume that beliefs or values are shared.

The nurse is caring for several clients of different cultures. Which client situation would the nurse recognize as the client with highest risk of culture shock? A. The client from Mexico states, "I am having difficulty reading these pamphlets you gave me." B. The client from England states, "I do not understand what all these new medications are for." C. The client from France states, "I miss my family back home." D. The client from Ethiopia states, "All these machines attached to me scare me and I need to get them off."

Answer: D Rationale: Culture shock occurs when a person is immersed in an environment different from the one the person is accustomed to, resulting in rapid disorientation and distress. The client stating the machines scare him is experiencing culture shock. Difficulty reading a different language, missing absent family, and not understanding the purpose of medications are not indicative of culture shock.

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

Answer: D Rationale: Monitoring the blood pressure is important for identifying the risk for hypertension and stroke, which are common health conditions among the Black population. The other statements are correct for preventing diabetes, breast cancer, and osteoporosis, but these diseases are not disproportionately common health conditions for the population.

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

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

The nurse overhears a colleague state, "All people from that client's country are rude." What is the appropriate nursing response? A. Report the colleague to the nurse manager. B. Say nothing and ignore the comment. C. Agree and state, "Yes, I've noticed the same thing." D. Respond by saying, "Stereotypes keep us from accepting others as unique individuals."

Answer: D Rationale: Stereotypes are preconceived ideas usually unsupported by facts. They tend to be neither real nor accurate. They can be dangerous because they interfere with accepting others as unique individuals. The nurse can professionally educate the colleague about the harm involved in stereotyping individuals. Ignoring the comment or reporting the colleague to the nurse manager would result in a missed opportunity to educate the colleague on stereotyping. Agreeing would only strengthen this harmful practice.

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

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

The nurse is preparing to administer prescribed medication to a client who is Native American/First Nations. The nurse enters the room and observes a tribal traditional healer performing a healing ritual for the client. What action would be the most appropriate by the nurse? A. Administer the medication while the healer continues the ritual. B. Ask the healer to leave the room. C. Wait in the room until the healer is done. D. Unless asked to stay, leave the room and return when the healer is finished.

Answer: D Rationale: Tribal traditional healers (sometimes referred to as shamans by western cultures) are tribal leaders or medicine men that are used in many Native American/First Nations cultures to relieve illness. The culturally competent nurse should allow privacy for the healing ritual and return when it is completed. The culturally competent nurse should incorporate the client's beliefs into the client's care, as long as the health belief and practice is safe. Administering the medications while the shaman continues the ritual or asking the shaman to leave may be perceived as disrespectful to the client.